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Sample records for acutely admitted psychiatric

  1. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

    PubMed Central

    2013-01-01

    Background We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. Method All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP). Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian) with univariate and multivariate statistics. Results Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. Conclusion Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”). Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian. PMID:23317010

  2. Influence of drugs of abuse and alcohol upon patients admitted to acute psychiatric wards: physician's assessment compared to blood drug concentrations.

    PubMed

    Mordal, Jon; Medhus, Sigrid; Holm, Bjørn; Mørland, Jørg; Bramness, Jørgen G

    2013-06-01

    In acute psychiatric services, rapid and accurate detection of psychoactive substance intake may be required for appropriate diagnosis and intervention. The aim of this study was to investigate the relationship between (a) drug influence as assessed by physicians and (b) blood drug concentrations among patients admitted to acute psychiatric wards. We also explored the possible effects of age, sex, and psychotic symptoms on physician's assessment of drug influence. In a cross-sectional study, the sample comprised 271 consecutive admissions from 2 acute psychiatric wards. At admission, the physician on call performed an overall judgment of drug influence. Psychotic symptoms were assessed with the positive subscale of the Positive and Negative Syndrome Scale. Blood samples were screened for a wide range of psychoactive substances, and quantitative results were used to calculate blood drug concentration scores. Patients were judged as being under the influence of drugs and/or alcohol in 28% of the 271 admissions. Psychoactive substances were detected in 56% of the blood samples. Altogether, 15 different substances were found; up to 8 substances were found in samples from 1 patient. Markedly elevated blood drug concentration scores were estimated for 15% of the patients. Physician's assessment was positively related to the blood drug concentration scores (r = 0.52; P < 0.001), to symptoms of excitement, and to the detection of alcohol, cannabis, and amphetamines. The study demonstrates the major impact of alcohol and drugs in acute psychiatric settings and illustrates the challenging nature of the initial clinical assessment.

  3. Unrecognized medical emergencies admitted to psychiatric units.

    PubMed

    Reeves, R R; Pendarvis, E J; Kimble, R

    2000-07-01

    Alteration of mental status secondary to medical illness may occasionally be incorrectly attributed to a psychiatric problem. The cases of 64 patients with unrecognized medical emergencies inappropriately admitted to psychiatric units from emergency departments were reviewed to determine the cause of the misdiagnoses. Medical diagnoses most often missed included severe intoxication with alcohol or other illicit substance (34.4%), drug or alcohol withdrawal or delirium tremens (12.5%), and prescription drug overdose (12.5%). In none of the cases (0%) was an appropriate mental status examination performed. Other common causes of misdiagnosis included inadequate physical examination (43.8%), failure to obtain indicated laboratory studies (34.4%), and failure to obtain available history (34.4%). A systematic approach is required for patients with altered mental status, including those with psychiatric presentations.

  4. Diagnostic Stability of Psychiatric Disorders in Re-Admitted Psychiatric Patients in Kerman, Iran

    PubMed Central

    Alavi, Fatemeh; Nakhaee, Nouzar; Sabahi, Abdolreza

    2014-01-01

    Background: Several studies have evaluated the stability of psychiatric diagnosis follow in readmission of patients in psychiatric hospitals. However, there is little data concerning this matter from Iran. This study is designed to evaluate this diagnostic stability of the commonest psychiatric disorders in Iran. Objectives: The objective of this study was to determine the long-term diagnostic stability of the most prevalent psychiatric disorders among re-admitted patients at the Shahid Beheshti teaching hospital in Kerman, Iran. Patients and Methods: This study was based on 485 adult patients re-admitted at the Shahid Beheshti hospital between July and November 2012. All of the diagnoses were made according to DSM IV TR. Prospective and retrospective consistency and the ratio of patients who were obtained a diagnosis in at least 75%, 100% of the admissions were calculated. Results: The most frequent diagnoses at the first admission were bipolar disorder (48.5%) and Major depressive disorder (18.8%). The most stable diagnosis was bipolar disorder (71% prospective consistency, 69.4% retrospective consistency). Schizoaffective disorder had the greatest diagnostic instability (28.5% prospective consistency, 16.6% retrospective consistency). Conclusions: Among the cases evaluated, bipolar disorder had the most stability in diagnosis and the stability of schizoaffective disorder was poor. PMID:25168983

  5. Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo

    PubMed Central

    2010-01-01

    Background Patients admitted to a psychiatric hospital with suicidal behavior (SB) are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan. Method 155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II) and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined. Results The common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD). SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range) of the total number of SBs in the lifetime history was 7 (1-141). Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified. Conclusions Features of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission and frequent SB repetition

  6. Improving Awareness of an Acute Psychiatric Unit's Capacity for Admission.

    PubMed

    Benolkin, Lauren; Kinstler, Dan; Delaney, Kathleen R

    2015-08-01

    New admissions to psychiatric inpatient units can significantly impact the environment and level of safety. Maintaining safety is a core and critical responsibility of nursing, but nurses are often overlooked in the decision to admit a patient. Missed opportunities for dialogue between nurses and the admitting physician challenge nurses' ability to proactively manage the therapeutic environment. When nurses are limited in this ability, the outcome can be an unpredictable and unstable milieu. In a 25-bed acute psychiatric inpatient unit, a formalized communication system among the multidisciplinary admission team was developed. Data collected over 1 year demonstrated improved safety. Increasing the admitting provider's awareness of the current unit acuity and involving the nursing staff early in the admission process improved collaboration among care team members and reduced risks to maintaining milieu safety. PMID:26268479

  7. Outcome of patients admitted to an acute geriatric medical unit

    PubMed Central

    Devine, M J; McAleer, J J A; Gallagher, P M; Beirne, J A; McElroy, J G

    1986-01-01

    To find out what happens to patients admitted to an acute geriatric medical unit, all admissions during 1982 were reviewed. Demographic features were compared with those of the community served, and rehabilitation, inpatient mortality and mortality in the year following discharge were assessed. Inpatients accounted for 4% of the community aged over 65, and most patients were discharged back to the community. Inpatient mortality was 25% and mortality in the year following discharge was 23%, giving a two year mortality of 42%, which was similar in all age groups. The achievement of high rehabilitation rates was tempered by the considerable mortality rates following discharge. PMID:3739060

  8. Clinical Features, Psychiatric Assessment, and Longitudinal Outcome of Suicide Attempters Admitted to a Tertiary Emergency Hospital.

    PubMed

    Ferreira, Alcinéia Donizeti; Sponholz, Alcion; Mantovani, Célia; Pazin-Filho, Antônio; Passos, Afonso Dinis Costa; Botega, Neury José; Del-Ben, Cristina Marta

    2016-01-01

    The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death. PMID:25961847

  9. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    ERIC Educational Resources Information Center

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  10. Prognostication in Acutely Admitted Older Patients by Nurses and Physicians

    PubMed Central

    Buurman, Bianca M.; van Munster, Barbara C.; Abu-Hanna, Ameen; Levi, Marcel; de Rooij, Sophia E.

    2008-01-01

    Background The process of prognostication has not been described for acutely hospitalized older patients. Objective To investigate (1) which factors are associated with 90-day mortality risk in a group of acutely hospitalized older medical patients, and (2) whether adding a clinical impression score of nurses or physicians improves the discriminatory ability of mortality prediction. Design Prospective cohort study. Participants Four hundred and sixty-three medical patients 65 years or older acutely admitted from November 1, 2002, through July 1, 2005, to a 1024-bed tertiary university teaching hospital. Measurements At admission, the attending nurse and physician were asked to give a clinical impression score for the illness the patient was admitted for. This score ranged from 1 (high possibility of a good outcome) until 10 (high possibility of a bad outcome, including mortality). Of all patients baseline characteristics and clinical parameters were collected. Mortality was registered up to 90 days after admission. Main Results In total, 23.8% ( = 110) of patients died within 90 days of admission. Four parameters were significantly associated with mortality risk: functional impairment, diagnosis malignancy, co-morbidities and high urea nitrogen serum levels. The AUC for the baseline model which included these risk factors (model 1) was 0.76 (95% CI 0.71 to 0.82). The AUC for the model using the risk factors and the clinical impression score of the physician (model 2) was 0.77 (0.71 to 0.82). The AUC for the model using the risk factors and the clinical impression score of the nurse (model 3) was 0.76 (0.71 to 0.82) and the AUC for the model, including the baseline covariates and the clinical impression score of both nurses and physicians was 0.77 (0.72 to 0.82). Adding clinical impression scores to model 1 did not significantly improve its accuracy. Conclusion A set of four clinical variables predicted mortality risk in acutely hospitalized older patients

  11. Associations between sleep disturbance and suicidal ideation in adolescents admitted to an inpatient psychiatric unit.

    PubMed

    Kaplan, Sebastian G; Ali, Shahzad K; Simpson, Brittany; Britt, Victoria; McCall, W Vaughn

    2014-01-01

    The goals of our study were to: 1) describe the incidence of disturbances in sleep quality, sleep hygiene, sleep-related cognitions and nightmares; and 2) investigate the association between these sleep-related disturbances and suicidal ideation (SI), in adolescents admitted to a psychiatric inpatient unit. Our sample consisted of 50 adolescents between the ages of 12 and 17 years (32 females and 18 males; 41 Caucasian and nine African American). Our cross-sectional design involved the administration of the Adolescent Sleep Wake Scale (ASWS), the Adolescent Sleep Hygiene Scale (ASHS), the Dysfunctional Beliefs and Attitudes about Sleep-Short version for use with children (DBAS-C10), the Disturbing Dreams and Nightmare Scale (DDNSI), and the Suicidal Ideation Questionnaire Jr (SIQ-JR). Analyses were conducted using Pearson correlations, as well as univariate and multivariate regression. Results indicated that our sample experienced sleep disturbances and SI to a greater degree than non-clinical samples. Sleep quality was correlated with nightmares, while sleep quality and nightmares were each correlated with SI. Sleep quality, dysfunctional beliefs, and nightmares each independently predicted SI. Our study was the first to use the four sleep measures with an adolescent psychiatric inpatient sample. It is important to develop sleep-related assessment tools in high-risk populations given the link between sleep disturbances and suicidality. Furthermore, a better understanding of the relationships between SI and sleep quality, sleep-related cognitions, and nightmares is needed to develop potential prevention and treatment options for suicidality in adolescents. PMID:24356389

  12. Why are patients with acute stroke admitted to hospital?

    PubMed Central

    Bamford, J; Sandercock, P; Warlow, C; Gray, M

    1986-01-01

    Data on 515 consecutive patients registered with the Oxfordshire Community Stroke Project were used to compare the characteristics of those patients who were admitted to hospital within one month after their first stroke with those who remained in the community during that time. Twenty eight patients had their stroke while in hospital for other conditions, and of the remaining 487, 266 were admitted. Though patients with a severe neurological deficit were significantly more likely to be admitted, 47 out of 202 such patients were managed in the community. In a substudy of 162 consecutive patients the general practitioners' reasons for either arranging admission to hospital or continuing with community care in the first week after the stroke were ascertained. Sixty patients were admitted. The only reason for admission was diagnostic uncertainty in five cases (though this was a contributing factor in 25) and to provide nursing or general, non-medical care in 25. Patients who lived alone were more likely to be admitted. All 12 patients who presented directly to the casualty department were admitted, though only five had had a severe stroke. A stroke service that provides a facility for rapid outpatient and domiciliary diagnosis as well as a rapidly acting domiciliary nursing team might reduce the number of patients with stroke admitted to hospital without adversely affecting the quality of patient care: this should be properly evaluated. PMID:3085852

  13. Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit.

    PubMed

    Christl, Bettina; Reilly, Nicole; Yin, Carolyn; Austin, Marie-Paule

    2015-12-01

    This study examines the clinical profile of women admitted to a psychiatric mother-baby unit as well as change in their clinical, parenting, attachment and quality of life outcomes. Data was collected from 191 mothers through self-report measures at admission and discharge. Change was analysed in terms of Edinburgh Postnatal Depression Scale (EPDS) score, parenting confidence, maternal attachment to the infant and overall functioning. Psychosocial factors impacting on symptom severity and recovery were examined. Most women (64.8 %) were admitted in the first 3 months after birth with an ICD-10 unipolar depressive episode (52.3 %) or anxiety disorder (25.7 %), and 47.6 % had comorbid diagnoses. Improvement from admission to discharge was seen with large effect sizes (≥one standard deviation, i.e. μ) in terms of clinical symptoms (EPDS, μ = 1.7), parenting confidence (Karitane Parenting Confidence Scale (KPCS), μ = 1.1) and attachment to their infant (Maternal Postpartum Attachment Scale (MPAS), μ = 0.9) as well as overall level of functioning (SF-14, μ = 1.9). The majority (73.3 %) recovered symptomatically, and this was associated with increasing maternal age (odds ratio (OR) = 1.129, p = 0.002) and lower levels of psychosocial risk at admission (OR = 0.963, p = 0.008). Improvement in parenting confidence was associated with increasing maternal age (OR = 1.17, p = 0.003). No predictive factors were found for improvement in maternal attachment after controlling for admission scores. In the short term, joint admission of mothers with their infants is highly beneficial in terms of clinical, functional and parenting outcomes, but follow up studies are needed to assess the longer term benefits for mother-infant dyads. The use of an observational tool to enhance our assessment of maternal-infant interaction and some measure of maternal emotional dysregulation-both important mediators of development of secure infant

  14. Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit.

    PubMed

    Christl, Bettina; Reilly, Nicole; Yin, Carolyn; Austin, Marie-Paule

    2015-12-01

    This study examines the clinical profile of women admitted to a psychiatric mother-baby unit as well as change in their clinical, parenting, attachment and quality of life outcomes. Data was collected from 191 mothers through self-report measures at admission and discharge. Change was analysed in terms of Edinburgh Postnatal Depression Scale (EPDS) score, parenting confidence, maternal attachment to the infant and overall functioning. Psychosocial factors impacting on symptom severity and recovery were examined. Most women (64.8 %) were admitted in the first 3 months after birth with an ICD-10 unipolar depressive episode (52.3 %) or anxiety disorder (25.7 %), and 47.6 % had comorbid diagnoses. Improvement from admission to discharge was seen with large effect sizes (≥one standard deviation, i.e. μ) in terms of clinical symptoms (EPDS, μ = 1.7), parenting confidence (Karitane Parenting Confidence Scale (KPCS), μ = 1.1) and attachment to their infant (Maternal Postpartum Attachment Scale (MPAS), μ = 0.9) as well as overall level of functioning (SF-14, μ = 1.9). The majority (73.3 %) recovered symptomatically, and this was associated with increasing maternal age (odds ratio (OR) = 1.129, p = 0.002) and lower levels of psychosocial risk at admission (OR = 0.963, p = 0.008). Improvement in parenting confidence was associated with increasing maternal age (OR = 1.17, p = 0.003). No predictive factors were found for improvement in maternal attachment after controlling for admission scores. In the short term, joint admission of mothers with their infants is highly beneficial in terms of clinical, functional and parenting outcomes, but follow up studies are needed to assess the longer term benefits for mother-infant dyads. The use of an observational tool to enhance our assessment of maternal-infant interaction and some measure of maternal emotional dysregulation-both important mediators of development of secure infant

  15. Management of Patients Admitted with Acute Decompensated Heart Failure

    PubMed Central

    Krim, Selim R.; Campbell, Patrick T.; Desai, Sapna; Mandras, Stacy; Patel, Hamang; Eiswirth, Clement; Ventura, Hector O.

    2015-01-01

    Background Hospital admission for the treatment of acute decompensated heart failure is an unfortunate certainty in the vast majority of patients with heart failure. Regardless of the etiology, inpatient treatment for acute decompensated heart failure portends a worsening prognosis. Methods This review identifies patients with heart failure who need inpatient therapy and provides an overview of recommended therapies and management of these patients in the hospital setting. Results Inpatient therapy for patients with acute decompensated heart failure should be directed at decongestion and symptom improvement. Clinicians should also treat possible precipitating events, identify comorbid conditions that may exacerbate heart failure, evaluate and update current guideline-directed medical therapy, and perform risk stratification for all patients. Finally, efforts should be made to educate patients about the importance of restricting salt and fluid, monitoring daily weights, and adhering to a graded exercise program. Conclusion Early discharge follow-up and continued optimization of guideline-directed medical therapy are key to preventing future heart failure readmissions. PMID:26413005

  16. [Investigation on acute stroke patients being admitted to hospital].

    PubMed

    Zi, X; Song, Z; Fan, X

    1999-01-01

    One hundred and twelve patients with acute stroke were studied. The results revealed that about 42 percent of 112 patients could get to hospital within 6 hours after onset, in which included 60.4 percent of the hemorrhagic group and 28.1 percent of the infarction group. Comparatively, among 30.3 percent of 112 patients CT scan was carried out within 6 hours, which included 41.7 percent of the hemorrhagic group and 21.8 percent of the infarction group. Linear correlation analysis was studied between admission time(AT) and the assessment of neural function defect(ANFD). The results showed that there was significant negative correlation between AT and ANFD in stroke patients. After analysing the serial reasons of delaying hospitalization, the authors have found that the key factor is the ignorance of the importance of stroke in early stage. PMID:12080684

  17. Cortisol Predicts Behavioral Dysregulation and Length of Stay among Children Admitted for Psychiatric Inpatient Treatment

    ERIC Educational Resources Information Center

    Luebbe, Aaron M.; Elledge, L. Christian; Kiel, Elizabeth J.; Stoppelbein, Laura

    2012-01-01

    Individual differences in behavioral regulation system (BRS) and stress response system (SRS) functioning may reflect greater biological sensitivity to context. The current study tested whether children's cortisol, a measure of the SRS, was related to observed dysregulated behavior, an indicator of the BRS, in a sample of children admitted for…

  18. Post-Admission Cognitive Therapy: A Brief Intervention for Psychiatric Inpatients Admitted After a Suicide Attempt

    ERIC Educational Resources Information Center

    Ghahramanlou-Holloway, Marjan; Cox, Daniel W.; Greene, Farrah N.

    2012-01-01

    To date, no empirically based inpatient intervention for individuals who have attempted suicide exists. We present an overview of a novel psychotherapeutic approach, Post-Admission Cognitive Therapy (PACT), currently under development and empirical testing for inpatients who have been admitted for a recent suicide attempt. PACT is adapted from an…

  19. Patient Management and Psychopharmacological Treatment Associated to Smoking Ban in an Acute Psychiatric Unit.

    PubMed

    Bergé, Daniel; Mané, Anna; Fonseca, Francina; Toll, Alba; Merino, Ana; Pérez, Victor; Bulbena, Antoni

    2015-08-01

    This study investigates differences in terms of clinical and treatment management in psychiatric hospitalization associated to smoking ban. We collected data regarding medication, socio-demographic and admission characteristics from all patients admitted to an acute psychiatric hospital before and after a smoking ban was in force. We also assessed a limited sample of patients before and after the ban regarding nicotine dependence, motivation to quit smoking and attitudes towards the ban. More number of leaves of absence and movement restrictions during the ban period occurred in comparison to the pre-ban period. On the contrary a lack of significant differences in terms of hospital stay (duration, rate of voluntary admissions and voluntary discharges), use of sedatives and doses of antipsychotics was found. A period of adjustment regarding the deal with leave of access and facilitate nicotine replacement treatment may help future psychiatric facilities planning smoking free policies.

  20. [Religion and psychiatric disorders in patients admitted to a university general hospital].

    PubMed

    Soeiro, Rachel Esteves; Colombo, Elisabetta S; Ferreira, Marianne H F; Guimarães, Paula S A; Botega, Neury J; Dalgalarrondo, Paulo

    2008-04-01

    In order to evaluate the prevalence of psychiatric disorders in a Brazilian general hospital and their association with religious denomination and religiosity, 253 inpatients were interviewed. A socio-demographic questionnaire and an instrument for diagnosis of mental disorders (MINI-Plus) were applied. Distribution of religious denominations was: Catholic 63.2% (n=177), Evangelical Protestant 20.4% (n=57), Spiritist 4.3% (n=12), traditional Protestant 2.3% (n=8), and "no religion" 7.5% (n=21). Degree of religiosity was: very religious 43.2% (n=116), religious 46.9% (n=129), hardly religious 9.8% (n=27), and not at all religious 1.1% (n=3). Evangelical (Pentecostal) religious affiliation and frequent attendance at worship services were associated with fewer alcohol problems. Membership in an Evangelical (Pentecostal) church may thus have an inhibitory effect on alcohol dependence or abuse. Intensity of religiosity was moderately associated with overall prevalence of disorders, especially bipolar disorder. It is reasonable to conclude that extreme situations (very intense versus very limited religious participation) are related to this finding, associating both an exacerbated pursuit of religion and alienation from it with altered mental states.

  1. Urinary tract infections in patients admitted to rehabilitation from acute care settings: a descriptive research study.

    PubMed

    Romito, Diane; Beaudoin, JoAnn M; Stein, Patricia

    2011-01-01

    The use of an indwelling urinary catheter comes with associated risks. At a hospital in southern California, nurses on the acute rehabilitation unit suspected their patients were arriving from acute care with undiagnosed urinary tract infections (UTIs). This descriptive research study quantified the incidence of UTI on admission to a rehabilitation unit and correlations with catheter use. During the study period, 132 patients were admitted to acute rehabilitation from an acute care setting, and 123 met criteria to participate in the study. Among participants, 12% had a UTI upon admission. Questionnaires examined nursing attitudes toward appropriate urinary catheter use and proactive catheter removal. The data revealed that nurses want to be involved in decisions about urinary catheter use and that medical/surgical and rehabilitation nurses agree strongly about advocating for patients with indwelling urinary catheters.

  2. Neuropsychological and psychiatric profiles in acute encephalitis in adults.

    PubMed

    Pewter, Stephen M; Williams, W Huw; Haslam, Catherine; Kay, Janice M

    2007-01-01

    Acute encephalitis is an inflammation of brain tissue that can result from activity in the central nervous system (CNS) of a number of viruses. Although the neurological and psychiatric effects of encephalitis in the acute phase of the illness are well-known (Caroff, Mann, Gliatto, Sullivan, & Campbell, 2001), larger scale studies of the pattern of neuropsychological and psychiatric impairment following recovery from the acute inflammatory phase are less apparent. This paper reports the results of neuropsychological testing with a range of standardised cognitive measures in a case series of long-term post-acute participants. Psychiatric abnormality is examined using the SCL-90-R self-report scale of distress (Derogatis, 1983). We also examined the role of emerging insight in the aetiology of depression in this population. Two clusters of cognitive dysfunction were observed, one group of primarily herpes simplex cases showing a severe generalised deficit across a number of cognitive domains and a second cluster showing a variety of more isolated disorders of executive function. Abnormally high levels of distress were reported by participants, with depression, obsessive-compulsive symptoms, interpersonal sensitivity and phobic anxiety most significantly increased. Depression was found to be least severe in those with most accurate insight into their problems. Examining the correlations between cognitive and psychiatric test results demonstrates a relationship between depression and interpersonal anxiety and specific cognitive measures. Obsessive-compulsive behaviour and phobic anxiety, however, appear to exist independently of the assessed cognitive deficits.

  3. Neuropsychological and psychiatric profiles in acute encephalitis in adults.

    PubMed

    Pewter, Stephen M; Williams, W Huw; Haslam, Catherine; Kay, Janice M

    2007-01-01

    Acute encephalitis is an inflammation of brain tissue that can result from activity in the central nervous system (CNS) of a number of viruses. Although the neurological and psychiatric effects of encephalitis in the acute phase of the illness are well-known (Caroff, Mann, Gliatto, Sullivan, & Campbell, 2001), larger scale studies of the pattern of neuropsychological and psychiatric impairment following recovery from the acute inflammatory phase are less apparent. This paper reports the results of neuropsychological testing with a range of standardised cognitive measures in a case series of long-term post-acute participants. Psychiatric abnormality is examined using the SCL-90-R self-report scale of distress (Derogatis, 1983). We also examined the role of emerging insight in the aetiology of depression in this population. Two clusters of cognitive dysfunction were observed, one group of primarily herpes simplex cases showing a severe generalised deficit across a number of cognitive domains and a second cluster showing a variety of more isolated disorders of executive function. Abnormally high levels of distress were reported by participants, with depression, obsessive-compulsive symptoms, interpersonal sensitivity and phobic anxiety most significantly increased. Depression was found to be least severe in those with most accurate insight into their problems. Examining the correlations between cognitive and psychiatric test results demonstrates a relationship between depression and interpersonal anxiety and specific cognitive measures. Obsessive-compulsive behaviour and phobic anxiety, however, appear to exist independently of the assessed cognitive deficits. PMID:17676531

  4. The Psychosocial Characteristics Associated with NSSI and Suicide Attempt of Youth Admitted to an In-patient Psychiatric Unit

    PubMed Central

    Preyde, Michèle; Vanderkooy, John; Chevalier, Pat; Heintzman, John; Warne, Amanda; Barrick, Kendra

    2014-01-01

    Introduction: The purpose of this study was to explore the prevalence of self-harm and the psychosocial factors associated with self-harming behaviours in youth admitted to an in-patient psychiatric unit. Methods: Cross-sectional surveys of standardized measures were administered to youth and a separate survey to their caregivers while the youth were in hospital. Results: The mean age of the 123 youth who participated was 15.74 (SD 1.51) years, and 90 of 121 (74.38%) reported being female. Of the 115 who completed this question, 101 (87.83%) indicated that they thought of injuring themselves and 89 (77.39%) did engage in NSSI within the past month, and 78 of 116 (67%) reported that they had made an attempt to take their life. Youth who reported that they had attempted suicide (lifetime) reported significantly less difficulty with emotion regulation than youth who engaged in NSSI only, or both NSSI and suicide attempts. Conclusions: These youth reported a very high prevalence of self-harm, and in general substantial difficulty with regulating their emotions, and difficulty with their interpersonal relationships. The psychosocial distinctions evident between groups may have practical utility. PMID:24872825

  5. Why are some patients admitted to psychiatric hospital while others are not? A study assessing risk during the admission interview and relationship to outcome.

    PubMed

    Hunt, Glenn E; O'Hara-Aarons, Maureen; O'Connor, Nick; Cleary, Michelle

    2012-04-01

    The aim of this study was to determine what patient characteristics are used to decide whether a patient is or is not admitted to a psychiatric hospital, and what happens to those not admitted. A further aim was to determine if high levels of risk on admission predict seclusions, length of stay, or readmission within 28 days. Data were collected prospectively on consecutive presentations to an admission office via case notes and electronic databases. Eighty percent (100/127) of the adults presenting to the admission office over a typical month were admitted to hospital. Patients were more likely to be admitted if they were experiencing psychosis or exacerbation of schizophrenia, referred by other doctors or mental health teams, had a legal reason for referral, or if they were homeless. There was no association between risk for violence or suicide and seclusion rates, length of stay, or being readmitted within 28 days. It was reassuring to find that 85% of those not admitted were referred to other mental health providers, and none required admission over the following month. This study found high rates of seclusion and readmissions within 1 year, which requires further study to find strategies to reduce these rates. PMID:22039923

  6. Acute outcome of treating patients admitted with electrical storm in a tertiary care centre

    PubMed Central

    Prabhu, Mukund A.; Namboodiri, Narayanan; Prasad BV, Srinivas; Abhilash, S.P.; Thajudeen, Anees; Ajith, Kumar V.K.

    2016-01-01

    Background Electrical storm (ES) is a life threatening emergency. There is little data available regarding acute outcome of ES. Aims The study aimed to analyze the acute outcome of ES, various treatment modalities used, and the factors associated with mortality. Methods This is a retrospective observational study involving patients admitted with ES at our centre between 1/1/2007 and 31/12/2013. Results 41 patients (mean age 54.61 ± 12.41 years; 86.7% males; mean ejection fraction (EF) 44.51 ± 16.48%) underwent treatment for ES. Hypokalemia (14.63%) and acute coronary syndrome (ACS) (14.63%) were the commonest identifiable triggers. Only 9 (21.95%) patients already had an ICD implanted. Apart from antiarrhythmic drugs (100%), deep sedation (87.8%), mechanical ventilation (24.39%) and neuraxial modulation using left sympathetic cardiac denervation (21.95%) were the common treatment modalities used. Thirty-three (80.49%) patients could be discharged after a mean duration of 14.2 ± 2.31 days. Eight (19.5%) patients died in hospital. The mortality was significantly higher in those with EF < 35% compared to those with a higher EF (8 (42.11% vs 0 (0%), p = 0.03)). There was no significant difference in mortality between those with versus without a structural heart disease (8 (21.1% vs 0 (0%), p = 0.32)). Comparison of mortality an ACS with ES versus ES of other aetiologies (3 (50%) vs 5 (14.29) %, p = 0.076)) showed a trend towards significance. Conclusion With comprehensive treatment, there is reasonable acute survival rate of ES. Hypokalemia and ACS are the commonest triggers of ES. Patients with low EF and ACS have higher mortality. PMID:27479203

  7. Day hospital versus admission for acute psychiatric disorders

    PubMed Central

    Marshall, Max; Crowther, Ruth; Sledge, William Hurt; Rathbone, John; Soares-Weiser, Karla

    2014-01-01

    Background Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. Objectives To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. Search methods We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. Selection criteria Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. Data collection and analysis Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. Main results Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days

  8. QTc Prolongation in Patients Acutely Admitted to Hospital for Psychosis and Treated with Second Generation Antipsychotics

    PubMed Central

    Kroken, Rune A.; Løberg, Else-Marie; Jørgensen, Hugo A.

    2013-01-01

    QTc interval prolongation is a side effect of several antipsychotic drugs, with associated risks of torsade de pointes arrhythmias and sudden cardiac death. There is an ongoing debate of whether or not electrocardiogram (ECG) assessments should be mandatory in patients starting antipsychotic drugs. To investigate QTc prolongation in a clinically relevant patient group 171 adult patients acutely admitted to an emergency ward for psychosis were consecutively recruited. ECGs were recorded at baseline and then at discharge or after 6 weeks at the latest (discharge/6 weeks), thus reflecting the acute phase treatment period. The mean QTc interval was 421.1 (30.4) ms at baseline and there was a positive association between the QTc interval and the agitation score whereas the QTc interval was inversely associated with the serum calcium level. A total of 11.6% had abnormally prolonged QTc intervals and another 14.3% had borderline prolongation. At discharge/6 weeks, the corresponding proportions were reduced to 4.2% and 5.3%, respectively. The reduction of the proportion with prolonged QTc intervals reached statistical significance (chi-square exact test: P = 0.046). The finding of about one-quarter of the patients with borderline or prolonged QTc intervals could indicate mandatory ECG recordings in this population. This trial is registered with ClinicalTrials.gov ID: NCT00932529. PMID:24490070

  9. Procalcitonin levels in acute exacerbation of COPD admitted in ICU: a prospective cohort study

    PubMed Central

    Daubin, Cédric; Parienti, Jean-Jacques; Vabret, Astrid; Ramakers, Michel; Fradin, Sabine; Terzi, Nicolas; Freymuth, François; Charbonneau, Pierre; du Cheyron, Damien

    2008-01-01

    Background Antibiotics are recommended for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to intensive care units (ICU). Serum procalcitonin (PCT) could be a useful tool for selecting patients with a lower probability of developing bacterial infection, but its measurement has not been investigated in this population. Methods We conducted a single center prospective cohort study in consecutive COPD patients admitted to the ICU for AECOPD between September 2005 and September 2006. Sputum samples or tracheal aspirates were tested for the presence of bacteria and viruses. PCT levels were measured at the time of admittance, six hours, and 24 hours using a sensitive immunoassay. Results Thirty nine AECOPD patients were included, 31 of which (79%) required a ventilator support at admission. The median [25%–75% interquartile range] PCT level, assessed in 35/39 patients, was: 0.096 μg/L [IQR, 0.065 to 0.178] at the time of admission, 0.113 μg/L [IQR, 0.074 to 0.548] at six hours, and 0.137 μg/L [IQR, 0.088 to 0.252] at 24 hours. The highest PCT (PCTmax) levels were less than 0.1 μg/L in 14/35 (40%) patients and more than 0.25 μg/L in 10/35 (29%) patients, suggesting low and high probability of bacterial infection, respectively. Five species of bacteria and nine species of viruses were detected in 12/39 (31%) patients. Among the four patients positive for Pseudomonas aeruginosa, one had a PCTmax less than 0.25 μg/L and three had a PCTmax less than 0.1 μg/L. The one patient positive for Haemophilus influenzae had a PCTmax more than 0.25 μg/L. The presence or absence of viruses did not influence PCT at time of admission (0.068 vs 0.098 μg/L respectively, P = 0.80). Conclusion The likelihood of bacterial infection is low among COPD patients admitted to ICU for AECOPD (40% with PCT < 0.1 μg/L) suggesting a possible inappropriate use of antibiotics. Further studies are necessary to assess the impact of a procalcitonin

  10. Evaluation of a urine on-site drugs of abuse screening test in patients admitted to a psychiatric emergency unit.

    PubMed

    Bagøien, Gunnhild; Morken, Gunnar; Zahlsen, Kolbjørn; Aamo, Trond; Spigset, Olav

    2009-06-01

    The objective of this study was to characterize the usefulness and reliability of a commonly used urinary on-site drugs of abuse screening test device when used routinely at admittances to a psychiatric emergency unit. Urine samples from 262 emergency psychiatric admittances representing 217 patients were analyzed by a commercially available on-site test for the detection of amphetamines, benzodiazepines, cannabis, cocaine, and opiates in urine. The samples were first screened by nurses at the psychiatric department, thereafter by 2 technicians at the laboratory, and finally, analyzed by liquid chromatography/mass spectrometry. Results of 45.8% of the screening tests were true negative for all 5 drugs/drug groups tested, whereas those of 29.4% were true positive for 1 or several drugs/drug groups and true negative for the others. Thus, in total, 75.2% were correct for all 5 drugs/drug groups. In general, the sensitivities (42.9%-90.0% for the various drug groups) were lower than the specificities (92.7%-100.0%). The accuracies were 86.3% for benzodiazepines, 92.4% for cannabis, 94.7% for opiates, and 97.0% for amphetamines. No cocaine was found in any of the samples. For cannabis, the accuracy was higher among the laboratory technicians than among the nurses. The results from on-site screening testing should not be considered as the final conclusion on the intake of drugs of abuse but must be interpreted with caution.

  11. Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran.

    PubMed

    Islambulchilar, M; Islambulchilar, Z; Kargar-Maher, M H

    2009-04-01

    The aim of our study was to investigate the etiological and demographical characteristics of acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. This retrospective study was performed on 1342 poisoning admissions to a university hospital from 2003 to 2005, by data collection from the medical records of patients. Poisonings were 5.40% of the total admissions. There was a predominance of female patients (55.7%) compared to male patients (44.3%) with a female-to-male ratio of 1.2:1. Most poisonings occurred in the age range of 11-20 years (38.9%). Drugs were the most common cause of poisonings (60.8%). Among the drug poisonings, benzodiazepines (40.31%) were the most frequent agents, followed by antidepressants (31.98%). The seasonal distribution in poisoning patients suggested a peak in spring (28%) and summer (27.5%). In 9.8% of cases accidental and in 90.2% intentional poisonings were evident. Most suicide attempts were made by women (58.51%) and unmarried people (51.4%).The mean duration of hospitalization was 3.02 +/- 2.8 days. There were 28 (2.3%) deaths; the majority (13 cases) was due to pesticides. This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information on the characteristics of the poisoning in this part of Iran. To prevent such poisonings, the community education about the danger of central nervous system-acting drugs and reducing the exposure period of people to pesticides are recommended. PMID:19734268

  12. Inpatient Opioid Withdrawal Management of Street Children and Adolescents Admitted to Child and Adolescent Psychiatric Ward: A Preliminary Case Series

    PubMed Central

    Firouzkouhi Moghadam, Mahboubeh; Hashemian, Seyed-Sepehr; Pishjoo, Masoud; Ghasemi, Sanaz; Hajebi, Ahmad; Noroozi, Alireza

    2016-01-01

    Background About 10 million children worldwide live or work on the street. International reports estimate the prevalence of substance use among street children to be between 25% - 90%, which is who were referredntal disorders and high-risk behaviors. Objectives The objective of this study was to report the outcomes of assisted withdrawal of opioid-dependent vulnerable children and adolescents who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb hospital, an academic hospital in Zahedan city. Methods Clinical chart abstractions were performed on a convenience sample of 40 serial opioid-dependent street children and adolescents (mean age: 11.14 ± 3.6 years) who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb treatment and research center from November 2014 to May 2015. The demographic data, drug use history, comorbid physical and psychiatric conditions, symptomatology of opioid withdrawal syndrome, pharmacotherapies and psychosocial services, length of hospital stay, and any adverse events were extracted from the patients’ files using a checklist developed by the authors. Results Twenty-four (60%) patients were male, and 16 (40%) were female. The main drug used by all patients was opioids. Heroin Kerack (which has a street name of crystal in southeast Iran) was the most common (75%) drug of use, followed by opium (10%) and opium residue (7.5%). None of the participants self-reported using injected drugs. The high rate of a lack of eligibility for guardianship was documented among parents (87.5%) mainly due to their use of illegal drugs. Musculoskeletal pain and diarrhea were the most common withdrawal symptoms of the patients upon admission. The mean length of stay was 10.8 (± 7.30) days, and no significant adverse events were reported during the symptomatic treatment of opioid withdrawal syndrome. Conclusions To our knowledge, this is the first study to report on the safety and feasibility of inpatient

  13. Switch Function and Pathological Dissociation in Acute Psychiatric Inpatients

    PubMed Central

    Chiu, Chui-De; Tseng, Mei-Chih Meg; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo

    2016-01-01

    Swift switching, along with atypical ability on updating and inhibition, has been found in non-clinical dissociators. However, whether swift switching is a cognitive endophenotype that intertwines with traumatisation and pathological dissociation remains unknown. Unspecified acute psychiatric patients were recruited to verify a hypothesis that pathological dissociation is associated with swift switching and traumatisation may explain this relationship. Behavioural measures of intellectual function and three executive functions including updating, switching and inhibition were administered, together with standardised scales to evaluate pathological dissociation and traumatisation. Our results showed superior control ability on switching and updating in inpatients who displayed more symptoms of pathological dissociation. When all three executive functions were entered as predictors, in addition to intellectual quotient and demographic variables to regress upon pathological dissociation, switching rather than updating remained the significant predictor. Importantly, the relationship between pathological dissociation and switching became non-significant when the effect of childhood trauma were controlled. The results support a trauma-related switching hypothesis which postulates swift switching as a cognitive endophenotype of pathological dissociation; traumatisation in childhood may explain the importance of swift switching. PMID:27123578

  14. Cardiac risk factors and metabolic syndrome in patients with schizophrenia admitted to a general hospital psychiatric unit

    PubMed Central

    Grover, Sandeep; Nebhinani, Naresh; Chakrabarti, Subho; Avasthi, Ajit; Basu, Debasish; Kulhara, Parmanand; Mattoo, Surendra Kumar; Malhotra, Savita

    2014-01-01

    Objective: The study aimed to evaluate the prevalence of cardiovascular risk (CVR) factors and metabolic syndrome (MS) in patients with schizophrenia. Materials and Methods: By consecutive sampling, 143 patients (of age ≥ 20 years), out of total 159 patients with schizophrenia admitted to the inpatient unit were evaluated for the coronary heart disease (CHD) risk as per Framingham (10-year all CHD events) function/risk equation and systematic coronary risk evaluation (SCORE) - 10-year cardiovascular mortality risk (CMR). Prevalence of MS was estimated by using the consensus definition. Results: Fifty-two (36.4%) patients fulfilled the criteria for MS. 10-year CHD risk was 1.65%, and 10-year CMR was 1.39%. Compared to females, males had higher Framingham score (1.96 ± 2.74 vs. 1.09 ± 0.41, U value 1987.5*, P < 0.05). Conclusion: Patients of schizophrenia have a high prevalence of MS and CVR factors. Hence, there is a need to screen the patient of schizophrenia for the same and manage the same as early as possible during the course of illness. PMID:25568478

  15. Acute Poisonings Admitted to a Tertiary Level Intensive Care Unit in Northern India: Patient Profile and Outcomes

    PubMed Central

    Mathai, Ashu Sara; Pannu, Aman; Arora, Rohit

    2015-01-01

    Background Poisoning is becoming a real health care burden for developing countries like India. An improved knowledge of the patterns of poisonings, as well as the clinical course and outcomes of these cases can help to formulate better preventive and management strategies. Aim To study the demographic and clinical profiles of patients admitted to the ICU with acute poisoning and to study the factors that predict their mortality. Materials and Methods Retrospective two years (September 1, 2010 to August 31, 2012) study of all consecutive patients admitted to the Intensive Care Unit (ICU) with acute poisoning at a tertiary care hospital in Northern India. Results Out of the 67 patients admitted to the ICU during the study period, the majority were young (median age 29 years) males (69%) who had consumed poison intentionally. Pesticides were the most commonly employed poison, notably organophosphorus compounds (22 patients, 32.8%) and aluminium phosphide (14 patients, 20.9%). While the overall mortality from all poisonings was low (18%), aluminium phosphide was highly toxic, with a mortality rate of 35%. The factors at ICU admission that were found to be associated with a significant risk of death were, high APACHE II and SOFA scores (p =0.0001 and p=0.006, respectively), as well as the need for mechanical ventilation and drugs for vasoactive support (p=0.012 and p= 0.0001, respectively). Conclusion Use of pesticides for intentional poisoning continues to be rampant in Northern India, with many patients presenting in a critical condition to tertiary level hospitals. Pesticide regulations laws, educational awareness, counseling and poison information centers will help to curtail this public health problem. PMID:26557594

  16. Characteristics of patients frequently subjected to pharmacological and mechanical restraint--a register study in three Norwegian acute psychiatric wards.

    PubMed

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Mjøsund, Nina Helen; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

    2014-01-30

    This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18-29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0-4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients.

  17. Nurse-police coalition: improves safety in acute psychiatric hospital.

    PubMed

    Allen, Diane E; Harris, Frank N; de Nesnera, Alexander

    2014-09-01

    Although police officers protect and secure the safety of citizens everywhere, nurses are the primary guardians of patient safety within the treatment milieu. At New Hampshire Hospital, both nurses and police officers share ownership of this responsibility, depending on the needs that arise specific to each profession. Psychiatric nurses take pride in their ability to de-escalate agitated and potentially aggressive patients; however, times arise when the best efforts of nurses fail, or when a situation requires intervention from police officers. Nurses and police officers at New Hampshire Hospital have worked together for many years to develop a trusting, respectful alliance. This coalition has resulted in a safe, clear, orderly process for transfer of authority from nurses to police during violent, clinically unmanageable psychiatric emergencies. Nurses and police officers work collaboratively toward the common goal of ensuring safety for patients and staff, while also acknowledging the unique strengths of each profession.

  18. Patients with Acute Myeloid Leukemia Admitted to Intensive Care Units: Outcome Analysis and Risk Prediction

    PubMed Central

    Braess, Jan; Thudium, Johannes; Schmid, Christoph; Kochanek, Matthias; Kreuzer, Karl-Anton; Lebiedz, Pia; Görlich, Dennis; Gerth, Hans U.; Rohde, Christian; Kessler, Torsten; Müller-Tidow, Carsten; Stelljes, Matthias; Büchner, Thomas; Schlimok, Günter; Hallek, Michael; Waltenberger, Johannes; Hiddemann, Wolfgang; Berdel, Wolfgang E.; Heilmeier, Bernhard; Krug, Utz

    2016-01-01

    Background This retrospective, multicenter study aimed to reveal risk predictors for mortality in the intensive care unit (ICU) as well as survival after ICU discharge in patients with acute myeloid leukemia (AML) requiring treatment in the ICU. Methods and Results Multivariate analysis of data for 187 adults with AML treated in the ICU in one institution revealed the following as independent prognostic factors for death in the ICU: arterial oxygen partial pressure below 72 mmHg, active AML and systemic inflammatory response syndrome upon ICU admission, and need for hemodialysis and mechanical ventilation in the ICU. Based on these variables, we developed an ICU mortality score and validated the score in an independent cohort of 264 patients treated in the ICU in three additional tertiary hospitals. Compared with the Simplified Acute Physiology Score (SAPS) II, the Logistic Organ Dysfunction (LOD) score, and the Sequential Organ Failure Assessment (SOFA) score, our score yielded a better prediction of ICU mortality in the receiver operator characteristics (ROC) analysis (AUC = 0.913 vs. AUC = 0.710 [SAPS II], AUC = 0.708 [LOD], and 0.770 [SOFA] in the training cohort; AUC = 0.841 for the developed score vs. AUC = 0.730 [SAPSII], AUC = 0.773 [LOD], and 0.783 [SOFA] in the validation cohort). Factors predicting decreased survival after ICU discharge were as follows: relapse or refractory disease, previous allogeneic stem cell transplantation, time between hospital admission and ICU admission, time spent in ICU, impaired diuresis, Glasgow Coma Scale <8 and hematocrit of ≥25% at ICU admission. Based on these factors, an ICU survival score was created and used for risk stratification into three risk groups. This stratification discriminated distinct survival rates after ICU discharge. Conclusions Our data emphasize that although individual risks differ widely depending on the patient and disease status, a substantial portion of critically ill patients with AML benefit

  19. Clinical Application of the "Scribble Technique" with Adults in an Acute Inpatient Psychiatric Hospital.

    ERIC Educational Resources Information Center

    Hanes, Michael J.

    1995-01-01

    The "scribble technique," described by Florence Cane's book, "The Artist in Each of Us" (1983), has historically been employed by art therapists as a technique to reduce inhibitions and liberate spontaneous imagery from the unconscious. Reviews the technique and presents examples produced by adult patients in an acute inpatient psychiatric ward.…

  20. A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

    PubMed Central

    2010-01-01

    Background Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards. Methods Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization. Results The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint. Conclusions The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors. PMID:20370928

  1. The Amsterdam Studies of Acute Psychiatry - II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands

    PubMed Central

    Koppelmans, Vincent; Schoevers, Robert; van Wijk, Cecile Gijsbers; Mulder, Wijnand; Hornbach, Annett; Barkhof, Emile; Klaassen, André; van Egmond, Marieke; van Venrooij, Janine; Bijpost, Yan; Nusselder, Hans; van Herrewaarden, Marjan; Maksimovic, Igor; Achilles, Alexander; Dekker, Jack

    2009-01-01

    Background The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and reports it has become evident that important dissimilarities exist between PICU's. The current study seeks to describe organisational as well as clinical and patient related factors across ten PICU's in and outside the Amsterdam region, adjusted for or stratified by level of urbanization. Method/Design This paper describes the design of the Amsterdam Studies of Acute Psychiatry II (ASAP-II). This study is a prospective observational cohort study comparing PICU's in and outside the Amsterdam region on various patient characteristics, treatment aspects and recovery related variables. Dissimilarities were measured by means of collecting standardized forms which were filled out in the framework of care as usual, by means of questionnaires filled out by mental health care professionals and by means of extracting data from patient files for every consecutive patient admitted at participating PICU's during a specific time period. Urbanization levels for every PICU were calculated conform procedures as proposed by the Dutch Central Bureau for Statistics (CBS). Discussion The current study may provide a deeper understanding of the differences between psychiatric intensive care units that can be used to promote best practice and benchmarking procedures, and thus improve the standard of care. PMID:19725981

  2. Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger

    PubMed Central

    Page, Anne-Laure; de Rekeneire, Nathalie; Sayadi, Sani; Aberrane, Said; Janssens, Ann-Carole; Rieux, Claire; Djibo, Ali; Manuguerra, Jean-Claude; Ducou-le-Pointe, Hubert; Grais, Rebecca F.; Schaefer, Myrto; Guerin, Philippe J.; Baron, Emmanuel

    2013-01-01

    Background Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger. Methods Children with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission. Results Among the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses. Conclusions These data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data. PMID:23874731

  3. Risk of prescribing errors in acutely admitted patients: a pilot study.

    PubMed

    Bonnerup, Dorthe Krogsgaard; Lisby, Marianne; Sædder, Eva Aggerholm; Sørensen, Charlotte Arp; Brock, Birgitte; Andersen, Ljubica; Eskildsen, Anette Gjetrup; Nielsen, Lars Peter

    2016-10-01

    Background Prescribing errors in emergency settings occur frequently. Knowing which patients have the highest risk of errors could improve patient outcomes. Objective The aim of this study was to test an algorithm designed to assess prescribing error risk in individual patients, and to test the feasibility of medication reviews in high-risk patients. Setting The study was performed at the Acute Admissions Unit at Aarhus University Hospital, Denmark. Methods The study was an interventional pilot study. Patients included were assessed according to risk of prescribing errors with the aid of an algorithm called 'Medication Risk Score' (MERIS). Based on the score, high-risk patients were offered a medication review. The clinical relevance of the medication reviews was assessed retrospectively. Main outcome measure The number and nature of prescribing errors during the patients' hospitalisation. Results The study included 103 patients, all of whom could be risk assessed with the algorithm MERIS. MERIS stratified 38 patients as high-risk patients and 65 as low-risk patients. The 103 patients were prescribed a total of 848 drugs in which 88 prescribing errors were found (10.4 %). Sixty-two of these were found in patients in the high-risk group. In general, the medication reviews were found to be clinically relevant and approximately 50 % of recommendations were implemented. Conclusion MERIS was found to be applicable in a clinical setting and stratified most patients with prescribing errors into the high-risk group. The medication reviews were feasible and found to be clinically relevant by most raters.

  4. Women in acute psychiatric units, their characteristics and needs: a review

    PubMed Central

    Archer, Michaela; Lau, Yasmine; Sethi, Faisil

    2016-01-01

    Aims and method Recent policy guidelines published by the Department of Health highlight the need to develop gender-sensitive psychiatric services. However, very little is currently known about the specific characteristics and needs of female patients entering acute psychiatric wards, particularly psychiatric intensive care units. This article aims to review the current literature on what is known about this group of patients. PubMed, Embase and PsycINFO were systematically searched using a number of key terms. Results A total of 27 articles were obtained. The findings were divided into four categories: admission characteristics, treatment needs, risk management and outcomes after discharge. Gender differences were found in diagnosis and presentation. Clinical implications The differences observed in the reviewed studies suggest that women may have different assessment and treatment needs, and ultimately, different philosophies of care. A dearth of studies in this area indicates that if services are to develop in line with government policies, more research is needed. PMID:27752346

  5. [Neurological and psychiatric disorders following acute arsine poisoning (author's transl)].

    PubMed

    Frank, G

    1976-07-15

    Follow-up study of 6 workers, who after survival of an acute arsine poisoning, developed psychopathologic and neurologic abnormalities. The symptoms appeared after a latency of 1 to 6 months indicating a toxic polyneuropathy and a mild psycho-organic syndrome. The severity of these reversible manifestations was directly related to the period of time of exposure to arsine. The clinical picture of arsine polyneuropathy was similar to that observed in arsenic poisoning, suggesting that arsine polyneuropathy is due to the action of arsenic. The psychopathologic syndrome corresponds to the so-called "Vergiftungsspätfolgesyndrom" and therefore does not appear to be a specific sequel of arsine poisoning.

  6. A prospective study of lipids and serotonin as risk markers of violence and self-harm in acute psychiatric patients.

    PubMed

    Roaldset, John O; Bakken, Anne M; Bjørkly, Stål

    2011-04-30

    Cross-sectional studies have reported an association between lipids and serotonin levels and aggression, but a literature search revealed a paucity of prospective studies. Subjects of the present naturalistic study were 254 of all (489) involuntary and voluntary acutely admitted patients to a psychiatric hospital during 1year. Serum lipids and platelet serotonin at admission were prospectively compared with recorded intra-institutional and 1-year post-discharge violence and self-harm. Total cholesterol had a significant negative relationship to inpatient suicidal behaviour and inpatient violent behaviour and to 3-month post-discharge violent behaviour. Triglycerides were a significant marker of inpatient self-mutilation and of self-mutilation in combination with suicidal behaviour at 3 and 12 months of follow-up. High-density lipoprotein (HDL) had a significant negative relationship to violence at 12-months, and to repeated violence in seven patients with two or more admissions. The post-discharge relationships between total cholesterol and violence and between triglycerides and self-harm remained significant even when controlling for other possible explanatory variables in a multivariate model. Results did not change after controlling for current medication at admission. There was no association between platelet serotonin and violence or self-harm. Future research may examine if lipid measurements add incremental validity to established clinical risk assessment procedures of violent and self-harm behaviour.

  7. A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

    PubMed Central

    Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

    2013-01-01

    Background and Objectives There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. Review Methods A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. Results 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. Conclusions No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to

  8. READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units.

    PubMed

    Vigod, Simone N; Kurdyak, Paul A; Seitz, Dallas; Herrmann, Nathan; Fung, Kinwah; Lin, Elizabeth; Perlman, Christopher; Taylor, Valerie H; Rochon, Paula A; Gruneir, Andrea

    2015-02-01

    Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.

  9. Acute Suicidal Affective Disturbance (ASAD): A confirmatory factor analysis with 1442 psychiatric inpatients.

    PubMed

    Stanley, Ian H; Rufino, Katrina A; Rogers, Megan L; Ellis, Thomas E; Joiner, Thomas E

    2016-09-01

    Acute Suicidal Affective Disturbance (ASAD) is a newly proposed diagnostic entity that characterizes rapid onset suicidal intent. This study aims to confirm the factor structure of ASAD among psychiatric inpatients, and to determine the clinical utility of ASAD in predicting suicide attempt status. Overall, 1442 psychiatric inpatients completed a battery of self-report questionnaires assessing symptoms theorized to comprise the ASAD construct. Utilizing these data, a confirmatory factor analysis with a one-factor solution was performed. Regression analyses were employed to determine if the ASAD construct predicted past suicide attempts, and analyses of variance (ANOVAs) were employed to determine if ASAD symptoms differed by the presence and number of past suicide attempts. The one-factor solution indicated good fit: χ(2)(77) = 309.1, p < 0.001, Tucker-Lewis Index (TLI) = 0.96, comparative fit index (CFI) = 0.97, root-mean-square error of approximation (RMSEA) = 0.05. Controlling for depressive disorders and current symptoms, the ASAD construct significantly predicted the presence of a past suicide attempt. Moreover, ASAD differentiated in the expected directions between individuals with a history of multiple suicide attempts, individuals with a single suicide attempt, and individuals with no history of a suicide attempt. Acute Suicidal Affective Disturbance (ASAD) appears to be a unified construct that predicts suicidal behavior and is distinct from an already-defined mood disorder. PMID:27344228

  10. Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards.

    PubMed

    Koivunen, Marita; Anttila, Minna; Kuosmanen, Lauri; Katajisto, Jouko; Välimäki, Maritta

    2015-01-01

    Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes' questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses' motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses' motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

  11. Content-Area Framework for Conducting Family Meetings for Acutely Ill Psychiatric Patients.

    PubMed

    Pon, Natalie C; Gordon, Mollie R; Coverdale, John; Nguyen, Phuong T

    2016-09-01

    Family meetings are a critically important component of managing acutely psychiatrically ill patients, and learning how to conduct such a meeting is critically important in the training of psychiatrists. Because we found no published comprehensive tools that dealt with the biopsychosocial content areas to be covered in family meetings in acute psychiatric settings, we developed and present such a comprehensive tool that is based in part on a review of existing tools utilized by other disciplines. This article describes the specific steps involved in premeeting planning, the formal topic areas that might be canvassed during the meeting, and postmeeting documentation and debriefing. The general content areas for discussion during the meeting include the setting of goals and expectations, relevant history-gathering, assessment of the family's understanding of the issues at stake, formal psychoeducation, and review of specific treatment strategies and clinical progress. The meeting may also include a discussion of resources available to the patient and family members and a review of issues related to the safety of the patient and others, management of early warning signs, and sensitive topics such as trauma, abuse, or violence that may play a role in the presentation or treatment of the patient to best translate established goals into a longer term plan of care. Implementation of this comprehensive and necessarily structured model should enhance the patient's and family's understanding of the issues at stake and should improve satisfaction, promote trust and an effective working alliance, and enhance the quality of the biopsychosocial care plan. PMID:27648507

  12. Demographic and Prognostic Factors of 455 Patients with Acute Leukemia Admitted to Two Referral Hospitals in Tehran-Iran During Ten Years (2001-2011)

    PubMed Central

    Ayremlou, Parvin; Razavi, Seyed Mohsen; Solaymani-Dodaran, Masoud; Vakili, Masoud; Asadi-Lari, Mohsen

    2012-01-01

    Background Global death toll of Acute Leukemia (AL), as a heterogeneous group of hematopoietic malignancies, is rather high, i.e. almost 74% of 300,000 new cases die every year. This reflects a poor prognosis of this malignancy in most parts of the world, where contemporary and rather complex remedies are not available. There are a few well documented reports about the epidemiologic features of AL at national level in Iran. This retrospective study demonstrates demographic and laboratory features of Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) patients admitted to the main referral oncology hospitals in the ex-Iran University of Medical Sciences in Tehran (Firoozgar and Rasoul-Akram hospitals) during the last decade (2001-2011). Methods Medical records of all patients admitted to the both hospitals diagnosed with AML and ALL were reviewed during the study period for demographic, biological and clinical characteristics at diagnosis. Results Four-hundred fifty five patients were diagnosed with AML and ALL, who admitted to the both hospitals during ten years, of whom 59.6 % (271 patients) were male. Fifty five percent of patients had AML and 44.6 % had ALL, both significantly dominated in men (p<0.001). AML patients died more significantly (p<0.05) and the most deaths occurred in older patients (p<0.001). Initial WBC count was significantly related to death (p= 0.001), where the least death (13%) occurred in the group with initial WBC between 5-10×103/μL and most of deceased had an initial WBC more than 10×103/μL. Logistic regression showed that age, fever and WBC were significant prognostic factors. Conclusion Demographic characteristics of AL patients were almost the same as other global reports. Most deaths occurred in older patients, those who had fever, and patients with higher WBC count at first admission, which warrants more investigations accurately and also improvements in hospital records. PMID:25628835

  13. 'Shared-rhythm cooperation' in cooperative team meetings in acute psychiatric inpatient care.

    PubMed

    Vuokila-Oikkonen, P; Janhonen, S; Vaisanen, L

    2004-04-01

    The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared-rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed.

  14. Pharmacist-initiated prior authorization process to improve patient care in a psychiatric acute care hospital.

    PubMed

    Allen, Shari N; Ojong-Salako, Mebanga

    2015-02-01

    A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient's discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA process implemented at an acute care psychiatric hospital. This process was initiated secondary to a need for a standardized process at the facility. To date, the process has been seen as a valuable aspect to patient care. Plans to expand this process include collecting data with regards to adherence and readmissions as well as applying for a grant to help develop a program to automate the PA program at this facility.

  15. Acute lead poisoning in nursing home and psychiatric patients from the ingestion of lead-based ceramic glazes.

    PubMed

    Vance, M V; Curry, S C; Bradley, J M; Kunkel, D B; Gerkin, R D; Bond, G R

    1990-10-01

    To our knowledge, acute inorganic lead poisoning from single ingestions of lead compounds has been only rarely reported. During a 14-month period, we were contacted regarding eight instances of acute ingestions of liquid lead-based ceramic glazes by mentally impaired residents of nursing homes or psychiatric facilities participating in ceramic arts programs. While some ingestions did not cause toxic effects, some patients developed acute lead poisoning characterized by abdominal pain, anemia, and basophilic stippling of red blood cells. In the blood of several patients, lead concentrations were far above normal (4 to 9.5 mumol/L). Urinary lead excretions were tremendously elevated during chelation therapy, with one patient excreting 535.9 mumol/L of lead during a 6-day period, the largest lead excretion ever reported in a patient suffering from acute lead poisoning, to our knowledge. All patients recovered following supportive care and appropriate use of chelating agents. Lead-based glazes are commonly found in nursing homes and psychiatric facilities. We suspect that acute or chronic lead poisoning from the ingestion(s) of lead-based ceramic glazes may be an unrecognized but not uncommon problem among such residents. We urge physicians to take ingestions of lead-based glazes seriously and to consider the diagnosis of lead poisoning in nursing home and psychiatric patients who have participated in ceramic crafts programs. PMID:2222094

  16. Mechanical and pharmacological restraints in acute psychiatric wards--why and how are they used?

    PubMed

    Knutzen, Maria; Bjørkly, Stål; Eidhammer, Gunnar; Lorentzen, Steinar; Helen Mjøsund, Nina; Opjordsmoen, Stein; Sandvik, Leiv; Friis, Svein

    2013-08-30

    Restraint use has been reported to be common in acute psychiatry, but empirical research is scarce concerning why and how restraints are used. This study analysed data from patients' first episodes of restraint in three acute psychiatric wards during a 2-year study period. Logistic regression analyses were used to identify predictors for type and duration of restraint. The distribution of restraint categories for the 371 restrained patients was as follows: mechanical restraint, 47.2%; mechanical and pharmacological restraint together, 35.3%; and pharmacological restraint, 17.5%. The most commonly reported reason for restraint was assault (occurred or imminent). It increased the likelihood of resulting in concomitant pharmacological restraint. Female patients had shorter duration of mechanical restraint than men. Age above 49 and female gender increased the likelihood of pharmacological versus mechanical restraint, whereas being restrained due to assault weakened this association. Episodes with mechanical restraint and coinciding pharmacological restraint lasted longer than mechanical restraint used separately, and were less common among patients with a personality disorder. Diagnoses, age and reason for restraint independently increased the likelihood for being subjected to specific types of restraint. Female gender predicted type of restraint and duration of episodes.

  17. 'The time it takes…' How doctors spend their time admitting a patient during the acute medical take.

    PubMed

    Sabin, Jodie; Khan, Waleed; Subbe, Christian P; Franklin, Marc; Abulela, Iman; Khan, Anwar; Mohammed, Hassan

    2016-08-01

    Patient safety depends on adequate staffing but the number of doctors required for safe staffing for medical emergencies is not known. We measured the duration of the admission process for patients seen by medical teams in emergency departments (EDs) and acute medical units. History taking and examination by a core medical trainee took 22 minutes for a patient referred from the ED and 21 minutes for a patient referred from primary care. A complete admission clerking with prescription and ordering of investigations ranged from a mean of 15 minutes for a consultant in acute medicine to a mean of 55 minutes for a foundation year 1 trainee. The duration of post-take ward rounds also showed significant variability.Our data can be used to model staffing patterns if combined with information about admission numbers and local set up.

  18. Nonalcoholic Fatty Liver Disease Is Associated With Higher 1-year All-Cause Rehospitalization Rates in Patients Admitted for Acute Heart Failure

    PubMed Central

    Valbusa, Filippo; Bonapace, Stefano; Grillo, Cristina; Scala, Luca; Chiampan, Andrea; Rossi, Andrea; Zoppini, Giacomo; Lonardo, Amedeo; Arcaro, Guido; Byrne, Christopher D.; Targher, Giovanni

    2016-01-01

    Abstract Repeat hospitalization due to acute heart failure (HF) is a global public health problem that markedly impacts on health resource use. Identifying novel predictors of rehospitalization would help physicians to determine the optimal postdischarge plan for preventing HF rehospitalization. Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for many heart diseases, including HF. We assessed whether NAFLD at hospital admission predicts 1-year all-cause rehospitalization in patients with acute HF. We enrolled all patients consecutively admitted for acute HF to our General Medicine Division, from January 2013 to April 2014, after excluding patients with acute myocardial infarction, severe heart valve diseases, malignancy, known liver diseases, and those with volume overload related to extracardiac causes. NAFLD was diagnosed by ultrasonography and exclusion of competing etiologies. The primary outcome of the study was the 1-year all-cause rehospitalization rate. Among the 107 patients enrolled in the study, the cumulative rehospitalization rate was 12.1% at 1 month, 25.2% at 3 months, 29.9% at 6 months, and 38.3% at 1 year. Patients with NAFLD had markedly higher 1-year rehospitalization rates than those without NAFLD (58% vs 21% at 1 y; P < 0.001 by the log-rank test). Cox regression analysis revealed that NAFLD was associated with a 5.5-fold increased risk of rehospitalization (adjusted hazard ratio 5.56, 95% confidence interval 2.46–12.1, P < 0.001) after adjustment for multiple HF risk factors and potential confounders. In conclusion, NAFLD was independently associated with higher 1-year rehospitalization in patients hospitalized for acute HF. PMID:26886619

  19. Relationship between Psychiatric Nurse Work Environments and Nurse Burnout in Acute Care General Hospitals

    PubMed Central

    Hanrahan, Nancy P.; Aiken, Linda H.; McClaine, Lakeetra; Hanlon, Alexandra L

    2010-01-01

    Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses’ capacity to sustain safe and effective patient care environments. PMID:20144031

  20. Correlation between levels of conflict and containment on acute psychiatric wards: the city-128 study.

    PubMed

    Bowers, Len; Stewart, Duncan; Papadopoulos, Chris; Iennaco, Joanne DeSanto

    2013-05-01

    OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.

  1. Comparison of the process of care of acute severe asthma in adults admitted to hospital before and 1 yr after the publication of national guidelines.

    PubMed

    Pearson, M G; Ryland, I; Harrison, B D

    1996-10-01

    This study set out to assess the effect of publication of the British Guidelines on Asthma Management on the processes and outcomes of the inpatient care of acute severe asthma in the U.K. A criterion-based audit of all acute asthma admissions during August and September 1990 (immediately before) and in 1991 (1 yr after publication of the Guidelines) using eight criteria of process and outcome was performed. Thirty-six teaching and district general hospitals in England, Scotland and Wales took part. In total, 766 patients admitted in 1990, and 900 patients admitted in 1991, were studied. The 1990 and 1991 cohorts were very similar demographically and had asthma of comparable severity. Respiratory physicians achieved similar high performance rates of between 75 and 91% for seven of the eight criteria for both years. Respiratory physicians were significantly more likely to provide patients with a written management plan in 1991. General physicians' performance was significantly lower in both years, but overall there was a very small, but just significant, improvement in their performance in 1991. Some hospitals performed consistently well in both years. It is concluded that respiratory physicians consistently provide better asthma care than general physicians. Though statistically significant, the small degree of improvement was disappointing. Possible reasons include: insufficient time for the Guidelines to be incorporated into practice; inaccessibility of the Guidelines to general physicians; failure to accept responsibility for implementing the good practice reflected in the Guidelines; and an explicit need for strategies to implement the Guidelines beyond publication in a widely-read general medical journal.

  2. [Acute alcohol intoxication among children and adolescents admitted to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical University of Silesia, Katowice during 2000-2010--preliminary study].

    PubMed

    Kamińska, Halla; Agnieszka, Zachurzok-Buczyńska; Gawlik, Aneta; Małecka-Tendera, Ewa

    2012-01-01

    The alcohol drinking at the young age is a risk factor of alcohol addiction later in life, and is connected with school problems, binge drinking, tobacco addiction, illegal drug use, violence, crime commitment, and risky sexual behaviors. Alcohol drinking in the last 12 months is declared by 78% Polish children. The aim of the study was to evaluate the frequency of admissions due to alcohol intoxication to the Department of Pediatrics, Pediatric Endocrinology and Diabetes, Pediatric Center of Silesia and the identification of the risk factors of the acute alcohol intoxication among Polish children and adolescents. Ten-year retrospective study includes investigation of patients medical records from the Department of Pediatrics. Among 8048 patients hospitalized in the Department of Pediatrics between the years 2000-2010, 220 (2.7%) cases of acute alcohol poisoning occurred The detailed data analysis from 139 patients [66 (47.5%) girls, 73 (52,5%) boys] was done. In the years 2006-2010 the number of girls admitted to the department increased in comparison to boys. The largest group of patients was at age between 14 and 16 years [61 (44%) children]. The blood alcohol concentration at the moment of admission to the hospital was 0.1 to 4.0 per thousand. In most cases (92.8%) the alcohol intoxication was intentional. Five percent of them were suicide attempts. In the youngest group of children alcohol abuse was unintentional. 23 (16.5%) of patients initially needed admission to the intensive care unit. In 30 (21.6%) patient the family was incomplete and five times more often father was absent. The alcohol addiction occurs in 18 (13.0%) fathers and 10 (7.2%) mothers of our patients. It is concluded that over the last decade the number of girls admitted due to alcohol abuse increased. Children at school grade between 7-9 are intoxicated most often. One six of intoxicated patents needed hospitalization at intensive care unit.

  3. What happens when 55% of acute psychiatric beds are closed in six days: an unexpected naturalistic observational study

    PubMed Central

    Branch, Matt; Mitchell, Anji; Parkin, Lindsay; Confue, Phil; Shankar, Rohit; Wilson-James, Diane; Marshall, Mike; Edgecombe, Maria; Keaney, Bernie; Gill, Kiran; Harrison, Juliet

    2016-01-01

    Objective The sudden closure of 30 out of 54 acute psychiatric beds in Cornwall presented a stressful challenge to staff but also a natural experiment on how a service dealt with this situation. We aimed to evaluate the outcomes of patients needing to leave the closed ward, how bed occupancy rates were affected and the impact on admission rates. Design A service evaluation of the impact of the ward closure. Setting A comprehensive secondary NHS mental health service in Cornwall serving 550,000 population. Main outcome measures The destination of the patients needing to leave the acute unit, the effect of the closure on bed occupancy, admission rates and serious untoward incidents. Results Of 26 patients needing to be moved from the acute ward, only 10 needed an acute psychiatric bed. None of the seven patients who had been on the ward longer than nine weeks needed an acute unit. Admission rates fell over the subsequent three months. There was no increase in serious incidents due to the closure. Conclusions This naturalistic event suggests that many patients on acute units could be cared for elsewhere, especially recovery/rehabilitation care environments, if political and financial urgency is present. Admission rates are responsive to the pressure on beds. PMID:27757241

  4. [Interest of ambulatory simplified acute physiology score (ASAPS) applied to patients admitted in an intensive care unit of an infectious diseases unit in Dakar].

    PubMed

    Dia, N M; Diallo, I; Manga, N M; Diop, S A; Fortes-Deguenonvo, L; Lakhe, N A; Ka, D; Seydi, M; Diop, B M; Sow, P S

    2015-08-01

    The evaluation of patients by a scale of gravity allows a better categorization of patients admitted in intensive care unit (ICU). Our study had for objective to estimate interest of Ambulatory Simplified Acute Physiologic Score (ASAPS) applied to patients admitted in ICU of infectious diseases department of FANN hospital. It was about a descriptive and analytical retrospective study, made from the data found in patients' files admitted into the USI infectious diseases department of FANN hospital in Dakar, from January 1(st), 2009 till December 31st, 2009.The data of 354 patients' files were analyzed. The sex-ratio was 1.77 with an average age of 37.6 years ± 19.4 years old [5-94 years]. The majority of the patients were unemployed paid (39.6%). The most frequent failures were the following ones: neurological (80.5%), cardio-respiratory (16.7%). The average duration of stay was 6.2 days ± 8.2 days going of less than 24 hours to more than 10 weeks. The deaths arose much more at night (53.1%) than in the daytime (46.9%) and the strongest rate of death was recorded in January (61.5%), most low in October (26.7%). The global mortality was 48.3%. The rate of lethality according to the highest main diagnosis was allocated to the AIDS (80.5%). The average ambulatory simplified acute physiology score was 5.3 ± 3.6 with extremes of 0 and 18. The deaths in our series increased with this index (p = 0.000005). The female patients had a rate of lethality higher than that of the men people, 55.5% against 44.2% (p = 0.03). In spite of a predictive score of a high survival (ASAPS < 8), certain number of patients died (n = 105) that is 61.4% of the deaths. The metabolic disturbances, hyperleukocytosis or leukopenia when realised, the presence of a chronic disease, seemed also to influence this lethality. ASAPS only, although interesting, would not good estimate the gravity of patients, where from the necessity thus of a minimum biological balance sheet. It seems better adapted

  5. Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units.

    PubMed

    Faulkner, Alastair; Reidy, Mike; Scicluna, Gabrielle; Love, Gavin J; Joss, Judith

    2016-03-01

    In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and CRP. The total number of blood tests requested for the duration of the patient's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per patient: January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates.

  6. Blood tests: One too many? Evaluating blood requesting guidance developed for acute patients admitted to trauma and orthopaedic units.

    PubMed

    Faulkner, Alastair; Reidy, Mike; Scicluna, Gabrielle; Love, Gavin J; Joss, Judith

    2016-03-01

    In a recently published report from the Academy of Medical Royal Colleges, around 20% of clinical practice which encompasses blood science investigations is considered wasteful. Blood tests including liver function tests (LFTs), C-reactive protein (CRP), coagulation screens, and international normalising ratios (INR) are frequently requested for patients who undergo emergency hospital admission. The paucity of guidance available for blood requesting in acute trauma and orthopaedic admissions can lead to inappropriate requesting practices and over investigation. Acute admissions over a period of one month were audited retrospectively for the frequency and clinical indications of requests for LFTs, coagulation screens/INR, and CRP. The total number of blood tests requested for the duration of the patient's admission was recorded. Initial auditing of 216 admissions in January 2014 demonstrated a striking amount of over-investigation. Clinical guidelines were developed with multidisciplinary expert input and implemented within the department. Re-audit of 233 admissions was carried out in September 2014. Total no. of LFTs requested: January 895, September 336 (-62.5%); coagulation screens/INR requested: January 307, September 210 (-31.6%); CRPs requested: January 894, September 317 (-64.5%). No. of blood requests per patient: January (M=4.81, SD 4.75), September (M=3.60, SD=4.70). Approximate combined total cost of LFT, coagulation/INR, CRP in January £2674.14 and September £1236.19 (-£1437.95, -53.77%). A large decrease was observed in admission requesting and subsequent monitoring (p<0.01) following the implementation. This both significantly reduced cost and venepuncture rates. PMID:26696248

  7. Acute effects of electroconvulsive therapy on regional cerebral blood flow (rCBF) in psychiatric disorders

    SciTech Connect

    Prohovnik, I.; Alderson, P.O.; Sackheim, H.A.; Decina, P.; Kahn, D.

    1984-01-01

    Electroconvulsive therapy (ECT) is frequently used in the treatment of major depression and other psychiatric disorders; its mechanism of action is not established, but previous evidence suggests that it is associated with postictal metabolic suppression. The authors have used measurements of rCBF as an index of cortical metabolic activity to study the acute effects of ECT. Measurements of rCBF were made in 32 cortical regions in 10 patients (pts) following one minute breathing of Xe-133 (5mCi/L); the measurements were performed 30min before and 50min after ECT. Bilateral ECT was administered to six pts (five diagnosed as major depressives and one schizophrenic) and unilateral ECT to four (all diagnosed as unipolar or bipolar affective disorder). The total rCBF material consists of 52 measurements in these pts, made before and after 16 bilateral and 10 unilateral treatments. ECT was found to cause significant reduction of rCBF. Mean hemispheric flows (using the Initial Slope Index to measure grey-matter flow) were reduced by about 5% in both hemispheres following bilateral treatment. Unilateral treatment caused a 9% reduction of flow in the treated hemisphere, but only 2% contralaterally. Regional patterns of flow decreases also differed between the two treatment modes: bilateral frontal reductions were found after bilateral treatment, whereas unilateral ECT caused a widespread flow reduction in the treated hemisphere, and almost no effect contralaterally. These results suggest that rCBF studies are useful for assessing ECT, and indicate that the acute cerebral effects of ECT vary with the mode of treatment.

  8. Neural network modeling of the level of observation decision in an acute psychiatric ward.

    PubMed

    Penny, W D; Frost, D P

    1997-02-01

    Patients in an acute psychiatric ward need to be observed with varying levels of closeness. We report a series of experiments in which neural networks were trained to model this "level of observation" decision. One hundred eighty-seven such clinical decisions were used to train and test the networks which were evaluated by a multitrial v-fold cross-validation procedure. One neural network modeling approach was to break down the decision process into four subproblems, each of which was solved by a perceptron unit. This resulted in a hierarchical perceptron network having a structure that was equivalent to a sparsely connected two-layer perceptron. Neural network approaches were compared with nearest neighbor, linear regression, and naive Bayes classifiers. The hierarchical and sparse neural networks were the most accurate classifiers. This shows that the decision process is nonlinear, that neural nets can be more accurate than other statistical approaches, and that hierarchical decomposition is a useful methodology for neural network design.

  9. Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia.

    PubMed

    Mosel, Krista A; Gerace, Adam; Muir-Cochrane, Eimear

    2010-06-01

    Absconding is increasingly being recognized as a problem within mental health settings with significant risks for consumers. This study examines absconding behaviours across three acute care wards within an Australian psychiatric hospital campus over a 12-month period. A descriptive statistical analysis determined the rate of absconding from 49 consumers who absconded 64 times. The absconding rate was 13.33% (absconding events), with most absconding events arising from males diagnosed with schizophrenia (57.14%) aged between 20 and 29 years, and with 62.50% of absconding events occurring whilst consumers were on their first 21-day detention order. Nearly half of all absconding events were by consumers who had absconded previously, with the highest proportion of events occurring during nursing handover. A profile of people who abscond, time of day of absconding, legal status and repeated absconding behaviours are described. The emergent profile of consumers who absconded within this study bears some similarities to that described in overseas research, although in this study consumers were slightly older and 25% of absconders were female. Of particular interest are findings that identify the timings of absconding events in relation to a consumer's legal status. Implications for practice, including assessment of risk of absconding and management, are considered.

  10. Outpatient mental health service use by older adults after acute psychiatric hospitalization.

    PubMed

    Li, Hong; Proctor, Enola; Morrow-Howell, Nancy

    2005-01-01

    This study described outpatient mental health service used by elderly patients discharged from acute inpatient psychiatric treatment for depression, assessed services barriers, and identified factors related to the use of outpatient mental health services. The sample consisted of 199 elderly patients discharged home from a geropsychiatric unit of an urban midwestern hospital. Multivariate logistic regression was used to identify factors associated with use of various mental health services. Almost three quarters of the elderly patients saw a psychiatrist within 6 weeks postdischarge, but few used other outpatient mental health services. The most frequently reported barriers to use included (1) cost of services, (2) personal belief that depression would improve on its own, and (3) lack of awareness of available services. The use of various outpatient services was differentially related to predisposing, need, and enabling factors. Female patients, those residing in rural areas, and those who wanted to solve their problems on their own were less likely to use outpatient mental health services. Patients who reported greater levels of functional impairment, resided in rural areas, and perceived that getting services required too much time were less likely to see a psychiatrist in the postacute period. African American patients were more likely than whites to use day treatment programs. This may be related to the fact that most day treatment centers were located in areas where the majority of residents were African Americans.

  11. Patients' lived seclusion experience in acute psychiatric hospital in the United States: a qualitative study.

    PubMed

    Ezeobele, I E; Malecha, A T; Mock, A; Mackey-Godine, A; Hughes, M

    2014-05-01

    The findings revealed that the patients perceived seclusion as an intervention that is punitive and a means used by the staff to exert control. Patients perceived that staff incitements and lack of communication skills led to their being secluded. The findings provided recommendations and strategies for seclusion reduction that were based on the patients' first-hand seclusion experiences. This phenomenological study used Husserlian's philosophy to explore and describe the lived experiences of psychiatric patients who were secluded at a free-standing acute care hospital located in South-western United States (US). The study is crucial because very few studies have been conducted in this area in the US. The study examined a purposive sample of 20 patients, 3 days post-seclusion. Data were generated through face-to-face, semi-structured interviews incorporating open-ended questions and probes to facilitate discussion until saturation was reached. Interviews were transcribed verbatim and data analysed using Colaizzi's seven steps method. Results were described according to the themes and subthemes identified. Findings uncovered four themes: (1) alone in the world; (2) staff exert power and control; (3) resentment towards staff; and (4) time for meditation. The findings from this study illuminated the views surrounding patients' seclusion experience. It provided first-hand information on the patients' seclusion experience that might be helpful to the mental health professionals in the seclusion reduction process.

  12. Acute exacerbation of psychiatric symptoms during influenza treatment with oseltamivir in chronic schizophrenia.

    PubMed

    Lan, Chen-Chia; Liu, Chia-Chien; Chen, Ying-Sheue

    2015-06-01

    Influenza treatment and prophylaxis with oseltamivir are critically important in reducing the morbidity and mortality of patients in chronic psychiatric facilities. Abnormal behavior, delusions, perceptual disturbances, mania, and depression have all been reported as oseltamivir-related psychiatric side effects. We hereby report two chronic schizophrenia patients in Taiwan manifesting psychiatric instability who were being treated with oseltamivir for suspected influenza infection, and further discuss other potential contributing factors. The possibility that oseltamivir can cause psychotic or affective symptoms suggests that additional caution is necessary for its use in patients with an established psychiatric diagnosis. PMID:25823677

  13. A comparison of acute psychiatric care under Medicaid carve-outs, HMOs, and fee-for-service.

    PubMed

    Hudson, Christopher G; Chafets, Julia

    2010-11-01

    This study compares the use of acute psychiatric hospitalization; selected outcomes, including rehospitalization; as well as costs associated with the health maintenance organization (HMO), carve-out, and fee-for-service models as implemented in the Massachusetts Medicaid program between FY1994 and FY2000. This is a longitudinal analysis that primarily uses unduplicated individual data from the Massachusetts Case Mix database. Analyses focus on 56,518 individuals who were psychiatrically hospitalized on acute units within 57 hospitals. They employ Cox regression to compare rehospitalization among the three programs. The hypotheses were strongly supported: HMOs have the most substantial impacts in minimizing service provision, with the carve-out program having an impact intermediate between the HMO and fee-for-service programs. Lower utilization rates were associated with lower overall rates of hospitalization, shorter lengths of stay, fewer repeated stays, and less geographic access and greater displacement of psychiatric patients to medical units. The final model of rehospitalization has an overall predictive accuracy of 59.6%.

  14. L-asparaginase-induced abnormality in plasma glucose level in patients of acute lymphoblastic leukemia admitted to a tertiary care hospital of Odisha

    PubMed Central

    Panigrahi, Mousumee; Swain, Trupti Rekha; Jena, Rabindra Kumar; Panigrahi, Ashutosh

    2016-01-01

    Objectives: The objective of this study was to evaluate any abnormal change in plasma glucose levels in patients treated with L-asparaginase (L-Asp)-based chemotherapy regimen in patients of acute lymphoblastic leukemia (ALL). Materials and Methods: This retrospective, hospital-based study was conducted in patients of ALL, admitted to the Clinical Haematology Department of a tertiary care hospital of Odisha from August 2014 to July 2015. Indoor records of 146 patients on multi-centered protocol-841 were evaluated for any alteration in plasma glucose level, time of onset of hypo/hyperglycemia, and persistence of plasma glucose alteration. Results: Twenty-one percent of patients showed abnormal plasma glucose level. Most of these patients developed hypoglycemia and were of lower age group. Most of these patients developed hypoglycemia and were of lower age group, whereas a majority of higher age group patients developed hyperglycemia. In majority of the cases, abnormal glucose developed after three doses of L-Asp. Hypoglycemia subsided whereas hyperglycemia persisted till the end of our observation period. Conclusions: L-Asp produces more incidences of hypoglycemia than hyperglycemia in a good number of ALL patients towards which clinicians should be more vigilant. However, hyperglycemia persists for a longer duration than hypoglycemia. PMID:27721550

  15. Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

    PubMed Central

    De Berardinis, Benedetta; Magrini, Laura; Zampini, Giorgio; Zancla, Benedetta; Salerno, Gerardo; Cardelli, Patrizia; Di Stasio, Enrico; Gaggin, Hanna K.; Belcher, Arianna; Parry, Blair A.; Nagurney, John T.; Januzzi, James L.; Di Somma, Salvatore

    2014-01-01

    Introduction. Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED). Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement. Results. GAL3 level was significantly higher in patients >71 years old, and with eGFR < 30 cc/min. The area under the curve (AUC) of GAL3 + BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P < 0.005). Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload. PMID:25101304

  16. Plasma suPAR levels are associated with mortality, admission time, and Charlson Comorbidity Index in the acutely admitted medical patient: a prospective observational study

    PubMed Central

    2012-01-01

    Introduction Soluble urokinase plasminogen activator receptor (suPAR) is the soluble form of the membrane-bound receptor (uPAR) expressed predominantly on various immune cells. Elevated plasma suPAR concentration is associated with increased mortality in various patient groups, and it is speculated that suPAR is a low-grade inflammation marker reflecting on disease severity. The aim of this prospective observational study was to determine if the plasma concentration of suPAR is associated with admission time, re-admission, disease severity/Charlson Comorbidity Index Score, and mortality. Methods We included 543 patients with various diseases from a Danish Acute Medical Unit during a two month period. A triage unit ensured that only medical patients were admitted to the Acute Medical Unit. SuPAR was measured on plasma samples drawn upon admission. Patients were followed-up for three months after inclusion by their unique civil registry number and using Danish registries to determine admission times, readmissions, International Classification of Diseases, 10th Edition (ICD-10) diagnoses, and mortality. Statistical analysis was used to determine suPAR's association with these endpoints. Results Increased suPAR was significantly associated with 90-day mortality (4.87 ng/ml in survivors versus 7.29 ng/ml in non-survivors, P < 0.0001), higher Charlson Score (P < 0.0001), and longer admission time (P < 0.0001), but not with readmissions. The association with mortality remained when adjusting for age, sex, C-reactive protein (CRP), and Charlson Score. Furthermore, among the various Charlson Score disease groups, suPAR was significantly higher in those with diabetes, cancer, cardiovascular disease, and liver disease compared to those without comorbidities. Conclusions SuPAR is a marker of disease severity, admission time, and risk of mortality in a heterogeneous cohort of patients with a variety of diseases. The independent value of suPAR suggests it could be of value in

  17. Treatments for common psychiatric conditions among adults during acute, rehabilitation, and reintegration phases.

    PubMed

    Difede, Joann; Cukor, Judith; Lee, Francis; Yurt, Roger

    2009-12-01

    Common and pernicious adult psychiatric disorders consequent to burn injury include post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and new-onset substance abuse disorder. Diagnosing and treating these disorders is complicated by the complex psychosocial issues associated with burns including grief, pain, role impairment, disfigurement, dysfunction, stigma, as well as financial and legal issues. Additionally, pre-morbid psychiatric and neurological illnesses are risk factors for burns, adding to the challenge of diagnosis and treatment. This article will focus on the diagnosis and treatment of PTSD and MDD consequent to burn trauma, as these are the major psychiatric outcomes, addressing the attendant psychosocial problems as threads in this post-trauma tapestry.

  18. Outcome of patients admitted with acute coronary syndrome on palliative treatment: insights from the nationwide AMIS Plus Registry 1997–2014

    PubMed Central

    Erne, Paul; Radovanovic, Dragana; Seifert, Burkhardt; Bertel, Osmund; Urban, Philip

    2015-01-01

    Objective Compliance with guidelines is increasingly used to benchmark the quality of hospital care, however, very little is known on patients admitted with acute coronary syndromes (ACS) and treated palliatively. This study aimed to evaluate the baseline characteristics and outcomes of these patients. Design Prospective cohort study. Setting Eighty-two Swiss hospitals enrolled patients from 1997 to 2014. Participants All patients with ACS enrolled in the AMIS Plus registry (n=45 091) were analysed according to three treatment groups: palliative treatment, defined as use of aspirin and analgesics only and no reperfusion; conservative treatment, defined as any treatment including antithrombotics or anticoagulants, heparins, P2Y12 inhibitors, GPIIb/IIIa but no pharmacological or mechanical reperfusion; and reperfusion treatment (thrombolysis and/or percutaneous coronary intervention during initial hospitalisation). The primary outcome measure was in-hospital mortality and the secondary measure was 1-year mortality. Results Of the patients, 1485 (3.3%) were palliatively treated, 11 119 (24.7%) were conservatively treated and 32 487 (72.0%) underwent reperfusion therapy. In 1997, 6% of all patients were treated palliatively and this continuously decreased to 2% in 2013. Baseline characteristics of palliative patients differed in comparison with conservatively treated and reperfusion patients in age, gender and comorbidities (all p<0.001). These patients had more in-hospital complications such as postadmission onset of cardiogenic shock (15.6% vs 5.2%; p<0.001), stroke (1.8% vs 0.8%; p=0.001) and a higher in-hospital mortality (25.8% vs 5.6%; p<0.001).The subgroup of patients followed 1 year after discharge (n=8316) had a higher rate of reinfarction (9.2% vs 3.4%; p=0.003) and mortality (14.0% vs 3.5%; p<0.001). Conclusions Patients with ACS treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. While

  19. Challenges in Obtaining HIV Testing in an Acute Involuntary Inpatient Psychiatric Setting.

    PubMed

    Weller, Jennifer; Levitt, Gwen; Myers, Robert; Riley, Aaron; Gesmundo, Celsius-Kit

    2016-01-01

    Even in health care professions, a stigma remains for patients with co-occurring HIV and serious mental illness. Researchers at a large, urban medical center encountered this stigma when they attempted to initiate a study of cognition in psychiatric inpatients with and without HIV who were seen as vulnerable in the context of research. Education efforts and advocacy on the part of the research team was instrumental and resulted in system-wide changes in the hospital, including the addition of HIV testing to the psychiatric admission laboratory panel. Within the first year that routine laboratory orders included an HIV test, the rate of testing ordered by inpatient-attending psychiatrists reached 60% of admissions. As of 2014, 13 HIV tests were found to be HIV seropositive in inpatients, with four of those cases classified as new-onset, as opposed to two positive tests in the year prior to our study. PMID:27426407

  20. The permeable institution: an ethnographic study of three acute psychiatric wards in London.

    PubMed

    Quirk, Alan; Lelliott, Paul; Seale, Clive

    2006-10-01

    In Asylums, Goffman [1961. Asylums. London: Penguin] identified some permeable features of the old mental hospitals but presented them as exceptions to the rule and focused on their impermeable aspects. We argue that this emphasis is no longer valid and offer an alternative ideal type that better represents the reality of everyday life in contemporary 'bricks and mortar' psychiatric institutions. We call this the "permeable institution". The research involved participant observation of between 3 and 4 months and interviews with patients, patient advocates and staff on 3 psychiatric wards. Evidence for permeability includes that ward membership is temporary and changes rapidly (patients tend to have very short stays and staff turnover is high); patients maintain contact with the outside world during their stay; and institutional identities are blurred to the point where visitors or new patients can easily mistake staff and patients for one another. Permeability has both positive consequences (e.g., reduced risk of institutionalism), and negative consequences (e.g., unwanted people coming into hospital to cause trouble, and illicit drug use among patients). Staff employ various methods to regulate their ward's permeability, within certain parameters. The metaphor of the total/closed institution remains valuable, but it fails to capture the highly permeable nature of the psychiatric institutions we studied. Analysts may therefore find the permeable institution a more helpful reference point or ideal type against which to examine and compare empirical cases. Perhaps most helpful is to conceptualise a continuum of institutional permeability with total and permeable institutions at each extreme.

  1. "Talking in a new way": older individuals' experiences of group work in an acute psychiatric ward.

    PubMed

    Partington, Jennifer; Gee, Susan; Leith, Anne-Marie; Croucher, Matthew

    2012-01-01

    Group work is frequently used in mental health, however qualitative studies on service-users' views are rare. Semistructured interviews explored 12 participants' experiences of a café-style social group and a mutual-aid group offered on an older persons psychiatric ward in Christchurch, New Zealand. The values of the strengths-based approach underpinning the groups were reflected back in the experience of an affirming environment, an exchange of strengths, and the capacity to change. The appeal of the café-style may be culturally specific to European women however, reinforcing the importance of an awareness of culture and diversity.

  2. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats

    PubMed Central

    Radcliffe, Jonathan; Bird, Laura

    2016-01-01

    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

  3. A comparison of cardiovascular risk factors among Indo-Asian and caucasian patients admitted with acute myocardial infarction in Kuala Lumpur, Malaysia and Birmingham, England.

    PubMed

    Dhanjal, T S; Lal, M; Haynes, R; Lip, G

    2001-12-01

    Indo-Asians in the UK are at an increased risk of coronary artery disease (CAD); this may be a reflection of their cardiovascular risk factor profile as well as of a more sedentary lifestyle. We hypothesised that Indo-Asians in Malaysia and the UK may exhibit a similar cardiovascular risk factor and physical activity profile, which would be more adverse compared with caucasians. We studied 70 consecutive Indo-Asian patients admitted to hospitals in Kuala Lumpur, Malaysia (n=42; 35 males; mean age 60.6 years, SD 11.8); and Birmingham, England (n=28; 20 males; mean age 60.8 years, SD 12.9). Both groups of Indo-Asian patients were compared with 20 caucasian patients (13 males; mean age 62.7 years, SD 9.4) admitted with myocardial infarction from Birmingham. There was a higher prevalence of diabetes among Indo-Asians in both countries than among caucasians (p=0.0225). By contrast, caucasians had a higher prevalence of hypercholesterolaemia (p=0.0113), peripheral vascular disease (p=0.0008), regular alcohol consumption (p<0.0001) and family history of CAD (p=0.0041). There were no significant differences in mean age, body mass index or blood pressures. There was a significantly lower leisure activity score (p=0.001) and total physical activity score (p=0.003) among Indo-Asians in both countries than among caucasians. This survey has demonstrated differences in cardiovascular risk factors among Indo-Asian and caucasian patients. The high prevalence of diabetes, as well as the lower physical activity and sedentary lifestyles among Indo-Asians, in both Malaysia and the UK, may in part contribute to the high incidence of CAD in this ethnic group.

  4. Psychiatric Emergencies.

    PubMed

    Wheat, Santina; Dschida, Dorothy; Talen, Mary R

    2016-06-01

    Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger. Ensuring the safety of the patient, surrounding persons, and the medical team is the first step of evaluation. Treatment focuses on stabilization of the patient, then on specific symptoms and ultimately the cause of symptoms. There are important legal considerations, particularly regarding involuntary admissions. It is important to debrief with the patient, surrounding family, and the health care team to ensure a continued therapeutic alliance and the emotional health of all involved. PMID:27262012

  5. The devil is in the detail: Acute Guillain–Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit

    PubMed Central

    Sarada, Pooja Prathapan; Sundararajan, Krishnaswamy

    2016-01-01

    Guillain–Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit. PMID:27303139

  6. Effects of music therapy on self- and experienced stigma in patients on an acute care psychiatric unit: a randomized three group effectiveness study.

    PubMed

    Silverman, Michael J

    2013-10-01

    Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N=83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for "the stigma blues." Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided.

  7. Effectiveness of a drinking-motive-tailored emergency-room intervention among adolescents admitted to hospital due to acute alcohol intoxication - A randomized controlled trial.

    PubMed

    Wurdak, Mara; Wolstein, Jörg; Kuntsche, Emmanuel

    2016-06-01

    The aim of this study is to develop and test the effectiveness of a drinking-motive-tailored intervention for adolescents hospitalized due to alcohol intoxication in eight cities in Germany between December 2011 and May 2012 against a similar, non-motive-tailored intervention. In a randomized controlled trial, 254 adolescents received a psychosocial intervention plus motive-tailored (intervention group; IG) or general exercises (control group; CG). Adolescents in the IG received exercises in accordance with their drinking motives as indicated at baseline (e.g. alternative ways of spending leisure time or dealing with stress). Exercises for the CG contained alcohol-related information in general (e.g. legal issues). The data of 81 adolescents (age: M = 15.6, SD = 1.0; 42.0% female) who participated in both the baseline and the follow-up were compared using ANOVA with repeated measurements and effect sizes (available case analyses). Adolescents reported lower alcohol use at the four-week follow-up independently of the kind of intervention. Significant interaction effects between time and IG were found for girls in terms of drinking frequency (F = 7.770, p < 0.01) and binge drinking (F = 7.0005, p < 0.05) but not for boys. For the former, the proportional reductions and corresponding effect sizes of drinking frequency (d = - 1.18), binge drinking (d = - 1.61) and drunkenness (d = - 2.87) were much higher than the .8 threshold for large effects. Conducting psychosocial interventions in a motive-tailored way appears more effective for girls admitted to hospital due to alcohol intoxication than without motive-tailoring. Further research is required to address the specific needs of boys in such interventions. (German Clinical Trials Register, DRKS ID: DRKS00005588).

  8. Effectiveness of a drinking-motive-tailored emergency-room intervention among adolescents admitted to hospital due to acute alcohol intoxication — A randomized controlled trial

    PubMed Central

    Wurdak, Mara; Wolstein, Jörg; Kuntsche, Emmanuel

    2015-01-01

    The aim of this study is to develop and test the effectiveness of a drinking-motive-tailored intervention for adolescents hospitalized due to alcohol intoxication in eight cities in Germany between December 2011 and May 2012 against a similar, non-motive-tailored intervention. In a randomized controlled trial, 254 adolescents received a psychosocial intervention plus motive-tailored (intervention group; IG) or general exercises (control group; CG). Adolescents in the IG received exercises in accordance with their drinking motives as indicated at baseline (e.g. alternative ways of spending leisure time or dealing with stress). Exercises for the CG contained alcohol-related information in general (e.g. legal issues). The data of 81 adolescents (age: M = 15.6, SD = 1.0; 42.0% female) who participated in both the baseline and the follow-up were compared using ANOVA with repeated measurements and effect sizes (available case analyses). Adolescents reported lower alcohol use at the four-week follow-up independently of the kind of intervention. Significant interaction effects between time and IG were found for girls in terms of drinking frequency (F = 7.770, p < 0.01) and binge drinking (F = 7.0005, p < 0.05) but not for boys. For the former, the proportional reductions and corresponding effect sizes of drinking frequency (d = − 1.18), binge drinking (d = − 1.61) and drunkenness (d = − 2.87) were much higher than the .8 threshold for large effects. Conducting psychosocial interventions in a motive-tailored way appears more effective for girls admitted to hospital due to alcohol intoxication than without motive-tailoring. Further research is required to address the specific needs of boys in such interventions. (German Clinical Trials Register, DRKS ID: DRKS00005588). PMID:26844193

  9. [Social integration and contacts to reference persons of the normal social environment in inpatient treatment in the psychiatric hospital. A prospective catamnestic study of patients admitted for the first time with schizophrenic and cyclothymic psychoses].

    PubMed

    Böcker, F M

    1984-01-01

    Fifty first-admission inpatients (27 women, 23 men; mean age 35.1 years) with schizophrenia (n = 35) or affective disorders (n = 15) participated in a standardized, half-open interview about contact with people outside the hospital. The frequency of contact was compared with outcome, as based on a 1-year follow-up. Nearly all patients (48 of 50) had "direct" contact with relatives and friends during the week (means = 3/week): 45 patients had visitors, 13 went home on weekends. Thirty-five patients had contact with the outside by telephone, and 21 by letter; only 12 patients indicated no "indirect" contact. The frequency of contact had no relationship to sex, age or diagnosis. The significant factors were: structure of the patient's family, his/her educational and occupational level, social network, means of admission, conditions of hospitalization, and length of stay. The distance between the patient's residence and the hospital markedly influenced the frequency of visits and weekend holidays. The importance of frequent interaction with the usual social environment was verified by follow-up: 11 patients with rare or only average contact had unfavorable results (readmission or suicide by 1 year after discharge or long-term hospitalization); on the other hand, none of the patients with frequent direct contact outside the hospital showed poor results. There is no reason for indiscriminate criticism of the relatives of psychiatric inpatients according to etiological hypotheses of "family research"; above all, patients without relationships with a family or friends have to be regarded as at risk.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6526062

  10. Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment.

    PubMed

    Walsh, Jim; Boyle, Joan

    2009-01-01

    This paper has been undertaken by people with experience with mental health issues and mental health care systems. The aim of the research was to explore psychiatric inpatients' strategies for coping with mental ill health and in what ways acute inpatient psychiatric hospital services are facilitative to the individual attempting recovery. Ten focus groups were facilitated and data were analysed through systematic content analysis. Findings revealed that the main areas of concern for inpatients were: information, communication, relationships, activities, self-help, patient involvement in care treatment plans, and the physical environment. The authors also make a case to improve the status of user-led research as a means to understand the needs of mental health service users. PMID:19148819

  11. Characteristics and Needs of Psychiatric Patients With Prolonged Hospital Stay

    PubMed Central

    Afilalo, Marc; Soucy, Nathalie; Xue, Xiaoqing; Colacone, Antoinette; Jourdenais, Emmanuelle; Boivin, Jean-François

    2015-01-01

    Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds. Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional’s evaluation. Descriptive and univariate analyses were performed. Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients’ needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions: Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients’ needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients. PMID:26174218

  12. A randomized trial of a mental health consumer-managed alternative to civil commitment for acute psychiatric crisis.

    PubMed

    Greenfield, Thomas K; Stoneking, Beth C; Humphreys, Keith; Sundby, Evan; Bond, Jason

    2008-09-01

    This experiment compared the effectiveness of an unlocked, mental health consumer-managed, crisis residential program (CRP) to a locked, inpatient psychiatric facility (LIPF) for adults civilly committed for severe psychiatric problems. Following screening and informed consent, participants (n = 393) were randomized to the CRP or the LIPF and interviewed at baseline and at 30-day, 6-month, and 1-year post admission. Outcomes were costs, level of functioning, psychiatric symptoms, self-esteem, enrichment, and service satisfaction. Treatment outcomes were compared using hierarchical linear models. Participants in the CRP experienced significantly greater improvement on interviewer-rated and self-reported psychopathology than did participants in the LIPF condition; service satisfaction was dramatically higher in the CRP condition. CRP-style facilities are a viable alternative to psychiatric hospitalization for many individuals facing civil commitment. PMID:18626766

  13. Effect of Patient Sex on the Severity of Coronary Artery Disease in Patients with Newly Diagnosis of Obstructive Sleep Apnoea Admitted by an Acute Coronary Syndrome

    PubMed Central

    Sánchez-de-la-Torre, Alicia; Abad, Jorge; Durán-Cantolla, Joaquín; Mediano, Olga; Cabriada, Valentín; Masdeu, María José; Terán, Joaquín; Masa, Juan Fernando; de la Peña, Mónica; Aldomá, Albina; Worner, Fernando; Valls, Joan; Barbé, Ferran; Sánchez-de-la-Torre, Manuel

    2016-01-01

    Background The cardiovascular consequences of obstructive sleep apnoea (OSA) differ by sex. We hypothesized that sex influences the severity of acute coronary syndrome (ACS) in patients with OSA. OSA was defined as an apnoea–hypopnoea index (AHI)>15 events·h-1. We evaluated the severity of ACS according to the ejection fraction, Killip class, number of diseased vessels, number of stents implanted and plasma peak troponin level. Methods We included 663 men (mean±SD, AHI 37±18 events·h-1) and 133 women (AHI 35±18 events·h-1) with OSA. Results The men were younger than the women (59±11 versus 66±11 years, p<0.0001), exhibited a higher neck circumference (p<0.0001), and were more likely to be smokers and alcohol users than women (p<0.0001, p = 0.0005, respectively). Body mass index and percentage of hypertensive patients or diabetics were similar between sexes. We observed a slight tendency for a higher Killip classification in women, although it was not statistically significant (p = 0.055). For men, we observed that the number of diseased vessels and the number of stents implanted were higher (p = 0.02, p = 0.001, respectively), and a decrease in the ejection fraction (p = 0.002). Conclusions This study shows that sex in OSA influences the severity of ACS. Men show a lower ejection fraction and an increased number of diseased vessels and number of stents implanted. PMID:27416494

  14. Japanese Encephalitis among Patients with Acute Encephalitic Syndrome Admitted to a Tertiary Hospital in Chitwan, Nepal – A Prospective Observational Study

    PubMed Central

    Ram, Sundar Twayana; Neuberger, Ami; Thapa, Lekh Jung; Vir Singh, Rana Pramendra; Shofty, Ben; Schwartz, Eli

    2014-01-01

    Introduction The reported incidence of JE among patients with acute encephalitic syndrome (AES) in Nepal ranges between 20% to 62%. In light of the lack of up-to-date data, we sought to describe the epidemiology of JE in Chitwan, Nepal. Methods A prospective observational study was conducted during 2010–2012 in the College of Medical Science in the Chitwan District. Patients with suspected JE were tested for anti-JE IgM in serum and cerebrospinal fluid (CSF). Results Of 227 all patients tested, 18 (7.9%) were found positive for JE. 17/202 (8.4%) patients with AES had JE. All, with the exception of two patients, were diagnosed on the basis of positive a serologic test, both in serum and CSF samples. Patients with JE were significantly older (42.1±27.6 years) than patients without JE (25.6±25.2 years, p = 0.02). Half of JE cases occurred in adults older than 50. More of the JE cases (11/18, 61.1%) occurred during the rainy season when compared to the JE negative patients [71/209, (34%), p = 0.01]. None of the JE patients had a relevant travel history, and one recalled having been immunized against JE. There was a variation in the geographic distribution of cases across the districts of the central Terai. Conclusions In this cohort, the proportion of patients with AES who had JE was lower than in previous studies. In addition, most patients were adults, and cases were not distributed uniformly across the central Terai region. The risk of acquiring JE by short-term travelers in the area is likely to be low. Vector-control programs and the promotion of mosquito avoidance behavior in the Terai region should continue. The high proportions of adults among patients with JE may suggest recent changes in the epidemiology of JE in the central Terai region, and routine immunization of all adults should be considered. PMID:24950104

  15. 'She's manipulative and he's right off': a critical analysis of psychiatric nurses' oral and written language in the acute inpatient setting.

    PubMed

    Hamilton, Bridget; Manias, Elizabeth

    2006-06-01

    Remarks such as 'she's manipulative' and 'he's right off' are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the diverse discourses implicated in nurses' writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses' oral and written language. A prominent debate in the literature surrounds nurses' use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses' use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses' use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as diverse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses' everyday language and explore what it produces for nurses, patients and society.

  16. 'She's manipulative and he's right off': a critical analysis of psychiatric nurses' oral and written language in the acute inpatient setting.

    PubMed

    Hamilton, Bridget; Manias, Elizabeth

    2006-06-01

    Remarks such as 'she's manipulative' and 'he's right off' are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the diverse discourses implicated in nurses' writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses' oral and written language. A prominent debate in the literature surrounds nurses' use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses' use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses' use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as diverse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses' everyday language and explore what it produces for nurses, patients and society. PMID:16643343

  17. Comparison of assessment and management of suicidal risk for acute psychiatric assessment between two state sponsored hospitals in England and Italy.

    PubMed

    Singh, Ranbir; Verdolini, Norma; Agius, Mark; Moretti, Patrizia; Quartesan, Roberto

    2015-09-01

    The risk of suicide is one of the most important risk factors looked into for acute psychiatric assessments that influences the management plan. The prevalence of suicide is on a rise across European countries; as a consequence, the different countries have created specific guidelines and policies in order to prevent suicides in the acute settings. These guidelines are based on both different cultural aspects as well as the different organization of the mental health system in the different countries. This paper wants to present the comparison between the guidelines of two European countries, England and Italy, in order to evaluate the systems, understand differences and common contact points. The different European countries could learn one from the other and a European shared point of view may be a way forward to create better understanding and preventing the risk of suicide across the population. PMID:26417782

  18. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City.

    PubMed

    Curtis, Sarah; Copeland, Alison; Fagg, James; Congdon, Peter; Almog, Michael; Fitzpatrick, Justine

    2006-03-01

    We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We

  19. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City.

    PubMed

    Curtis, Sarah; Copeland, Alison; Fagg, James; Congdon, Peter; Almog, Michael; Fitzpatrick, Justine

    2006-03-01

    We report on comparative analyses of small area variation in rates of acute hospital admissions for psychiatric conditions in Greater London around the year 1998 and in New York City (NYC) in 2000. Based on a theoretical model of the factors likely to influence psychiatric admission rates, and using data from the most recent population censuses and other sources, we examine the association with area indicators designed to measure access to hospital beds, socio-economic deprivation, social fragmentation and ethnic/racial composition. We report results on admissions for men and women aged 15-64 for all psychiatric conditions (excluding self-harm), drug-related substance abuse/addiction, schizophrenia and affective disorders. The units of analysis in NYC were 165 five-digit Zip Code Areas and, in London, 760 electoral wards as defined in 1998. The analysis controls for age and sex composition and, as a proxy for access to care, spatial proximity to hospitals with psychiatric beds. Poisson regression modeling incorporating random effects was used to control for both overdispersion in the counts of admissions and for the effects of spatial autocorrelation. The results for NYC and London showed that local admission rates for all types of condition were positively and significantly associated with deprivation and the association is independent of demographic composition or 'access' to beds. In NYC, social fragmentation showed a significant association with admissions due to affective disorders and schizophrenia, and for drug dependency among females. Racial minority concentration was significantly and positively associated with admissions for schizophrenia. In London, social fragmentation was associated positively with admissions for men and women due to schizophrenia and affective disorders. The variable measuring racial/ethnic minority concentration for London wards showed a negative association with admission rates for drug dependency and for affective disorders. We

  20. A comparison of symptoms and drug use between patients with methamphetamine associated psychoses and patients diagnosed with schizophrenia in two acute psychiatric wards.

    PubMed

    Medhus, Sigrid; Mordal, Jon; Holm, Bjørn; Mørland, Jørg; Bramness, Jørgen G

    2013-03-30

    Psychosis induced by the use of amphetamine or methamphetamine leads to dramatic symptoms and frequent readmissions and poses diagnostic challenges. Earlier studies have often relied on history taking and/or urine samples to reveal drug use. The aim of this study was to compare the psychotic symptoms of two groups: (1) acutely admitted patients who tested positive for methamphetamines and were diagnosed with drug-induced or methamphetamine-induced psychoses and (2) acutely admitted patients who tested negative for methamphetamines and were diagnosed with schizophrenia. Blood and urine samples were used. In addition, we investigated whether the severity of symptoms, in those who tested positive, was related to the blood concentration of methamphetamine. Of 285 patients who volunteered blood and/or urine samples within 48h of admission, 37 (13%) had recently taken methamphetamine. Positive psychotic symptoms between the two groups were compared by PANSS using the positive subscale. The results showed no differences in positive psychotic symptoms between the two groups. The severity of positive psychotic symptoms in patients with three different levels of urine/blood methamphetamine concentrations, were compared. We found no clinically or statistically significant relationship between blood methamphetamine levels and severity of psychotic symptoms.

  1. Patients' own statements of their future risk for violent and self-harm behaviour: a prospective inpatient and post-discharge follow-up study in an acute psychiatric unit.

    PubMed

    Roaldset, John Olav; Bjørkly, Stål

    2010-06-30

    Recently patients' responsibility for and ownership of their own treatment have been emphasised. A literature search on patients'' structured self-reported assessment of future risk of violent, suicidal or self mutilating behaviour failed to disclose any published empirical research. The present prospective naturalistic study comprised all involuntary and voluntary acutely admitted patients (n=489) to a psychiatric hospital during one year. Patients' self-reported risks of violence and self-harm at admission and at discharge were compared with episodes recorded during hospital stay and 3 months post-discharge. Patients' predictions were significant concerning violent, suicidal and self-injurious behaviour, with AUC values of 0.73 (95%CI=0.61-0.85), 0.92 (95%CI=0.88-0.96) and 0.82 (95%CI=0.67-0.98) for hospital stay, and 0.67 (95%CI=0.58-0.76), 0.63 (95%CI=0.55-0.72) and 0.66 (95%CI=0.57-0.76) after 3 months, respectively. Moderate or higher risk predictions remained significant in multivariate analysis, and risk of violence even after gender stratification. Self-harm predictions were significant for women. Moderate or higher risk scores remained significant predictors of violence one year post-discharge. Controlling for readmissions the results remained the same. Low sensitivity limits the clinical value, but relatively high positive predictive values might be clinically important. Still future research is recommended to explore if self prediction is a valid adjuvant method to established risk assessment procedures.

  2. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

    PubMed Central

    Patel, Rashmi; Chesney, Edward; Cullen, Alexis E.; Tulloch, Alex D.; Broadbent, Matthew; Stewart, Robert; McGuire, Philip

    2016-01-01

    Background Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals. Aims To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes. Method Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week. Results There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient −21.1 days, 95% CI −24.6 to −17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. Conclusions Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a

  3. The periodicities in and biometeorological relationships with bed occupancy of an acute psychiatric ward in Antwerp, Belgium

    NASA Astrophysics Data System (ADS)

    Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.

    1993-06-01

    Recently, some investigators have established a seasonal pattern in normal human psychology, physiology and behaviour, and in the incidence of psychiatric psychopathology. In an attempt to elucidate the chronopsy and meteotropism in the latter, we have examined the chronograms of, and the biometeorological relationships to bed occupancy of the psychiatric ward of the Antwerp University Hospital during three consecutive calendar years (1987 1989). Weather data for the vicinity were provided by a local meteorological station and comprise mean atmospheric pressure, air temperature, relative humidity, wind speed and minutes of sunlight and precipitation/day. The number of psychiatric beds occupied during the study period exhibited a significant seasonal variation. Peaks in bed occupancy were observed in March and November, with lows in August. An important part of the variability in the number of beds occupied could be explained by the composite effects of weather variables of the preceding weeks. Our results suggest that short-term fluctuations in atmospheric activity may dictate some of the periodicities in psychiatric psychopathology.

  4. Psychiatric diagnosis, psychiatric power and psychiatric abuse.

    PubMed Central

    Szasz, T

    1994-01-01

    Psychiatric abuse, such as we usually associate with practices in the former Soviet Union, is related not to the misuse of psychiatric diagnoses, but to the political power intrinsic to the social role of the psychiatrist in totalitarian and democratic societies alike. Some reflections are offered on the modern, therapeutic state's proclivity to treat adults as patients rather than citizens, disjoin rights from responsibilities, and thus corrupt the language of political-philosophical discourse. PMID:7996558

  5. Brain Tumours Simulating Psychiatric Disease

    PubMed Central

    Hobbs, G. E.

    1963-01-01

    Brain tumours may present with symptoms indistinguishable from psychiatric disease. The impression of most psychiatrists is that individuals suffering from brain tumour rarely appear among their patients. A priori reasoning based on evidence from neurological, neurosurgical and pathological sources suggests the contrary. The present study is a frequency analysis of cases of previously undiagnosed brain tumours admitted to either an open psychoneurotic ward or a mental hospital over a period of 15 years. The results support the impression held by psychiatrists that brain tumours are uncommon among psychiatric patients. PMID:13954870

  6. Acute psychosis in a verified Huntington disease gene carrier with subtle motor signs: psychiatric criteria should be considered for the diagnosis.

    PubMed

    Nagel, M; Rumpf, H J; Kasten, M

    2014-01-01

    Huntington disease (HD) is an inherited, progressive, autosomal dominant disorder. Some patients develop severe chorea or cognitive symptoms. The genetic defect causes progressive atrophy of the striatum, the cortex and extrastriatal structures (Sheperd GM. Corticostriatal connectivity and its role in disease. Nat Rev Neurosci 2013;14:278-91). The precise timing of clinical diagnosis of HD is poorly characterized and is mainly based on motor symptoms (Huntington, Study and Group. Unified Huntington's Disease Rating Scale: reliability and consistency. Huntington Study Group. Mov Discord 1996:136-42). Patients suffering from HD frequently show cognitive or affective symptoms even before manifesting motor signs. Psychiatric symptoms like depression, apathy, aggression, and disinhibition are common, and suicide rates are over four times higher than in the general population (Di Maio L, Squitieri F, Napolitano G, Campanella G, Trofatter JA, Conneally PM. Suicide risk in Huntington's disease. J Med Genet 1993;30:293-5). This case report of a female patient with genetically proven HD is of special interest because motor or cognitive impairment were absent whereas she suffered from symptoms of an acute and severe psychosis likely to be symptomatic signs of HD.

  7. An acute in-patient psychiatric service for 16- to 17-year-old adolescents in the UK: a descriptive evaluation

    PubMed Central

    Duddu, Venu; Rhouma, Abdulhakim; Qureshi, Masood; Chaudhry, Imran Bashir; Drake, Terry; Sumra, Altaf; Husain, Nusrat

    2016-01-01

    Aims and method The need for an age-appropriate in-patient service for 16- to 17-year-olds led to the development of a 6-bed acute admissions unit in a non-metropolitan county in the UK. We provide a descriptive evaluation of the first 2 years of its operation. All admissions from April 2010 to March 2012 were reviewed, clinical details systematically recorded and descriptively analysed. Results Ninety-seven young people were admitted during this period (a third were compulsorily detained under the Mental Health Act 1983). The average length of stay was 3–4 weeks. The most common presenting complaints were self-harm and low mood, usually in the context of life events and childhood adversity. Nearly half had substance misuse and other risk-taking behaviours. A third presented with psychotic symptoms. Adjustment and anxiety disorders were most common, followed by alcohol/substance use disorders, depressive illnesses and psychotic illnesses. Comorbidity was the rule rather than the exception. Most patients improved by the time of discharge. Clinical implications The unit provides an accessible and effective age-appropriate service and is likely to constitute an important component of the comprehensive child and adolescent mental health service strategy in the county. PMID:27752345

  8. Finding solutions through empowerment: a preliminary study of a solution-orientated approach to nursing in acute psychiatric settings.

    PubMed

    Stevenson, C; Jackson, S; Barker, P

    2003-12-01

    Acute inpatient care is not a therapeutic milieu, perhaps owing to the lack of nursing skills. Solution-focused therapy (SFT) has been successful in US inpatient facilities in relation to both objective and subjective 'measures'. This paper reports a study of SFT in a UK context, with the aim of developing a user-friendly SFT training course and assessing its impact on both nurses and clients, via a multifaceted, triangulated data collection design. Nurses' knowledge and clinical performance were assessed, as was the client's perspective. There was a significant difference in nurses' SFT knowledge after training and strong evidence of the model being used in practice during the course of training, although nursing documentation was not fully completed. Eighty-three per cent of nurses said that they would continue using the model, and clients found the SFT approach helpful. The findings match the US experience of using SFT.

  9. Nursing interventions for substance use during psychiatric hospital admissions: Clinical context and predictors.

    PubMed

    Stewart, Duncan; Warren, Jonathan; Odubanwo, Adewunmi; Bowers, Len

    2015-12-01

    Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London. Searches were conducted for all patients admitted during 2012 and details of incidents and patient characteristics were extracted for analysis. Substance use was reported for 291 patients, with 25 incidents per 100 patients admitted to hospital. Only half of the incidents were followed by a response that specifically addressed the patients' substance use behaviour. These interactions usually concerned the circumstances and reasons for use, but rarely involved specific support for patients' substance use problems. The likelihood of staff taking any form of action was increased if the patient had been formally admitted, and was reduced if the patient was subject to containment during the shift or had a history of self-harm. The results demonstrate that nurses require specific training and guidance on supporting substance using patients. PMID:26300518

  10. Psychiatric Adjustment in the Year after Meningococcal Disease in Childhood

    ERIC Educational Resources Information Center

    Shears, Daniel; Nadel, Simon; Gledhill, Julia; Gordon, Fabiana; Garralda, M. Elena

    2007-01-01

    Objective: To assess psychiatric status after meningococcal disease. Method: Cohort study of 66 children (34 boys, 32 girls) ages 4 to 17 years admitted to pediatric hospitals with meningococcal disease. The main outcome measure was psychiatric disorder (1-year period and point prevalence on the Schedule for Affective Disorders and Schizophrenia…

  11. Stress, Coping, and Suicide Risk in Psychiatric Inpatients.

    ERIC Educational Resources Information Center

    Josepho, Sharon A.; Plutchik, Robert

    1994-01-01

    Investigated relationship between interpersonal problems, coping style, and suicide risk among 71 adult psychiatric inpatients. Patients admitted with history of suicidal attempts were compared with patients admitted for other reasons. Interpersonal problems were significantly and positively related to suicide risk. Coping style of suppression was…

  12. Children in Foster Care: Before, during, and after Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Persi, Joe; Sisson, Megan

    2008-01-01

    Although it is generally accepted that foster children are at greater risk for mental health problems than are children in the general population, very little is known about the smaller group of foster children admitted to psychiatric hospitals. The present study sought to determine whether foster children admitted to inpatient care are a distinct…

  13. Psychiatric wards: places of safety?

    PubMed

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K

    2010-03-01

    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience.

  14. Psychiatric wards: places of safety?

    PubMed

    Jones, J; Nolan, P; Bowers, L; Simpson, A; Whittington, R; Hackney, D; Bhui, K

    2010-03-01

    In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience. PMID:20465757

  15. Charged gravastars admitting conformal motion

    NASA Astrophysics Data System (ADS)

    Usmani, A. A.; Rahaman, F.; Ray, Saibal; Nandi, K. K.; Kuhfittig, Peter K. F.; Rakib, Sk. A.; Hasan, Z.

    2011-07-01

    We propose a new model of a gravastar admitting conformal motion. While retaining the framework of the Mazur-Mottola model, the gravastar is assumed to be internally charged, with an exterior defined by a Reissner-Nordström instead of a Schwarzschild line element. The solutions, obtained by exploiting an assumed conformal Killing vector, involve (i) the interior region, (ii) the shell, and (iii) the exterior region of the sphere. Of these three cases the first one is of primary interest since the total gravitational mass here turns out to be an electromagnetic mass under some specific conditions. This suggests that the interior de Sitter vacuum of a charged gravastar is essentially an electromagnetic mass model that must generate gravitational mass which provides a stable configuration by balancing the repulsive pressure arising from charge with its attractive gravity to avert a singularity. Therefore the present model, like the Mazur-Mottola model, results in the construction of a compact astrophysical object, as an alternative to a black hole. We have also analyzed various other aspects such as the stress energy tensor in the thin shell and the entropy of the system.

  16. Non-Psychiatric Health Problems among Psychiatric Inpatients with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Charlot, L.; Abend, S.; Ravin, P.; Mastis, K.; Hunt, A.; Deutsch, C.

    2011-01-01

    Background: Physical distress resulting from medical problems has been found to cause increased behaviour problems in patients with intellectual disabilities (ID). Despite this fact, little has been documented on the medical problems of individuals with ID admitted for inpatient psychiatric care. We conducted an exploratory investigation based on…

  17. [Acute pancreatitis after ingestion of ibuprofen in a 16-year-old boy].

    PubMed

    Bruusgaard-Mouritsen, Mads Emil; Leerhøy, Bonna; Hansen, Mark Berner

    2015-07-01

    This is a case report of a 16-year-old boy with possible drug-induced pancreatitis (DIP) caused by ibuprofen. The patient had a history of psychiatric, but no somatic, disease, and he was admitted with a clinical presentation consistent with acute pancreatitis after a bolus ingestion of 10 g of ibuprofen in a suicidal attempt. No evidence of other causality for acute pancreatitis was identified. The patient was treated with a standard pancreatitis treatment regime and was discharged against medical advice after four days. The case represents a possible causality between ibuprofen and DIP. PMID:26239856

  18. Implementing a Music Therapy Program at a New 72-Hour Acute Psychiatric Admissions Unit: A Case Study of a Patient Who Was Malingering

    ERIC Educational Resources Information Center

    Silverman, Michael J.

    2009-01-01

    Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons who…

  19. Iowa record-linkage study: death rates in psychiatric patients.

    PubMed

    Black, D W

    1998-09-01

    The Iowa record-linkage study was developed to investigate death rates in psychiatric patients, and involved computer matching of death certificates with a roster of patients. A list of all patients admitted to our hospital from 1972 through 1981 was obtained and after removing duplicate entries the list was pared to 5412 names. The record included multiple identifiers (e.g., name, gender, date-of-birth, hospital number). This information was then linked by computer with all Iowa death certificates for the same period; a total of 331 deaths were identified. Patients were assigned to a single psychiatric diagnostic category based on a computer program that reviewed each patient's clinical diagnoses and picked the one with the highest priority in a hierarchy we had created. Age and sex adjusted mortality tables were constructed, allowing us to compute expected numbers of deaths. Relative risk for premature death was greatest among women, and those under 20 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either gender with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psychophysiological disorders; and men with neuroses. Death from natural causes, especially from heart disease, was significantly excessive among women, while death from accidents and suicides was excessive for both men and women. The overall SMR was 1.65 (P < 0.001). Most importantly, we found that the greatest excess of mortality occurred within the first 2 years following hospital discharge. Thus, we were able to demonstrate that risk of mortality in general, and of suicide specifically, differed according to age, gender, diagnosis, and portion of the follow-up. We have subsequently used this method to investigate specific risk factors associated with mortality in mood disorders, schizophrenia, and antisocial personality disorder. Findings from these studies are

  20. The nature of psychiatric disorders.

    PubMed

    Kendler, Kenneth S

    2016-02-01

    A foundational question for the discipline of psychiatry is the nature of psychiatric disorders. What kinds of things are they? In this paper, I review and critique three major relevant theories: realism, pragmatism and constructivism. Realism assumes that the content of science is real and independent of human activities. I distinguish two "flavors" of realism: chemistry-based, for which the paradigmatic example is elements of the periodic table, and biology-based, for which the paradigm is species. The latter is a much better fit for psychiatry. Pragmatism articulates a sensible approach to psychiatric disorders just seeking categories that perform well in the world. But it makes no claim about the reality of those disorders. This is problematic, because we have a duty to advocate for our profession and our patients against other physicians who never doubt the reality of the disorders they treat. Constructivism has been associated with anti-psychiatry activists, but we should admit that social forces play a role in the creation of our diagnoses, as they do in many sciences. However, truly socially constructed psychiatric disorders are rare. I then describe powerful arguments against a realist theory of psychiatric disorders. Because so many prior psychiatric diagnoses have been proposed and then abandoned, can we really claim that our current nosologies have it right? Much of our current nosology arose from a series of historical figures and events which could have gone differently. If we re-run the tape of history over and over again, the DSM and ICD would not likely have the same categories on every iteration. Therefore, we should argue more confidently for the reality of broader constructs of psychiatric illness rather than our current diagnostic categories, which remain tentative. Finally, instead of thinking that our disorders are true because they correspond to clear entities in the world, we should consider a coherence theory of truth by which disorders

  1. The nature of psychiatric disorders.

    PubMed

    Kendler, Kenneth S

    2016-02-01

    A foundational question for the discipline of psychiatry is the nature of psychiatric disorders. What kinds of things are they? In this paper, I review and critique three major relevant theories: realism, pragmatism and constructivism. Realism assumes that the content of science is real and independent of human activities. I distinguish two "flavors" of realism: chemistry-based, for which the paradigmatic example is elements of the periodic table, and biology-based, for which the paradigm is species. The latter is a much better fit for psychiatry. Pragmatism articulates a sensible approach to psychiatric disorders just seeking categories that perform well in the world. But it makes no claim about the reality of those disorders. This is problematic, because we have a duty to advocate for our profession and our patients against other physicians who never doubt the reality of the disorders they treat. Constructivism has been associated with anti-psychiatry activists, but we should admit that social forces play a role in the creation of our diagnoses, as they do in many sciences. However, truly socially constructed psychiatric disorders are rare. I then describe powerful arguments against a realist theory of psychiatric disorders. Because so many prior psychiatric diagnoses have been proposed and then abandoned, can we really claim that our current nosologies have it right? Much of our current nosology arose from a series of historical figures and events which could have gone differently. If we re-run the tape of history over and over again, the DSM and ICD would not likely have the same categories on every iteration. Therefore, we should argue more confidently for the reality of broader constructs of psychiatric illness rather than our current diagnostic categories, which remain tentative. Finally, instead of thinking that our disorders are true because they correspond to clear entities in the world, we should consider a coherence theory of truth by which disorders

  2. Influence of psychiatric comorbidity on 30-day readmissions for heart failure, myocardial infarction, and pneumonia

    PubMed Central

    Ahmedani, Brian K.; Solberg, Leif I.; Copeland, Laurel; Fang, Ying; Stewart, Christine; Hu, Jianhui; Nerenz, David R.; Williams, L. Keoki; Cassidy-Bushrow, Andrea E.; Waxmonsky, Jeanette; Lu, Christine Y.; Waitzfelder, Beth E.; Owen-Smith, Ashli A.; Coleman, Karen J.; Lynch, Frances L.; Ahmed, Ameena T.; Beck, Arne L.; Rossom, Rebecca C.; Simon, Gregory E.

    2014-01-01

    Objective The Centers for Medicare and Medicaid Services (CMS) implemented a policy in 2012 that penalizes hospitals for ‘excessive’ all-cause hospital readmissions within 30 days after discharge for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. The aim of this study is to investigate the influence of psychiatric comorbidities on 30-day all-cause readmissions for heart failure, acute myocardial infarction, and pneumonia. Methods Longitudinal study from 2009-2011 within 11 Mental Health Research Network (MHRN) affiliated health systems. Data were derived from the HMO Research Network Virtual Data Warehouse. Participants were individuals admitted to the hospital for HF, AMI, and pneumonia. All index inpatient hospitalizations for HF, AMI and pneumonia were captured (n=160,169 patient index admissions). Psychiatric diagnoses were measured for the year prior to admission. All-cause readmissions within 30 days of discharge were the outcome variable. Results Approximately 18% of all individuals with these conditions were readmitted within 30-days. The rate was 5% greater for individuals with a past-year psychiatric comorbidity (21.7%) than for those without (16.5%; p<.001). Depression, anxiety, and dementia were associated with more readmissions for those with index hospitalizations for all three conditions independently and combined (p<.05). Substance use and bipolar disorders were linked with higher readmissions for those with initial HF and pneumonia hospitalizations (p<.05). Readmission rates declined overall from 2009-2011. Conclusions Individuals with HF, AMI, and pneumonia experience high rates of readmission, but psychiatric comorbidities appear to increase that risk. Future readmission interventions should consider adding mental health components. PMID:25642610

  3. Inclusion of carers when confused relatives are admitted to hospital.

    PubMed

    Barber, Jeanette

    2015-06-01

    It is well recognised that many older people have dementia but have never been investigated or received a formal diagnosis. If they are admitted to acute hospitals from their own homes or long-term care settings with confusion and little background information about their usual condition, it can be challenging for staff to determine if they have dementia, delirium, delirium superimposed on pre-existing dementia or confusion with a reversible cause such as vitamin deficiency. A careful history and information seeking from carers or family members about their loved one's pre-admission baseline can inform nursing and medical assessments and help nurses to provide high quality care. PMID:26018488

  4. Practice of Acute and Maintenance Electroconvulsive Therapy in the Psychiatric Clinic of a University Hospital from Turkey: between 2007 and 2013

    PubMed Central

    Sengul, Melike Ceyhan Balci; Kenar, Ayse Nur Inci; Hanci, Ezgi; Sendur, İbrahim; Sengul, Cem; Herken, Hasan

    2016-01-01

    Objective Electroconvulsive therapy (ECT) can be given as the form of acute, continuation or maintenance ECT according to the process of administration. We report our 7 years’ observation with acute and maintenance ECT in a university hospital in Turkey. Methods The medical records of the hospitalized patients treated with acute or maintenance ECT between the years 2007 and 2013 was retrospectively analyzed. The sociodemographic characteristics, diagnosis, data of ECT and the co-administered psychotropic drugs were recorded. The frequency of ECT was calculated by identifying the total number of the hospitalized patients during the study period from the hospital records. Results A total number of 1,432 female and 1,141 male patients hospitalized in a period of 7 years, with a total number of 111 patients treated with ECT. The ratio of ECT was 4%, maintenance/acute ECT 11%. For acute ECT, affective disorders (65.3%) and psychotic disorders (21.6%) were among the leading diagnoses. Maintenance ECT, the diagnosis was; 6 affective disorders, 4 psychotic disorders and 1 obsessive compulsive disorder. There was a significant difference between the patients receiving acute and maintenance ECT in terms of age, duration of illness, and number of previous hospitalizations and ECTs. Conclusion The percentage of patients treated with acute ECT is lower in our institution than that in many other institutions from our country. Acute and maintenance ECT should be considered as an important treatment option particularly for patients with long disease duration, a high number of hospitalizations and a history of benefiting from previous ECTs. PMID:26792041

  5. The challenge of admitting the very elderly to intensive care.

    PubMed

    Nguyen, Yên-Lan; Angus, Derek C; Boumendil, Ariane; Guidet, Bertrand

    2011-01-01

    The aging of the population has increased the demand for healthcare resources. The number of patients aged 80 years and older admitted to the intensive care unit (ICU) increased during the past decade, as has the intensity of care for such patients. Yet, many physicians remain reluctant to admit the oldest, arguing a "squandering" of societal resources, that ICU care could be deleterious, or that ICU care may not actually be what the patient or family wants in this instance. Other ICU physicians are strong advocates for admission of a selected elderly population. These discrepant opinions may partly be explained by the current lack of validated criteria to select accurately the patients (of any age) who will benefit most from ICU hospitalization. This review describes the epidemiology of the elderly aged 80 years and older admitted in the ICU, their long-term outcomes, and to discuss some of the solutions to cope with the burden of an aging population receiving acute care hospitalization. PMID:21906383

  6. Factors affecting the decision to hospitalise children admitted to the emergency department due to non-fatal suicide attempts by pills

    PubMed Central

    Gokalp, Gamze; Anil, Murat; Bal, Alkan; Bicilioglu, Yuksel; Kamit Can, Fulya; Anil, Ayse Berna

    2016-01-01

    Objective: Suicide attempts (SAs) in the paediatric age group represent an important cause of morbidity and mortality. Our aim was to examine the factors affecting the decision to hospitalize children with a diagnosis of non-fatal SA by pills. Methods: Children <18 years of age admitted with SA by pills during 2014 were evaluated retrospectively. Patients were divided into two groups: Group-I comprised hospitalised patients and Group-II included those who were discharged from the PED. These two groups were compared in terms of clinical and demographic characteristics recorded upon PED admission. Results: A total of 196 patients were included in the study. The number of pills taken for self-poisoning in Group-I (median: 20 pills) was higher than that in Group-II (median: 12 pills) (p < 0.001), and the rate of pathological findings during the first paediatric psychiatric consultation was higher in Group-I (91.1%) than in the Group-II (54.8%) (p < 0.001). Conclusion: Factors affecting the disposition decision in cases of children who performed non-fatal SA via pills included the amount of medication taken for the suicide attempt and the presence of psychiatric disorders, as determined by a paediatric psychiatrist during the acute phase. PMID:27375723

  7. [Authority in the psychiatric clinic].

    PubMed

    Laemmel, K

    1983-01-01

    patient. Attempts of intrusion into the independence and authority of the psychiatric hospital can also occur from the families of the patients, the admitting physicians or the mass media who developed a last a somewhat unsavory interest into the psychiatric institution. To deal with these challenges authoritative authority is mandatory as much as the understanding of the dynamics of human behavior. Special problems exist for the psychiatric service within a general hospital. As the most recent arrival from the banishment in the outskirts into the fold of medicine, it has to prove itself first.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6635585

  8. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study.

    PubMed

    Sampson, Elizabeth L; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-04-01

    Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen-Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia. PMID:25790457

  9. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study.

    PubMed

    Sampson, Elizabeth L; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-04-01

    Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen-Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.

  10. Characterizing Aggressive and Noncompliant Behaviors in a Children's Psychiatric Inpatient Setting

    ERIC Educational Resources Information Center

    Sukhodolsky, Denis G.; Cardona, Laurie; Martin, Andres

    2005-01-01

    This study was conducted to evaluate aggression and noncompliance among child psychiatric inpatients in relation to demographic, clinical, and hospitalization characteristics, including the use of restraints and seclusion. Eighty six children (10.8 plus or minus 2.4 years old, 67% male) consecutively admitted to an inpatient psychiatric unit were…

  11. Elements of Successful School Reentry after Psychiatric Hospitalization

    ERIC Educational Resources Information Center

    Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.

    2011-01-01

    Psychiatric hospitalization is an intensive intervention designed to stabilize adolescents who are experiencing an acute mental health crisis. Reintegrating to school after discharge from psychiatric hospitalization can be overwhelming for many adolescents (E. V. Clemens, L. E. Welfare, & A. M. Williams, 2010). The authors used a consensual…

  12. Irresistible impulse: psychiatric viewpoint.

    PubMed

    Weil, F

    1989-01-01

    The responses of the psychiatric profession to the legal criteria applied to irresistible impulse in cases of psychotic offenders are examined. An illustrative case, and its legal consequences, support the desirability of the psychiatric approach.

  13. Hepatitis E: are psychiatric patients on special risk?

    PubMed

    Reinheimer, Claudia; Allwinn, Regina; Berger, Annemarie

    2012-05-01

    Hepatitis E virus (HEV) is largely confined to travelers returning from endemic areas, but the number of autochthonous cases of acute HEV infections in developed countries is increasing. Reservoirs for HEV are surface water, wild boar meat, and raw or undercooked pork meat. Usually, hepatitis E is a self-limiting disease presenting with acute hepatitis as a major clinical symptom. The seroprevalence of anti-HEV-IgG was investigated in 833 serum samples routinely collected from patients admitted to the university hospital in Frankfurt a. M., Germany (FFM) between 01.06.2008 and 31.12.2010. After determination of overall seroprevalence, we tested serum samples from patients diagnosed with acute elevation of liver enzymes (AELE), psychiatric (PSYCH), infectiological patients and serum samples from the red-cross blood donor service in FFM for anti-HEV-IgG using an ELISA. Between 01.06.2008 and 31.12.2010, 833 serum samples were analyzed for anti-HEV-IgG using an ELISA. We observed an overall seroprevalence of anti-HEV-IgG of 11.2% (95%CI: 9.6-13.2). Significantly higher rate of seropositivity was found in the group of PSYCH (26.0%; 95%CI: 14.63-40.34) and AELE (30.0%; 95%CI: 17.86-44.61). Overall seroprevalence of anti-HEV-IgG in FFM is higher than in Germany on average. The group of AELE and PSYCH shows significantly more often marker of HEV infections than other groups in our collective. PMID:22006172

  14. Profiles of Personal Resiliency in Child and Adolescent Psychiatric Inpatients

    ERIC Educational Resources Information Center

    Kumar, Geetha; Steer, Robert A.; Gulab, Nazli A.

    2010-01-01

    To ascertain whether children and adolescents whose ages ranged from 9 to 17 years described distinct profiles of personal resiliency, the Resiliency Scales for Children and Adolescents (RSCA) were administered to 100 youth who were admitted to an inpatient psychiatric unit and were diagnosed with various "DSM-IV-TR" disorders along with the Beck…

  15. Psychiatric Inpatient Admissions of Adults with Intellectual Disabilities: Predictive Factors

    ERIC Educational Resources Information Center

    Cowley, Amy; Newton, Jonathan; Sturmey, Peter; Bouras, Nick; Holt, Geraldine

    2005-01-01

    Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples…

  16. Psychiatric symptoms and an anterior cranial fossa meningioma.

    PubMed

    Hutchinson, G; Austin, H; Neehall, J E

    1998-09-01

    We present a case of a patient admitted to a psychiatric hospital with psychotic symptoms and cognitive impairment but who was subsequently found to have an anterior interhemispheric falx meningioma. There must be a high index of suspicion for organic brain disease in patients over age 45 years presenting with psychotic symptoms and seizures for the first time.

  17. [Dual diagnosis in psychiatric inpatients: prevalence and general characteristics].

    PubMed

    Rodríguez-Jiménez, Roberto; Aragüés, María; Jiménez-Arriero, Miguel Angel; Ponce, Guillermo; Muñoz, Antonio; Bagney, Alexandra; Hoenicka, Janet; Palomo, Tomás

    2008-06-01

    Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. It is of great relevance due to its important clinical consequences and costs of care. There are practically no published studies on dual diagnosis prevalence in patients admitted to psychiatric hospitalization units in general hospitals (PHUGH) in our country. The objectives were to estimate the prevalence of dual diagnosis in psychiatric inpatients admitted consecutively to a Psychiatric Hospitalization Unit (Hospital Universitario 12 de Octubre, Madrid, Spain) in one year, to compare clinical and sociodemographic variables between the dual diagnosis group (DD group) and the group with a psychiatric disorder but no SUD (PD group), and to study the types of substances used. This is a retrospective study, based on the review of the clinical charts of the 257 patients admitted to this PHUGH in one year. The results showed that, excluding nicotine dependence, 24.9% of our inpatients had a SUD as well as another psychiatric disorder. A statistically significant predominance of men was found in the DD group, as well as a younger age at the time of the study, at the beginning of their psychiatric attention and on their first psychiatric admission, and they had received diagnoses of schizophrenia or related psychoses more often than the PD group, who had mostly affective disorders. The substances most frequently used in the DD group were alcohol (78.1%), cannabis (62.5%), and cocaine (51.6%). Due to the high prevalence and repercussions of dual diagnosis, it would be advisable to have specialized therapeutic programs for its treatment. PMID:18717266

  18. Use of Inpatient Psychiatric Services by Children and Youth under Age 18, United States, 1980. Mental Health Statistical Note No. 175.

    ERIC Educational Resources Information Center

    Milazzo-Sayre, Laura J.; And Others

    The report examines data from three sample surveys of admissions during 1980 to the inpatient psychiatric services of state and mental hospitals and private psychiatric hospitals and the separate inpatient psychiatric services of non-federal general hospitals. Findings revealed that an estimated 81,532 persons under 18 years were admitted to…

  19. Children's Motives for Admitting to Prosocial Behavior

    PubMed Central

    Watanabe, Yayoi; Lee, Kayo

    2016-01-01

    There has been extensive research on children's moral evaluation of lying in prosocial situations. Current knowledge regarding the concept of lying has been derived from studies showing that cultural differences exist, whereby non-Western children tend to rate lie telling more positively than Western children do. These findings suggest that there are different views about whether children should publicize their prosocial behaviors and that children have universal motives when they admit to engaging in prosocial behavior. A gender difference has also been found in relation to prosocial behavior. However, previous studies did not investigate in detail children's motives for admission or non-admission to prosocial behavior, and if there is a gender difference. Therefore, this study examined the diversity in and development of motives for admitting or not admitting to engaging in prosocial behavior, with the aim of clarifying these behaviors as a function of children's grade level in school, and how such motives differ with age and gender. Questionnaires from 1345 elementary and junior high school students in Japan were analyzed. Results showed that children's communication tendency with regard to prosocial behavior reports peaked in the fourth grade of elementary school and gradually decreased thereafter. From the third grade of elementary school onwards, children reported that they refrained from admitting prosocial behaviors. Younger children more likely cited honesty as a crucial motive for admitting to prosocial behaviors. Girls were more likely to endorse honesty as a motive than boys were. Moreover, among younger children, girls feared others' negative evaluation and wanted to comply with modesty norms when not admitting. Further research is needed to examine the developmental process for motives behind prosocial behaviors. PMID:26925025

  20. Diversion from custody. I: Psychiatric assessment at the magistrates' court.

    PubMed

    Joseph, P L; Potter, M

    1993-03-01

    The homeless mentally disordered defendant facing minor charges poses considerable problems regarding appropriate disposal. Psychiatric assessment may be required in order to facilitate the court's decision, but this is often available only after remand in custody. A psychiatric assessment service based at two inner-London magistrates' courts is described. Over 18 months, 201 defendants were referred. They were predominantly male, single, and of no fixed abode, suffering from serious psychiatric disorder; these defendants had often received previous in-patient treatment, frequently as detained patients. They typically were recidivists charged with minor offences. Following initial assessment, 25% were admitted to hospital, 50% were released, and 25% returned to custody. The Crown Prosecution Service discontinued 29% of cases. For those admitted directly to hospital, the mean (s.d.) time from arrest to hospital admission was 5.8 (6.8) days, significantly quicker than with prison-based assessments.

  1. A profile of middle-aged and older adults admitted to nursing homes: 2000-2008.

    PubMed

    Miller, Nancy A; Pinet-Peralta, Luis M; Elder, Keith T

    2012-01-01

    Middle-aged adults are becoming an increasing share of the nursing home population. Minimum Data Set assessment data for 2000 and 2008 are used to explore similarities and differences in sociodemographic, residential, medical, and psychiatric characteristics of newly admitted middle-aged adults (31-64) compared to their older counterparts (65+). Relative to their share of the state population, Black middle-aged adults are overrepresented in nursing homes across 45 states and the District of Columbia. Chronic conditions, including diabetes, renal failure, chronic obstructive pulmonary disease, asthma, and circulatory/heart disorders, appeared to contribute to the increasing presence of middle-aged adults. There were substantial increases in diagnoses of psychiatric disorders at admission; psychiatric diagnoses were significantly higher among middle-aged adults. Middle-aged adults were also more likely to have residential histories of prior stays in psychiatric facilities relative to older adults. States' rebalancing efforts need to attend to the increasing presence of disability associated with chronic medical and psychiatric conditions among middle-aged adults. PMID:22720887

  2. Impact of the Syrian Crisis on the Hospitalization of Syrians in a Psychiatric Setting.

    PubMed

    Lama, Souaiby; François, Kazour; Marwan, Zoghbi; Sami, Richa

    2016-01-01

    Determine the impact of the Syrian crisis on the hospitalization of Syrians in a psychiatric setting. All Syrians admitted to a psychiatric hospital in Lebanon between the 1st of January 2009 and the 31st of December 2013 were included. Number of admissions, psychiatric disorders and demographic and clinical data relative to patients were compared between those admitted before and after the crisis. 44 patients were admitted before the crisis and 106 after it. The distribution of diagnosis varied significantly after the crisis (p = 0.056) with the majority of patients being admitted for schizophrenia (37.7 %). The prevalence of suicidal ideation was higher after the crisis (p = 0.03) but suicidal attempts, need for electroconvulsive therapy and length of hospitalization did not differ significantly between both groups. Clinicians should be aware of the possible burden of mental illness in Syrians after the beginning of the Syrian crisis.

  3. ADMIT: The ALMA Data Mining Toolkit

    NASA Astrophysics Data System (ADS)

    Teuben, P.; Pound, M.; Mundy, L.; Rauch, K.; Friedel, D.; Looney, L.; Xu, L.; Kern, J.

    2015-09-01

    ADMIT (ALMA Data Mining ToolkiT), a toolkit for the creation of new science products from ALMA data, is being developed as an ALMA Development Project. It is written in Python and, while specifically targeted for a uniform analysis of the ALMA science products that come out of the ALMA pipeline, it is designed to be generally applicable to (radio) astronomical data. It first provides users with a detailed view of their science products created by ADMIT inside the ALMA pipeline: line identifications, line ‘cutout' cubes, moment maps, emission type analysis (e.g., feature detection). Using descriptor vectors the ALMA data archive is enriched with useful information to make archive data mining possible. Users can also opt to download the (small) ADMIT pipeline product, then fine-tune and re-run the pipeline and inspect their hopefully improved data. By running many projects in a parallel fashion, data mining between many astronomical sources and line transitions will also be possible. Future implementations of ADMIT may include EVLA and other instruments.

  4. Acute cocaine-related health problems in patients presenting to an urban emergency department in Switzerland: a case series

    PubMed Central

    2014-01-01

    Background Emergency departments may be a useful information source to describe the demographics and clinical characteristics of patients with acute cocaine-related medical problems. We therefore conducted a retrospective analysis of 165 acute, laboratory-confirmed cocaine intoxications admitted to an urban emergency department in Switzerland between January 2007 and March 2011. Results A total of 165 patients with a mean age of 32 years were included. Most patients were male (73%) and unemployed (65%). Only a minority (16%) had abused cocaine alone while 84% of the patients had used at least one additional substance, most commonly ethanol (41%), opioids (38%), or cannabis (36%) as confirmed by their detection in blood samples. The most frequently reported symptoms were chest pain (21%), palpitations (19%), anxiety (36%) and restlessness (36%). Psychiatric symptoms were present in 64%. Hypertension and tachycardia were observed in 53% and 44% of the patients, respectively. Severe poisonings only occurred in patients with multiple substance intoxication (15%). Severe intoxications were non-significantly more frequent with injected drug use compared to nasal, oral, or inhalational drug use. Severe complications included acute myocardial infarction (2 cases), stroke (one case), and seizures (3 cases). Most patients (75%) were discharged home within 24 h after admission. A psychiatric evaluation in the ED was performed in 24% of the patients and 19% were referred to a psychiatric clinic. Conclusions Patients with acute cocaine intoxication often used cocaine together with ethanol and opioids and presented with sympathomimetic toxicity and/or psychiatric disorders. Severe acute toxicity was more frequent with multiple substance use. Toxicity was typically short-lasting but psychiatric evaluation and referral was often needed. PMID:24666782

  5. Predictors of PTSD symptoms in adults admitted to a Level I trauma center: a prospective analysis.

    PubMed

    Powers, Mark B; Warren, Ann Marie; Rosenfield, David; Roden-Foreman, Kenleigh; Bennett, Monica; Reynolds, Megan C; Davis, Michelle L; Foreman, Michael L; Petrey, Laura B; Smits, Jasper A J

    2014-04-01

    Trauma centers are an ideal point of intervention in efforts to prevent posttraumatic stress disorder (PTSD). In order to assist in the development of prevention efforts, this study sought to identify early predictors of PTSD symptoms among adults admitted to a Level I trauma center using a novel analytic strategy (Fournier et al., 2009). Upon admission, participants (N=327) were screened for PTSD symptoms and provided information on potential predictor variables. Their PTSD symptoms were assessed again 3 months later (N=227). Participants were classified as symptomatic (positive PTSD screen) or asymptomatic (negative PTSD screen) at the follow-up assessment. Multinomial logistic regression showed that age, depression, number of premorbid psychiatric disorders, gunshot wound, auto vs. pedestrian injury, and alcohol use predicted who had PTSD symptoms at FU with 76.3% accuracy. However, when controlling for PTSD severity at baseline, only age, number of premorbid psychiatric disorders, and gunshot wounds predicted PTSD symptoms at FU but with 78.5% accuracy. These findings suggest that psychological prevention efforts in trauma centers may be best directed toward adults who are young, have premorbid psychiatric disorders, and those admitted with gunshot wounds.

  6. Psychiatric morbidity in prisoners

    PubMed Central

    Goyal, Sandeep Kumar; Singh, Paramjit; Gargi, Parshotam D.; Goyal, Samta; Garg, Aseem

    2011-01-01

    Context: The prevalence of psychiatric illness in correctional settings is significantly elevated, with higher than community rates reported for most mental disorders. Aims: (1) To examine the socio-demographic profile of convicted prisoners. (2) To evaluate the prevalence of psychiatric disorders in convicted prisoners. Materials and Methods: 500 convicts were assessed for psychiatric morbidity with the help of (a) Socio-demographic proforma, (b) Pareek Udai and Trivedi G's socio-economic status scale (rural) (household schedule), (c) Kuppuswamy's economic status scale (urban) and (d) Present State Examination (PSE). Results: 23.8% of the convicted prisoners were suffering from psychiatric illness excluding substance abuse. 56.4% of the prisoners had history of substance abuse / dependence prior to incarceration. Conclusions: The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of India and the burden of psychiatric illness in this vulnerable and marginalized population poses a serious challenge to psychiatrists. PMID:22135446

  7. The health-care environment on a locked psychiatric ward: an ethnographic study.

    PubMed

    Johansson, Inger M; Skärsäter, Ingela; Danielson, Ella

    2006-12-01

    Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.

  8. [On the admittance of forensic patients to general psychiatric wards].

    PubMed

    Schalast, N; Balten, A; Leygraf, N

    2003-03-01

    In Germany, due to an increasing number of "hospital order sentences," the capacities of forensic hospitals are exhausted. In the late 1990s,general psychiatric hospitals admitted a remarkable number of mentally disturbed offenders. In this study,data of 140 patients treated in general psychiatric hospitals in the German lower Rhine region are presented. These patients clearly differ from those treated in forensic hospitals. Approximately 60% of them suffer from schizophrenic psychosis. Only a few reveal a long antisocial background, a severe personality disorder, or a sexual offence as an index crime. Though the staff in the general psychiatric units often complain about the circumstances of patients' admittance to the hospitals, in about half of the cases they do not agree with a transferring of their patients to a forensic hospital. The results of this study are discussed in regard to general questions of organizing forensic psychiatric treatment.

  9. Psychiatric illness in the New Zealand Maori.

    PubMed

    Sachdev, P S

    1989-12-01

    This paper compares psychiatric illness in the contemporary Maori with that in the non-Maori New Zealander. The ethnic data available are all from secondary sources. The limitations of this and the problems of achieving a satisfactory definition of "a Maori" are discussed. The data suggest that the Maori have a slightly greater risk of psychiatric hospitalization than the non-Maori. First admission rates for schizophrenia are higher for the Maori, as are the readmission rates. First admission rates for major affective illness are roughly comparable in the two groups, and those for neuroses and neurotic depression are lower in the Maori. Rates of admission for alcohol abuse, alcohol dependence and personality disorders are much higher for the Maori male aged 20-40 years and this group is at greatest risk of psychiatric hospitalization. A larger proportion of Maori are admitted involuntarily, especially under the Criminal Justice Act. The median stay in hospital is not longer for the Maori but their re-admissions are more frequent. The Maori have shown an increase in first psychiatric admission rates since the 1950s, with rapid increases in the early 60s and the 80s. The rates for psychotic disorders have been relatively constant and the most significant changes have been for alcohol abuse, alcohol dependence and personality disorders. The author relates this historical change to socioeconomic and politico-cultural factors, particularly the stress of rapid urbanization. PMID:2610653

  10. Psychiatric comorbidity in alcoholics treated at an institution with both coerced and voluntary admission.

    PubMed

    Sallmén, B; Nilsson, L; Berglund, M

    1997-01-01

    Psychiatric comorbidity in alcoholics admitted to a rehabilitation center on either a voluntary or a coerced basis were studied. A group of 104 alcoholics (37 coerced and 35 voluntarily admitted men; and 21 coerced and ten voluntarily admitted women) with a mean age (SD) of 43 +/- 8 years were assessed by means of a Structural Clinical Interview in accordance with the Diagnostic and Statistical Manual (DSM)-III-R (SCID). The interview took place a mean of 7 days after admission. The frequencies of lifetime/current axis I psychiatric comorbidity (substance use disorders excluded) were 66 and 61%, respectively. Drug dependence was present in 41 and 39%, respectively, of the cases. Thirty-seven percent had a lifetime diagnosis, and 33% a current diagnosis of affective disorders, 27 and 23%, respectively, of anxiety disorders and 20 and 13%, respectively, of non-organic psychotic disorders. In a subsample of 20 subjects, depressive symptoms were found to be stable during the course of treatment. No differences in frequency of psychiatric comorbidity were found between coerced and voluntarily admitted patients (67 and 56%, respectively) or between men and women (65 and 52%, respectively). The combination of psychiatric comorbidity and drug dependence was overrepresented among the coerced patients (50 vs 16%). It was concluded that the frequencies of psychiatric comorbidity were high in the present group. The co-occurrence of alcohol dependence, drug dependence and psychiatric comorbidity was more frequent among subjects who were coercively treated.

  11. Association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic

    PubMed Central

    Hocagil, Hilal; Izci, Filiz; Hocagil, Abdullah Cüneyt; Findikli, Ebru; Korkmaz, Sevda; Koc, Merve Iris

    2016-01-01

    Background Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic. Methods This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients. Results Of the patients exposed to violence 63% (n=46) were female and 27% (n=27) were male. Of these patients, 68.5% (n=50) were married, 43.8% (n=25) were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41) were primary school, 21.9% (n=16) were high school, and 21.9% (n=16) were university graduates. Smoking and alcohol use rates were 54.8% (n=40) and 17.8% (n=13), respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57). In addition, anxiety scores were high in 42.5% (n=31) and moderate in 9.6% (n=7) of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13) of the patients and 19.2% (n=14) of the patients’ relatives. The correlation between sociodemographic characteristics and anxiety scores revealed that married patients had higher anxiety scores (P<0.01) and patients assaulted by their parents had lower anxiety scores (P<0.00). Conclusion A total of 63% of the violence-exposed patients admitted to emergency room were females, 56.2% were primary school graduates, and 43.8% were factory workers; this result shows that low socioeconomical status and education level affect exposure to trauma especially in females. In addition, ~20% of the patients and patients’ relatives had a psychiatric disorder and 53.4% of perpetrators

  12. [History of psychiatric care].

    PubMed

    Häfner, H

    2006-01-01

    The lecture incorporates stages of the Ettelbruck jubilee-hospital into european psychiatric history of the two last centuries. Beginning with social exclusion in the sense of a Michel Foucauld ("Central Hospice"), then turning into a typical large psychiatric hospital the CHNP is nowadays a specialized clinic with national tasks within the network of mental health community care. Milestones of this evolution are: the isolation theory of the 19th and beginning of the 20th centuries; eugenics and euthanasia on patients in Nazi-Germany; the second psychiatric revolution after World War 2 and it's impact in Luxembourg.

  13. [Anticonvulsants treatment of psychiatric disorder in elderly patients].

    PubMed

    Bidzan, Leszek

    2006-01-01

    Agents introduced for the treatment of epilepsy have also been usedsimultaneously for psychiatric indications. The therapeutic effects of anticonvulsants are recognized in many psychiatric disorders. Growing literature suggests that anticonvulsant medication have efficacy in treating acute mania, bipolar disorder, psychotic disorders, behavioral disturbances especially agitation and impulsive aggression and anxiety, alcohol withdrawal and dependence. However, study of anticonvulsants among elderly patients has been limited. Further research in the field of psychogeriatry is needed to clarify the efficacy and tolerance of anticonvulsants. PMID:17203814

  14. Psychiatric hospitalization in Poland.

    PubMed

    Frydman, L

    1983-01-01

    An overview of psychiatric hospitalization in Poland is presented in the context of Polish political and socio-cultural developments. The areas addressed include: the characteristics of the patient population; the organization of Polish mental health service; the nature of psychiatric treatment; psychiatric legislation; patients' rights; and the training and social status of the various mental health professionals. In spite of the meager resources allocated to mental health services, and the consequent staff shortages and overcrowded, drab living conditions in psychiatric facilities, the care afforded patients is generally humane and nonoppressive. Polish psychiatry has succeeded in maintaining its professional autonomy and has assumed a leadership role in the modernization of its service delivery system.

  15. Neuroinflammation and psychiatric illness

    PubMed Central

    2013-01-01

    Multiple lines of evidence support the pathogenic role of neuroinflammation in psychiatric illness. While systemic autoimmune diseases are well-documented causes of neuropsychiatric disorders, synaptic autoimmune encephalitides with psychotic symptoms often go under-recognized. Parallel to the link between psychiatric symptoms and autoimmunity in autoimmune diseases, neuroimmunological abnormalities occur in classical psychiatric disorders (for example, major depressive, bipolar, schizophrenia, and obsessive-compulsive disorders). Investigations into the pathophysiology of these conditions traditionally stressed dysregulation of the glutamatergic and monoaminergic systems, but the mechanisms causing these neurotransmitter abnormalities remained elusive. We review the link between autoimmunity and neuropsychiatric disorders, and the human and experimental evidence supporting the pathogenic role of neuroinflammation in selected classical psychiatric disorders. Understanding how psychosocial, genetic, immunological and neurotransmitter systems interact can reveal pathogenic clues and help target new preventive and symptomatic therapies. PMID:23547920

  16. Psychiatric testimony in Britain.

    PubMed

    Chiswick, D

    1989-01-01

    In the criminal-justice system psychiatric evidence may be relevant both before and after conviction. The scope of psychiatric testimony in the criminal courts has been more restricted in Britain than it has been elsewhere. It is generally confined to questions of fitness to plead, responsibility and disposal after conviction. A distinction must be made between matters of clinical psychiatry and those of moral culpability or legal competence. When psychiatric evidence strays from purely clinical questions there is an increased likelihood of misuse and abuse. Even when considering clinical issues there are factors of a non-clinical nature which may distort the type of evidence given. The implications of these matters for psychiatric witnesses are discussed. It is suggested that forensic psychiatrists are refining their role as expert witnesses.

  17. Comprehensive Psychiatric Evaluation

    MedlinePlus

    ... for Families Guide Skip breadcrumb navigation Comprehensive Psychiatric Evaluation Quick Links Facts For Families Guide Facts For ... Families Guide - Search No. 52; Updated November 2012 Evaluation by a child and adolescent psychiatrist is appropriate ...

  18. Psychiatric disorders and sleep issues.

    PubMed

    Sutton, Eliza L

    2014-09-01

    Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety.

  19. Risk factors associated with psychiatric readmission.

    PubMed

    Lorine, Kim; Goenjian, Haig; Kim, Soeun; Steinberg, Alan M; Schmidt, Kendall; Goenjian, Armen K

    2015-06-01

    The present study focused on identifying risk factors for early readmission of patients discharged from an urban community hospital. Retrospective chart reviews were conducted on 207 consecutive inpatient psychiatric admissions that included patients who were readmitted within 15 days, within 3 to 6 months, and not admitted for at least 12 months post-discharge. Findings indicated that a diagnosis of schizophrenia/schizoaffective disorder (OR = 18; 95% CI 2.70-117.7; p < 0.05), history of alcohol abuse (OR = 9; 95% CI 1.80-40.60; p < 0.05), number of previous psychiatric hospitalizations (OR = 2; 95% CI 1.28-3.73; p < 0.05), and type of residence at initial admission (e.g., homeless, OR = 29; 95% CI 3.99-217; p < 0.05) were significant risk factors for early readmission, where OR compares readmission group 1 versus group 3 in the multinomial logistic regression. Initial positive urine drug screen, history of drug abuse or incarceration, and legal status at initial admission did not predict early readmission. Reducing the risk factors associated with psychiatric readmissions has the potential to lead to the identification and development of preventative intervention strategies that can significantly improve patient safety, quality of care, well-being, and contain health care expenditures. PMID:25974053

  20. Substance abuse in an inpatient psychiatric sample.

    PubMed

    Brady, K; Casto, S; Lydiard, R B; Malcolm, R; Arana, G

    1991-01-01

    The relationship between psychoactive drug abuse and psychopathology is complex. There have been few systematic explorations of substance abuse in psychiatric populations since the recent epidemic of cocaine abuse. To update and further explore the relationship between psychiatric illness and substance abuse, 100 consecutively admitted patients to an inpatient psychiatry unit were administered a drug and alcohol use/abuse questionnaire. Sixty-four percent endorsed current or past problems with substance abuse and 29% met DSM-III-R criteria for substance abuse in the 30 days prior to admission. For the major diagnostic categories, there were no significant differences between groups in percentages of patients with substance abuse disorders. There was a trend (p less than or equal to .2) toward an increased number of lifetime psychiatric hospitalizations in the substance-abusing group. Alcohol was the most common drug of choice followed by stimulants, cannabis, and sedative hypnotics. Differences in drug choices between diagnostic categories are discussed. Forty-three percent of urine drug screens obtained were positive, and of those with positive urine drug screens, 42% denied drug use upon admission. Only 40% of patients with current or past substance abuse problems had received treatment for their chemical dependency. In our sample, while substance abuse was very prevalent, it was underreported and undertreated.

  1. Should psychiatric patients be granted access to their hospital records?

    PubMed

    Sergeant, H

    1986-12-01

    Beginning in September 1987, the British public will have the right to consult their computerized medical records and by extension, it is expected, noncomputerized ones as well. The author analyzed the case notes of 100 consecutive patients admitted under his care to a psychiatric day hospital. He classified material likely to affect patients adversely as puzzling or unintelligible, alarming, apparently insulting or objectionable, or sensitive information from or about others. Sergeant rejects proposals to omit sensitive material, to keep secret notes, or to grant access only to some psychiatric patients or to deny access to psychiatric patients as a class. Maintaining that there is no dividing line between somatic and psychological medicine, he concludes that access to personal health data for all patients should be limited to the disclosure of bare administrative details. Further information should be supplied within the traditional medical consultation.

  2. Equipercentile linking of the Brief Psychiatric Rating Scale and the Clinical Global Impression Scale in a catchment area.

    PubMed

    Leucht, Stefan; Engel, Rolf R; Davis, John M; Kissling, Werner; Meyer Zur Capellen, Katrin; Schmauß, Max; Messer, Thomas

    2012-07-01

    Recent analyses tried to explain the meaning of the Brief Psychiatric Rating Scale total score (BPRS) and its percentage change from baseline by equipercentile linking with the Clinical Global Impression Scale (CGI). A major limitation was that they were conducted in clinical trial populations limiting generalisability to 'real-world' patients. We therefore replicated the findings in a large sample covering patients admitted to a state hospital with a catchment area. BPRS and CGI ratings at admission (n=1772) and at discharge from all patients with schizophrenic disorders (ICD-10 F20.0-F20.9) admitted between 2005 and 2008 were compared using equipercentile linking. Being considered "mildly ill" according to the CGI severity score approximately corresponded to a BPRS total score of 25, "moderately ill" to a BPRS of 33-35, "markedly ill" to a BPRS of 50 and severely ill to a BPRS of 70. To be "minimally improved" according to the CGI change score was associated with a mean BPRS reduction of 13%; and "much improved" with 50% BPRS reduction. The linking functions were not identical, but overall comparable to those in previous randomised trial samples. The suggestion that a 50% BPRS reduction from baseline is a clinically meaningful definition of response in acutely ill patients was reinforced.

  3. Causally nonseparable processes admitting a causal model

    NASA Astrophysics Data System (ADS)

    Feix, Adrien; Araújo, Mateus; Brukner, Časlav

    2016-08-01

    A recent framework of quantum theory with no global causal order predicts the existence of ‘causally nonseparable’ processes. Some of these processes produce correlations incompatible with any causal order (they violate so-called ‘causal inequalities’ analogous to Bell inequalities) while others do not (they admit a ‘causal model’ analogous to a local model). Here we show for the first time that bipartite causally nonseparable processes with a causal model exist, and give evidence that they have no clear physical interpretation. We also provide an algorithm to generate processes of this kind and show that they have nonzero measure in the set of all processes. We demonstrate the existence of processes which stop violating causal inequalities but are still causally nonseparable when mixed with a certain amount of ‘white noise’. This is reminiscent of the behavior of Werner states in the context of entanglement and nonlocality. Finally, we provide numerical evidence for the existence of causally nonseparable processes which have a causal model even when extended with an entangled state shared among the parties.

  4. [Dichotomy of psychiatric and somatic emergency care; fundamental flaw should be addressed].

    PubMed

    Tuerlings, Joep H A M; Pelger, E C M Noor; de Pont, Boudewijn J H B; van Waarde, Jeroen A

    2015-01-01

    In the Netherlands, acute psychiatric care is characterised by mind-body dualism. For acute psychiatric patients, the first port of call is the general practitioner (GP); after-hour care is provided by the out-of-hours GP service. In contrast to patients with other medical illnesses, the out-of-hours GP service does not usually refer patients with acute psychiatric issues to the accident and emergency (A&E) department of the general hospital, but to the local ambulant psychiatric 'crisis' service. However, some of these patients still end up at the A&E department, as our three cases demonstrate. Integration of the out-of-hours GP service, A&E and acute psychiatric care, therefore, would enable elimination of the current partitioning of somatic and psychiatric medicine in acute emergency care. This solution would not only improve acute emergency care, but would also ensure a targeted and efficient implementation of services and might even lead to a decreased stigmatisation of psychiatric patients in general. PMID:26230348

  5. Aggressive behaviors in the psychiatric emergency service

    PubMed Central

    Chaput, Yves; Beaulieu, Lucie; Paradis, Michel; Labonté, Edith

    2011-01-01

    Introduction: Studies of aggressive behaviors in a nonforensic mental health setting have focused primarily on the inpatient ward and, on event prediction, using behavior-based clinical rating scales. Few studies have specifically targeted aggressive behaviors in the psychiatric emergency service or determined whether assessing the demographic and clinical characteristics of such patients might prove useful for their more rapid identification. Methods: We used a prospectively acquired database of over 20,900 visits to four services in the province of Quebec, Canada, over a two-year period from September 2002 onwards. A maximum of 72 variables could be acquired per visit. Visits with aggression (any verbally or physically intimidating behavior), both present and past, were tagged. Binary logistic regressions and cross-tabulations were used to determine whether the profile of a variable differed in visits with aggression from those without aggression. Results: About 7% of visits were marked by current aggression (verbal 49%, physical 12%, verbal and physical 39%). Including visits with a “past only” history of aggression increased this number to 20%. Variables associated with aggression were gender (male), marital status (single/separated), education (high school or less), employment (none), judicial history (any type), substance abuse (prior or active), medication compliance (poor), type of arrival to psychiatric emergency services (involuntary, police, judiciary, landlord), reason for referral (behavioral dyscontrol), diagnosis (less frequent in anxiety disorders), and outcome (more frequently placed under observation or admitted). Conclusion: Our results suggest that many state-independent variables are associated with aggressive behaviors in the psychiatric emergency service. Although their sum may not add up to a specific patient profile, they can nevertheless be useful in service planning, being easily integrated alongside state-dependent rating scales in a

  6. Length of stay and hospital costs among patients admitted to hospital by family physicians

    PubMed Central

    Wen, Chuck K.; Chambers, Catharine; Fang, Dianne; Mazowita, Garey; Hwang, Stephen W.

    2012-01-01

    Abstract Objective To compare length of stay and total hospital costs among patients admitted to hospital under the care of family physicians who were their usual health care providers in the community (group A) and patients admitted to the same inpatient service under the care of family physicians who were not their usual health care providers (group B). Design Retrospective observational study. Setting A large urban hospital in Vancouver, BC. Participants All adult admissions to the family practice inpatient service between April 1, 2006, and June 30, 2008. Main outcome measures Ratio of length of stay to expected length of stay and total hospital costs per resource intensity weight unit. Multivariate linear regression was performed to determine the effect of admitting group (group A vs group B) on the natural logarithm transformations of the outcomes. Results The median acute length of stay was 8.0 days (interquartile range [IQR] 4.0 to 13.0 days) for group A admissions and 8.0 days (IQR 4.0 to 15.0 days) for group B admissions. The median (IQR) total hospital costs were $6498 ($4035 to $11 313) for group A admissions and $6798 ($4040 to $12 713) for group B admissions. After adjustment for patient characteristics, patients admitted to hospital under the care of their own family physicians did not significantly differ in terms of acute length of stay to expected length of stay ratio (percent change 0.6%, P = .942) or total hospital costs per resource intensity weight unit (percent change −2.0%, P = .722) compared with patients admitted under the care of other family physicians. Conclusion These findings suggest that having networks of family physicians involved in hospital care for patients is not less efficient than having family physicians provide care for their own patients. PMID:22518905

  7. Transporting Forensic Psychiatric Patients.

    PubMed

    Dike, Charles C; Nicholson, Elizabeth; Young, John L

    2015-12-01

    Patients in a forensic psychiatric facility often require escorted transport to medical facilities for investigations or treatments of physical health ailments. Transporting these patients presents significant safety and custody challenges because of the nature of patients housed in forensic psychiatric facilities. A significant proportion of these patients may be transfers from the Department of Corrections (DOC) under legal mandates for psychiatric evaluation and treatment better provided in a hospital setting, and most of them will return to the DOC. Although departments of correction have protocols for escorting these potentially dangerous individuals, it is unclear whether receiving psychiatric hospitals have established procedures for maintaining the safety of others and custody of these individuals during transportation outside the hospital facility. The literature is sparse on precautions to be observed when transporting dangerous forensic psychiatric patients, including those with high escape risk. In this article, we describe one forensic inpatient facility's procedure for determining the appropriate level needed to transport these individuals outside of the forensic facility. We also describe the risk assessment procedure for determining level of transport. These are quality improvement measures resulting from a critical review of an incident of escape from the forensic facility several years ago.

  8. Transporting Forensic Psychiatric Patients.

    PubMed

    Dike, Charles C; Nicholson, Elizabeth; Young, John L

    2015-12-01

    Patients in a forensic psychiatric facility often require escorted transport to medical facilities for investigations or treatments of physical health ailments. Transporting these patients presents significant safety and custody challenges because of the nature of patients housed in forensic psychiatric facilities. A significant proportion of these patients may be transfers from the Department of Corrections (DOC) under legal mandates for psychiatric evaluation and treatment better provided in a hospital setting, and most of them will return to the DOC. Although departments of correction have protocols for escorting these potentially dangerous individuals, it is unclear whether receiving psychiatric hospitals have established procedures for maintaining the safety of others and custody of these individuals during transportation outside the hospital facility. The literature is sparse on precautions to be observed when transporting dangerous forensic psychiatric patients, including those with high escape risk. In this article, we describe one forensic inpatient facility's procedure for determining the appropriate level needed to transport these individuals outside of the forensic facility. We also describe the risk assessment procedure for determining level of transport. These are quality improvement measures resulting from a critical review of an incident of escape from the forensic facility several years ago. PMID:26668224

  9. Pharmacogenomics in Psychiatric Practice.

    PubMed

    El-Mallakh, Rif S; Roberts, R Jeannie; El-Mallakh, Peggy L; Findlay, Lillian Jan; Reynolds, Kristen K

    2016-09-01

    Pharmacogenomic testing in psychiatry is becoming an established clinical procedure. Several vendors provide clinical interpretation of combinatorial pharmacogenomic testing of gene variants that have documented predictive implications regarding either pharmacologic response or adverse effects in depression and other psychiatric conditions. Such gene profiles have demonstrated improvements in outcome in depression, and reduction of cost of care of patients with inadequate clinical response. Additionally, several new gene variants are being studied to predict specific response in individuals. Many of these genes have demonstrated a role in the pathophysiology of depression or specific depressive symptoms. This article reviews the current state-of-the-art application of psychiatric pharmacogenomics. PMID:27514465

  10. Postoperative hospital course of patients with history of severe psychiatric illness.

    PubMed

    Solomon, S; McCartney, J R; Saravay, S M; Katz, E

    1987-09-01

    The postoperative hospital course of 54 patients with a past history of psychiatric illness was studied through chart review. Both chronic schizophrenics and chronic depressives tolerated surgical procedures well, without any unusual difficulties or exacerbation of psychiatric illness. They represented no management problems. Patients with acute, severe upset in the preoperative period (regardless of diagnosis) presented most of the management problems postoperatively. PMID:3678811

  11. Deprivation of liberty in psychiatric hospital care: the patient's perspective.

    PubMed

    Kuosmanen, Lauri; Hätönen, Heli; Malkavaara, Heikki; Kylmä, Jari; Välimäki, Maritta

    2007-09-01

    Deprivation of liberty in psychiatric hospitals is common world-wide. The aim of this study was to find out whether patients had experienced deprivation of their liberty during psychiatric hospitalization and to explore their views about it. Patients (n = 51) in two acute psychiatric inpatient wards were interviewed in 2001. They were asked to describe in their own words their experiences of being deprived of their liberty. The data were analysed by inductive content analysis. The types of deprivation of liberty in psychiatric hospital care reported by these patients were: restrictions on leaving the ward and on communication, confiscation of property, and various coercive measures. The patients' experiences of being deprived of their liberty were negative, although some saw the rationale for using these interventions, considering them as part of hospital care.

  12. Psychiatric personnel, risk management and the new institutionalism.

    PubMed

    Hazelton, M

    1999-12-01

    This article reports the findings of a series of ethnographic research interviews conducted with psychiatric personnel in one region of Tasmania between 1995 and 1997. These interviews formed part of a more wide-ranging project examining changes in the regulatory practices of psychiatric personnel in the light of the professional, media and policy discourses that inform them, especially in relation to the impact of social justice reforms spelt out in recent Australian mental health policy. In discussing the nature of psychiatric work the personnel interviewed returned repeatedly to the themes of safety and risk management. The study presents an analysis of discourses deployed around these themes and argues that concerns over safety and risk are central to the emergence of a new institutionalism in acute in-patient psychiatric services.

  13. [The rights of psychiatric patients].

    PubMed

    Baudis, P

    1995-05-01

    The author gives a historical account of patient's rights and in particular the development of codes of rights of psychiatric patients during the past twenty years. He describes differences in attitudes to rights of psychiatric patients in different societies and the different emphasis on patient's rights, as compared with rights of society. Briefly the so far most elaborated account of rights of psychiatric patients submitted by the American Psychiatric Association is described.

  14. Pathological Gambling: Psychiatric Models

    ERIC Educational Resources Information Center

    Westphal, James R.

    2008-01-01

    Three psychiatric conceptual models: addictive, obsessive-compulsive spectrum and mood spectrum disorder have been proposed for pathological gambling. The objectives of this paper are to (1) evaluate the evidence base from the most recent reviews of each model, (2) update the evidence through 2007 and (3) summarize the status of the evidence for…

  15. Teaching psychiatric ethics.

    PubMed

    Bloch, S

    1988-11-01

    In the last decade, we have witnessed a burgeoning of interest in ethical issues amongst psychiatrists. Teaching of the subject, however, remains at a rudimentary stage. Various approaches to such instruction are available, particularly modelling (students observe their experienced counterpart), the case method (examining specific clinical situations which involve a need for ethical decision-making), and the seminar approach (trainees are exposed to a core body of knowledge, mainly theoretical in nature). Faced with these different teaching models, the University of Oxford Department of Psychiatry has opted for a blend of all three approaches, which incorporates two goals: an increase in the trainees' sensitivity to the many intricate moral dilemmas facing the psychiatric profession; and their familiarity with salient concepts in moral philosophy which constitute a basis for ethical reasoning and which have a bearing on clinical practice. The teaching programme comprises the following: a pair of trainees prepares a presentation on an aspect of psychiatric ethics under the supervision of a senior psychiatrist. A moral philosopher assumes the role of discussant of the ethical problems raised by the trainees; this is followed by a general discussion. Topics have included involuntary hospitalization, dual loyalty, suicide, psychiatric diagnosis, and ethical issues in various spheres of psychiatric practice such as sex therapy, psychotherapy and child psychiatry. The approach has worked effectively and proved rewarding to all participants involved. PMID:3226351

  16. Psychiatric Morbidity Following Neurocysticercosis

    PubMed Central

    Mishra, B.N.; Swain, S.P.

    2004-01-01

    A Case of cerebral neurocysticercosis reported with manic episode on first presentation which was confirmed after CT scan of Brain. Psychiatric manifestation showed a gradual decline following treatment with medication. Normal social and occupational functioning was ensured by prolonged treatment with Mood Stabilizer. PMID:21224909

  17. 27 CFR 71.65 - Answer admitting facts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Answer admitting facts. 71... Hearing Procedure Answers § 71.65 Answer admitting facts. If the respondent desires to waive the hearing on the allegations of fact set forth in the order to show cause, and does not contest the facts,...

  18. 27 CFR 71.65 - Answer admitting facts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Answer admitting facts. 71... Hearing Procedure Answers § 71.65 Answer admitting facts. If the respondent desires to waive the hearing on the allegations of fact set forth in the order to show cause, and does not contest the facts,...

  19. Ethical issues in psychiatric research.

    PubMed

    Barry, Liliana Kalogjera

    2009-06-01

    The field of psychiatric research ethics has evolved in recent years. This evolution seems to stem from the efforts of various groups (eg, medical ethicists, regulatory bodies, and the profession's own association, the APA) and from increased understanding of the endeavor of psychiatric empirical research. Current data regarding mental illness highlight the need for the continued expansion of psychiatric research to help relieve the suffering of the many individuals whom mental illness affects. The ethics for psychiatric research should parallel this expansion of psychiatric research to ensure that studies sufficiently address ethical considerations and thus foster the proper, delicate balance between progress and protection (see Table 1).

  20. Psychiatric adverse effects of pediatric corticosteroid use.

    PubMed

    Drozdowicz, Linda B; Bostwick, J Michael

    2014-06-01

    Corticosteroids, highly effective drugs for myriad disease states, have considerable neuropsychiatric adverse effects that can manifest in cognitive disorders, behavioral changes, and frank psychiatric disease. Recent reviews have summarized these effects in adults, but a comprehensive review on corticosteroid effects in children has not been published since 2005. Here, we systematically review articles published since then that, we find, naturally divide into 3 main areas: (1) chronic effects of acute prenatal and neonatal exposure associated with prematurity and congenital conditions; (2) immediate behavioral effects of acute exposure via oncological protocols; and (3) acute behavioral effects of sporadic use in children and adolescents with other conditions. PsycInfo, MEDLINE, Embase, and Scopus were queried to identify articles reporting psychiatric adverse effects of corticosteroids in pediatric patients. Search terms included corticosteroids, adrenal cortex hormones, steroid psychosis, substance-induced psychoses, glucocorticoids, dexamethasone, hydrocortisone, prednisone, adverse effects, mood disorders, mental disorders, psychosis, psychotic, psychoses, side effect, chemically induced, emotions, affective symptoms, toxicity, behavior, behavioral symptoms, infant, child, adolescent, pediatric, paediatric, neonatal, children, teen, and teenager. Following guidelines for systematic reviews from the Potsdam Consultation on Meta-Analysis, we have found it difficult to draw specific conclusions that are more than general impressions owing to the quality of the available studies. We find a mixed picture with neonates exposed to dexamethasone, with some articles reporting eventual deficits in neuropsychiatric functioning and others reporting no effect. In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions

  1. The characteristics of patients frequently admitted to academic medical centers in the United States

    PubMed Central

    Williams, Mark V.; Carrier, Danielle; Hensley, Laurie; Thomas, Stephen; Cerese, Julie

    2015-01-01

    BACKGROUND The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishing characteristics that require novel solutions. METHODS A comprehensive administrative database (University HealthSystem Consortium's Clinical Data Base/Resource Manager™) was analyzed to identify demographic, social, and clinical characteristics of frequently admitted patients in 101 US academic medical centers. RESULTS We studied 28,291 frequently admitted patients with 180,185 admissions over a 1‐year period (2011–2012). These patients comprise 1.6% of all patients, but account for 8% of all admissions and 7% of direct costs. Their admissions are driven by multiple chronic conditions; compared to other hospitalized patients, they have significantly more comorbidities (an average of 7.1 vs 2.5), and 84% of their admissions are to medical services. A minority, but significantly more than other patients, have comorbidities of psychosis or substance abuse. Moreover, although they are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% vs 21.6%), nearly three‐quarters have private or Medicare coverage. CONCLUSIONS Patients who are frequently admitted to US academic medical centers are likely to have multiple complex chronic conditions and may have behavioral comorbidities that mediate their health behaviors, resulting in acute episodes requiring hospitalization. This information can be used to identify solutions for preventing repeat hospitalization for this small group of patients who consume a highly disproportionate share of healthcare resources. Journal of Hospital Medicine 2015;10:563–568. © 2015 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital

  2. [Tinnitus and psychiatric comorbidities].

    PubMed

    Goebel, G

    2015-04-01

    Tinnitus is an auditory phantom phenomenon characterized by the sensation of sounds without objectively identifiable sound sources. To date, its causes are not well understood. The perceived severity of tinnitus correlates more closely to psychological and general health factors than to audiometric parameters. Together with limbic structures in the ventral striatum, the prefrontal cortex forms an internal "noise cancelling system", which normally helps to block out unpleasant sounds, including the tinnitus signal. If this pathway is compromised, chronic tinnitus results. Patients with chronic tinnitus show increased functional connectivity in corticolimbic pathways. Psychiatric comorbidities are common in patients who seek help for tinnitus or hyperacusis. Clinicians need valid screening tools in order to identify patients with psychiatric disorders and to tailor treatment in a multidisciplinary setting.

  3. The Use of the Addiction Severity Index Psychiatric Composite Scores to Predict Psychiatric Inpatient Admissions.

    PubMed

    Drymalski, Walter M; Nunley, Michael R

    2016-01-01

    The high prevalence of co-occurring mental health and substance use disorders indicates a need for integrated behavioral health treatment that addresses both types of disorder simultaneously. One component of this integrated treatment is the use of an assessment process that can concurrently identify the presence of each class of disorder. The Addiction Severity Index (ASI) has been extensively used and researched in the field of substance use disorders for over 30 years. The ASI has seven sections, including a section on substance use disorders and a section on psychiatric symptoms, making it a potential candidate for a co-occurring screen during intake. The following study utilized a receiver operating characteristic curve analysis to determine an optimal cutoff score on the ASI psychiatric composite score to identify which individuals seeking substance use disorder treatment were admitted to the Milwaukee County Behavioral Health Division's psychiatric hospital in the year subsequent to their ASI administration. Of the 19,320 individuals who completed an initial ASI in our system, 343 had an inpatient admission. The receiver operating characteristic curve was statistically significant, with an area under the curve of 0.75. A cutoff of 0.27 had a sensitivity of 0.77 and a specificity of 0.61, such that over 60% (11,963/19,320) of the sample was excluded. These results suggest that the ASI psychiatric composite score may be a useful initial screen to identify those with potential mental health problems/needs in a behavioral health system attempting to integrate addiction and mental health services. PMID:27580192

  4. The Use of the Addiction Severity Index Psychiatric Composite Scores to Predict Psychiatric Inpatient Admissions.

    PubMed

    Drymalski, Walter M; Nunley, Michael R

    2016-01-01

    The high prevalence of co-occurring mental health and substance use disorders indicates a need for integrated behavioral health treatment that addresses both types of disorder simultaneously. One component of this integrated treatment is the use of an assessment process that can concurrently identify the presence of each class of disorder. The Addiction Severity Index (ASI) has been extensively used and researched in the field of substance use disorders for over 30 years. The ASI has seven sections, including a section on substance use disorders and a section on psychiatric symptoms, making it a potential candidate for a co-occurring screen during intake. The following study utilized a receiver operating characteristic curve analysis to determine an optimal cutoff score on the ASI psychiatric composite score to identify which individuals seeking substance use disorder treatment were admitted to the Milwaukee County Behavioral Health Division's psychiatric hospital in the year subsequent to their ASI administration. Of the 19,320 individuals who completed an initial ASI in our system, 343 had an inpatient admission. The receiver operating characteristic curve was statistically significant, with an area under the curve of 0.75. A cutoff of 0.27 had a sensitivity of 0.77 and a specificity of 0.61, such that over 60% (11,963/19,320) of the sample was excluded. These results suggest that the ASI psychiatric composite score may be a useful initial screen to identify those with potential mental health problems/needs in a behavioral health system attempting to integrate addiction and mental health services.

  5. Culture and psychiatric diagnosis.

    PubMed

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan

    2013-01-01

    Since the publication of DSM-IV in 1994, neurobiologists and anthropologists have criticized the rigidity of its diagnostic criteria that appear to exclude whole classes of alternate illness presentations, as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis - composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress - as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning.

  6. A Fatal Case of Acute Butane-Propane Poisoning in a Prisoner Under Psychiatric Treatment: Do These 2 Factors Have an Arrhythmogenic Interaction, Thus Increasing the Cardiovascular Risk Profile?

    PubMed

    Gioia, Sara; Lancia, Massimo; Bacci, Mauro; Suadoni, Fabio

    2015-12-01

    Sudden death due to inhalation of aliphatic hydrocarbons such as butane and propane is well described in the literature. The main mechanism involved is the induction of a fatal cardiac arrhythmia. This phenomenon is frequently associated with prisoners who accidentally die while sniffing these volatile substances with an abuse purpose. Furthermore, such prisoners are often under psychiatric treatment; specific drugs belonging to this pharmacological class lead to a drug-related QT interval prolongation, setting the stage for torsade de pointes. In this article, we present the case of a prisoner died after sniffing a butane-propane gas mixture from a prefilled camping stove gas canister. The man was under psychiatric drugs due to mental disorders. He was constantly subjected to electrocardiogram to monitor the QTc (corrected QT interval), which was 460 milliseconds long. Toxicological analysis on cadaveric samples was performed by means of gas chromatography (head space) and revealed the presence of butane and propane at low levels. The aim of this article was to discuss a possible arrhythmogenic interaction of QT interval prolongation induced by psychiatric drugs and butane-propane inhalations, increasing the cardiovascular risk profile. In other words, evidence may suggest that prisoners, under these circumstances, are more likely to experience cardiovascular adverse effects. We believe that this study underlines the need to take this hypothesis into account to reduce death risk in prison and any medical-related responsibilities. Further studies are needed to validate the hypothesis.

  7. A Fatal Case of Acute Butane-Propane Poisoning in a Prisoner Under Psychiatric Treatment: Do These 2 Factors Have an Arrhythmogenic Interaction, Thus Increasing the Cardiovascular Risk Profile?

    PubMed

    Gioia, Sara; Lancia, Massimo; Bacci, Mauro; Suadoni, Fabio

    2015-12-01

    Sudden death due to inhalation of aliphatic hydrocarbons such as butane and propane is well described in the literature. The main mechanism involved is the induction of a fatal cardiac arrhythmia. This phenomenon is frequently associated with prisoners who accidentally die while sniffing these volatile substances with an abuse purpose. Furthermore, such prisoners are often under psychiatric treatment; specific drugs belonging to this pharmacological class lead to a drug-related QT interval prolongation, setting the stage for torsade de pointes. In this article, we present the case of a prisoner died after sniffing a butane-propane gas mixture from a prefilled camping stove gas canister. The man was under psychiatric drugs due to mental disorders. He was constantly subjected to electrocardiogram to monitor the QTc (corrected QT interval), which was 460 milliseconds long. Toxicological analysis on cadaveric samples was performed by means of gas chromatography (head space) and revealed the presence of butane and propane at low levels. The aim of this article was to discuss a possible arrhythmogenic interaction of QT interval prolongation induced by psychiatric drugs and butane-propane inhalations, increasing the cardiovascular risk profile. In other words, evidence may suggest that prisoners, under these circumstances, are more likely to experience cardiovascular adverse effects. We believe that this study underlines the need to take this hypothesis into account to reduce death risk in prison and any medical-related responsibilities. Further studies are needed to validate the hypothesis. PMID:26332645

  8. Psychiatric Patients Experiences with Mechanical Restraints: An Interview Study

    PubMed Central

    Lanthén, Klas; Rask, Mikael; Sunnqvist, Charlotta

    2015-01-01

    Objective. To examine psychiatric patients' experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients' experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable. PMID:26199931

  9. Short-term outcomes of sport- and recreation-related concussion in patients admitted to a pediatric trauma service.

    PubMed

    Bramley, Harry; Mcfarland, Carol; Lewis, Mechelle M; Shaffer, Michele L; Cilley, Robert; Engbrecht, Brett; Santos, Mary; Rzucidlo, Susan; Shirk, Beverly; Simmons, Lynn; Dias, Mark S

    2014-07-01

    The outcomes of patients admitted to the hospital following a sport-related concussion are largely unknown. Medical records of patients admitted to the pediatric trauma service between 2008 and 2011 after sustaining a sport-related concussion were reviewed. In all, 59 participants were in the high-velocity activities group, and 21 in the field or court sport group. Abnormal CT scans were found in 14 patients in the high-velocity group and 2 in the field or court sport group. The majority of participants in the field or court sport group were football players, all of whom had normal CT scans. Headache was predictive of an abnormal CT scan. Among the patients, 56% clinically improved and were discharged the following day. Patients with field or court sport-related concussion admitted to a pediatric trauma service appear to be at low risk for clinically significant intracranial pathology and do well in the acute setting.

  10. [Acute arsenic poisoning].

    PubMed

    Montelescaut, Etienne; Vermeersch, Véronique; Commandeur, Diane; Huynh, Sophie; Danguy des Deserts, Marc; Sapin, Jeanne; Ould-Ahmed, Mehdi; Drouillard, Isabelle

    2014-01-01

    Acute arsenic poisoning is a rare cause of suicide attempt. It causes a multiple organs failure caused by cardiogenic shock. We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment.

  11. [Acute arsenic poisoning].

    PubMed

    Montelescaut, Etienne; Vermeersch, Véronique; Commandeur, Diane; Huynh, Sophie; Danguy des Deserts, Marc; Sapin, Jeanne; Ould-Ahmed, Mehdi; Drouillard, Isabelle

    2014-01-01

    Acute arsenic poisoning is a rare cause of suicide attempt. It causes a multiple organs failure caused by cardiogenic shock. We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment. PMID:25486670

  12. Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy

    PubMed Central

    Weber, Ralph; Reimann, Gernot; Weimar, Christian; Winkler, Angela; Berger, Klaus; Nordmeyer, Hannes; Hadisurya, Jeffrie; Brassel, Friedhelm; Kitzrow, Martin; Krogias, Christos; Weber, Werner; Busch, Elmar W.; Eyding, Jens

    2015-01-01

    Background: After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated. Aims: We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit. Methods: Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients. Results: In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0–2, 44.0% versus 35.7%, p = 0.08). Conclusions: Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging. PMID:27006695

  13. Psychiatric UR worksheet.

    PubMed

    Barnes, H

    1988-01-01

    This worksheet was developed in response to an ever increasing number and intensity of admission and concurrent telephone reviews conducted by third and fourth-party payors. This worksheet was developed as an aid in information gathering for subsequent telephone and other reviews. The left-margin headings evolved from queries for information from the most demanding psychiatric nurse reviewers. When I have fully addressed all the information in my review, it is usually no problem in obtaining certification for admission or continued stay for the patient.

  14. Forensic psychiatric examinations: competency.

    PubMed

    Koson, D F

    1982-01-01

    The many definitions of competency in civil, criminal, and domestic relations law are discussed with emphasis on the various legal criteria for competency and the different classes of psychiatric information required to apply the criteria to a given case. Within the context of a general discussion of forensic examinations, techniques for gathering the right kind of information are systematically related to the exigencies of evaluating past, present, or future mental states by selectively altering the focus of mental status evaluations and history-taking. In addition, special investigative techniques such as hypnosis, Amytal sodium interview, stress interview, psychological testing, and others are discussed.

  15. 75 FR 71441 - Universal Health Services, Inc. and Psychiatric Solutions, Inc.; Analysis of Agreement Containing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-23

    ... facilities that would be eliminated by the proposed acquisition. In each of the local markets, consumers have... operating in three local acute inpatient psychiatric care markets to acquirers who receive the approval of... removing an actual, direct, and substantial competitor from three local markets for acute...

  16. [Psychiatric dossier and firing.].

    PubMed

    Beau, R

    1985-01-01

    This article is part of a general outline on the Psychiatry of Work, and with the help of case histories, looks upon a sector not well researched in the literature: the direct or indirect use of the psychiatric file in the firing of an employee. The first case presents a patient known as such, who had become too ill to reintegrate his job and who needed help having his fundamental rights recognized. In the second case, the employer, on the strength of a psychiatric evaluation he himself had ordered, fired an employee, invoquing a refusal on his part to accept treatment. Testimonies revealed afterwards that abnormal pressures were used on this employee. The author concludes that in similar cases, caution is necessary especially when the demand for an evaluation comes from the employer. He wishes that in an overall perspective of social réintégration, the therapeutic teams give more attention to the réintégration in the work field.

  17. [Management strategies and choice of antithrombotic treatment in patients admitted with acute coronary syndrome--executive summary for clinical practice. Consensus Document of the Regional Chapters of the Italian National Association of Hospital Cardiologists (ANMCO) and of the Italian Society of Emergency Medicine (SIMEU)].

    PubMed

    Uguccioni, Massimo; Pugliese, Francesco; De Luca, Leonardo; Tubaro, Marco; Ruggieri, Maria Pia; Colivicchi, Furio; Ammirati, Fabrizio; Ansalone, Gerardo; Avella, Andrea; Azzolini, Paolo; Bertazzoni, Giuliano; Brama, Paolo; Cacciatore, Giuseppe; De Luca, Massimo; De Simone, Massimo; Di Fusco, Stefania Angela; Ferraiuolo, Giuseppe; Ferranti, Fabio; Granatelli, Antonino; Loschiavo, Paolo; Mezzanotte, Roberto; Mirante, Enrico; Monti, Francesco; Pajes, Giuseppe; Pandolfo, Luciano; Proiettil, Fabrizio; Revello, Alessandra; Rigattieri, Stefano; Sabetta, Francesco; Sciahbasi, Alessandro; Scioli, Roberto; Serdoz, Roberto; Susi, Beniamino; Vincentelli, Giovanni Maria; Zuccalà, Giuseppe; Zulli, Luigi

    2013-03-01

    This document has been developed by the Lazio regional chapters of two scientific associations, the Italian National Association of Hospital Cardiologists (ANMCO) and the Italian Society of Emergency Medicine (SIMEU), whose members are actively involved in the everyday management of Acute Coronary Syndromes (ACS). The document is aimed at providing a specific, practical, evidence-based guideline for the effective management of antithrombotic treatment (antiplatelet and anticoagulant) in the complex and ever changing scenario of ACS. The document employs a synthetic approach which considers two main issues: the actual operative context of treatment delivery and the general management strategy.

  18. Occupational Psychiatric Disorders in Korea

    PubMed Central

    Kang, Seong-Kyu

    2010-01-01

    We searched databases and used various online resources to identify and systematically review all articles on occupational psychiatric disorders among Korean workers published in English and Korean before 2009. Three kinds of occupational psychiatric disorders were studied: disorders related to job stress and mental illness, psychiatric symptoms emerging in victims of industrial injuries, and occupational psychiatric disorders compensated by Industrial Accident Compensation Insurance (IACI). Korea does not maintain official statistical records for occupational psychiatric disorders, but several studies have estimated the number of occupational psychiatric disorders using the Korea Workers' Compensation and Welfare Service (COMWEL, formerly KLWC) database. The major compensated occupational psychiatric disorders in Korea were "personality and behavioral disorders due to brain disease, damage, and dysfunction", "other mental disorders due to brain damage and dysfunction and to physical diseases", "reactions to severe stress and adjustment disorders", and "depressive episodes". The most common work-related psychiatric disorders, excluding accidents, were "neurotic, stress-related, and somatoform disorders" followed by "mood disorders". PMID:21258596

  19. College Students with Psychiatric Disabilities

    ERIC Educational Resources Information Center

    Singh, Delar K.

    2011-01-01

    This paper focuses on college students with psychiatric disabilities. It defines and discusses various psychiatric conditions such as mood disorders, anxiety disorders, eating disorders, and personality disorders. It concludes with accommodations that a college professor can make to help these students succeed in higher education. (Contains 1…

  20. The Psychiatric Disorders of Childhood.

    ERIC Educational Resources Information Center

    Shaw, Charles R.; Lucas, Alexander R.

    A general textbook on the psychiatric disorders of childhood, the book is intended to be an introductory text for students and practitioners working with children (such as psychiatric and pediatric residents and psychologists, teachers, medical students). The genesis of mental illness is discussed in terms of the contributions of heredity and the…

  1. The management of acute pericarditis.

    PubMed

    Wells, T A; Curzen, N P

    2005-01-01

    Acute pericarditis is usually a benign self-limiting condition, often of unexplained or viral aetiology, involving inflammation of the pericardial layers. It is often part of the differential diagnosis in patients admitted with acute chest pain and can be confused with acute myocardial infarction, acute pulmonary embolism and pleurisy. Occasionally it can result in cardiac tamponade and, if associated with myocarditis, in heart failure. This article sets out how to diagnose acute pericarditis, the common underlying causes, the possible treatment options and outcomes. PMID:21655516

  2. Broader Indications for Psychiatric Consultation

    PubMed Central

    Steinberg, Paul

    1987-01-01

    A liaison approach to psychiatric consultation increases the patient population who can benefit from psychiatric assessment during hospitalization for medical or surgical conditions. It also broadens the scope of the psychiatric investigation of the individual patient. The meaning of the illness to the patient, and the patient's present methods of adapting to his or her illness are important considerations. Unconscious concerns, which interfere with the patient's compliance to medical treatment, may be sufficiently clarified and resolved so that medical progress is expedited. Psychiatric consultation can be used to prevent an untoward psychological reaction to illness, if this is foreseen. This preventive consultation, which is often possible only because of the family physician's awareness of the psychological vulnerability of some of her or his patients, can result in reduced medical and psychiatric morbidity. PMID:21263836

  3. Psychiatric morbidity in primary care.

    PubMed

    al-Haddad, M K; al-Garf, A; al-Jowder, S; al-Zurba, F I

    1999-01-01

    The prevalence of hidden psychiatric morbidity was assessed using the General Health Questionnaire (GHQ) and Hospital Anxiety Depression Scale (HAD). A total of 149 Bahraini patients aged > or = 16 years were selected randomly from those attending primary health care centres for problems other than psychiatric illness. The prevalence of psychiatric morbidity using GHQ was 45.1% (cut-off > or = 5) and 27.1% (cut-off > or = 9). Using the HAD scale, the prevalence was 44.4% (cut-off > or = 8) and 23.6% (cut-off > or = 11). Psychiatric morbidity was more common in women aged 50-55 years, in divorcees or widows and in lesser educated patients. Either instrument could be used to diagnose psychiatric illness.

  4. Exorcism: a psychiatric viewpoint.

    PubMed Central

    Trethowan, W. H.

    1976-01-01

    Doctors, for several reasons, should be concerned with exorcism is the view of Professor Trethowan, who in this paper, looks at the main features of exorcism as practised in the middle ages and now appearing in the modern world, as was seen in the recent Ossett case in Britain. He examines in some detail the nature of supposed demoniacal possession and describes its symptoms and signs. He also touches on the social, as opposed to the religious, background in which demoniacal possession flourished (not lacking in the world today), so leading to an examination of the psychodynamic aspects of demoniacal possession and the question of absolute evil. Finally he compares the techniques of exorcism and of modern psychiatric practice. PMID:966260

  5. The impact of psychiatric comorbidity on Medicare reimbursement for inpatient medical care.

    PubMed

    Goldberg, R J; Daly, J; Golinger, R C

    1994-01-01

    Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of psychiatric co-morbidities in Medicare patients on medical services could generate incremental hospital revenue by moving patients from a lower to a higher paying Diagnostic Related Group (DRG). This increased revenue could be used as a means of supporting the psychiatric C-L service. This study documents the financial impact of screening for and documenting psychiatric co-morbidities on a general acute medical service. We clinically assessed 100 consecutive Medicare admissions and found 25 psychiatric co-morbidities in 20 patients. In only one case did the psychiatric diagnosis result in moving the case to a higher DRG. However, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatric diagnoses by the medical team. The authors discuss both the financial and clinical implications of screening medical inpatients for psychiatric co-morbidities and propose directions for further studies in this area.

  6. The impact of psychiatric comorbidity on Medicare reimbursement for inpatient medical care.

    PubMed

    Goldberg, R J; Daly, J; Golinger, R C

    1994-01-01

    Funding for psychiatric consultation-liaison (C-L) services has been a difficult problem. It has been suggested that the identification of psychiatric co-morbidities in Medicare patients on medical services could generate incremental hospital revenue by moving patients from a lower to a higher paying Diagnostic Related Group (DRG). This increased revenue could be used as a means of supporting the psychiatric C-L service. This study documents the financial impact of screening for and documenting psychiatric co-morbidities on a general acute medical service. We clinically assessed 100 consecutive Medicare admissions and found 25 psychiatric co-morbidities in 20 patients. In only one case did the psychiatric diagnosis result in moving the case to a higher DRG. However, the need for psychiatric consultation remains evident as there was significant lack of recognition and documentation of the psychiatric diagnoses by the medical team. The authors discuss both the financial and clinical implications of screening medical inpatients for psychiatric co-morbidities and propose directions for further studies in this area. PMID:8039679

  7. Psychiatric manifestations of treatable hereditary metabolic disorders in adults

    PubMed Central

    2014-01-01

    Detecting psychiatric disorders of secondary origin is a crucial concern for the psychiatrist. But how can this reliably be done among a large number of conditions, most of which have a very low prevalence? Metabolic screening undertaken in a population of subjects with psychosis demonstrated the presence of treatable metabolic disorders in a significant number of cases. The nature of the symptoms that should alert the clinician is also a fundamental issue and is not limited to psychosis. Hereditary metabolic disorders (HMD) are a rare but important cause of psychiatric disorders in adolescents and adults, the signs of which may remain isolated for years before other more specific organic signs appear. HMDs that present purely with psychiatric symptoms are very difficult to diagnose due to low awareness of these rare diseases among psychiatrists. However, it is important to identify HMDs in order to refer patients to specialist centres for appropriate management, disease-specific treatment and possible prevention of irreversible physical and neurological complications. Genetic counselling can also be provided. This review focuses on three HMD categories: acute, treatable HMDs (urea cycle abnormalities, remethylation disorders, acute intermittent porphyria); chronic, treatable HMDs (Wilson’s disease, Niemann-Pick disease type C, homocystinuria due to cystathionine beta-synthase deficiency, cerebrotendinous xanthomatosis); and chronic HMDs that are difficult to treat (lysosomal storage diseases, X-linked adrenoleukodystrophy, creatine deficiency syndrome). We also propose an algorithm for the diagnosis of HMDs in patients with psychiatric symptoms. PMID:25478001

  8. Gender, status, and psychiatric labels.

    PubMed

    Kroska, Amy; Harkness, Sarah K; Brown, Ryan P; Thomas, Lauren S

    2015-11-01

    We examine a key modified labeling theory proposition-that a psychiatric label increases vulnerability to competence-based criticism and rejection-within task- and collectively oriented dyads comprised of same-sex individuals with equivalent education. Drawing on empirical work that approximates these conditions, we expect the proposition to hold only among men. We also expect education, operationalized with college class standing, to moderate the effects of gender by reducing men's and increasing women's criticism and rejection. But, we also expect the effect of education to weaken when men work with a psychiatric patient. As predicted, men reject suggestions from teammates with a psychiatric history more frequently than they reject suggestions from other teammates, while women's resistance to influence is unaffected by their teammate's psychiatric status. Men also rate psychiatric patient teammates as less powerful but no lower in status than other teammates, while women's teammate assessments are unaffected by their teammate's psychiatric status. Also as predicted, education reduces men's resistance to influence when their teammate has no psychiatric history. Education also increases men's ratings of their teammate's power, as predicted, but has no effect on women's resistance to influence or teammate ratings. We discuss the implications of these findings for the modified labeling theory of mental illness and status characteristics theory.

  9. Borderline personality disorder associates with violent criminality in women: A population based follow-up study of adolescent psychiatric inpatients in Northern Finland.

    PubMed

    Arola, Riikka; Antila, Henna; Riipinen, Pirkko; Hakko, Helinä; Riala, Kaisa; Kantojärvi, Liisa

    2016-09-01

    Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals. The study sample consisted of 508 adolescents (age 13-17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare. A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24-29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38-13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61-38.76, p<0.001) and parent's substance use disorder (OR 7.74, CI 2.30-26.10, p=0.001). In men, no association was observed between PD and any kind of criminal behaviour. Significant predictors for violent criminality in males were conduct disorder (OR 4.05, CI 1.75-9.38, p=0.001), substance use disorder (OR 2.51, CI 1.22-5.17, p=0.012) and special services at school (OR 2.58, CI 1.16-5.76, p=0.021). Females with Borderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD.

  10. Borderline personality disorder associates with violent criminality in women: A population based follow-up study of adolescent psychiatric inpatients in Northern Finland.

    PubMed

    Arola, Riikka; Antila, Henna; Riipinen, Pirkko; Hakko, Helinä; Riala, Kaisa; Kantojärvi, Liisa

    2016-09-01

    Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals. The study sample consisted of 508 adolescents (age 13-17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare. A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24-29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38-13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61-38.76, p<0.001) and parent's substance use disorder (OR 7.74, CI 2.30-26.10, p=0.001). In men, no association was observed between PD and any kind of criminal behaviour. Significant predictors for violent criminality in males were conduct disorder (OR 4.05, CI 1.75-9.38, p=0.001), substance use disorder (OR 2.51, CI 1.22-5.17, p=0.012) and special services at school (OR 2.58, CI 1.16-5.76, p=0.021). Females with Borderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD. PMID:27399875

  11. The quality of psychiatric services provided by an Australian tertiary hospital emergency department: a client perspective.

    PubMed

    Summers, Monica; Happell, Brenda

    2002-10-01

    The mainstreaming of psychiatric services within the general health care system has created fundamental changes to the manner in which clients access acute psychiatric services. A review of the literature suggests that this process has been problematic. The current study involved the conduct of telephone interviews with psychiatric clients (n = 136) to ascertain their level of satisfaction with the services received in the emergency department of a Melbourne Metropolitan Hospital. The results were analysed using descriptive statistics. The study participants indicated a high level of satisfaction. Particular emphasis was placed upon the availability of staff with psychiatric qualifications and experience to provide treatment, support and care. Dissatisfaction was noted by some clients regarding lengthy waiting times, lack of privacy in the triage area and negative attitudes of emergency department staff. These findings support the value of psychiatric consultancy services in the emergency department, and further identify the need for triage guidelines to be tailored to the needs of mental health clients.

  12. Circadian Disruption in Psychiatric Disorders.

    PubMed

    Jones, Stephanie G; Benca, Ruth M

    2015-12-01

    Evidence suggests that abnormalities in circadian rhythms might prove causally or pathophysiologically significant in psychiatric illness. The circadian regulation of hormonal and behavioral timekeeping processes is often altered in patients with major depression, bipolar disorder, and schizophrenia, and a susceptibility to rhythm instability may contribute to the functional impairment. For some patients, interventions that stabilize or resynchronize circadian rhythms prove therapeutically effective. Circadian disruption in the clinical profiles of most psychiatric illnesses and the treatment efficacy of chronobiological interventions suggest that attention to circadian phenotypes in a range of psychiatric disorders may help to uncover shared pathophysiologic mechanisms. PMID:26568124

  13. Care systematization in psychiatric nursing within the psychiatric reform context.

    PubMed

    Hirdes, A; Kantorski, L P

    2002-02-01

    The aim of this study was to approach care systematization in psychiatric nursing in two psychiatric disorder patients who attended 'Nossa Casa', São Lourenço do Sul, RS, Brazil. Nossa Casa services psychiatric patients in the community, focussing on: (i) permanence in their environment, allowing patients to remain close to their families and social spheres; (ii) integral attendance to meet individual needs; (iii) respecting individual differences; (iv) rehabilitation practices; and (v) social reinsertion. Concepts and assumptions of the psychiatric reform and the Irving's nursing process were used as theoretical-methodological references to elaborate this systematization. A therapeutic project for the psychiatric patient was elaborated, in accordance with the interdisciplinary proposal accepted by Nossa Casa. Interdisciplinary team intervention, guided by a previously discussed common orientation and defined through an individualized therapeutic project, allowed for an effective process of psychosocial rehabilitation. The authors concluded that a therapeutic project based on the mentioned premises leads to consistent, comprehensive, dialectical and ethical assistance in mental health, thereby reinstating the citizenship of psychiatric patients.

  14. [Psychiatric advance directives--medical models into psychiatric medicine].

    PubMed

    Mautner, Sigal; Lachman, Max; Kaplan, Zeev; Shalev, Anat

    2014-01-01

    Since the year 2005, in the field of general medicine, the legislature in Israel determined ways to implement medically advanced directives according to the power of the law. Different states in the world had implemented parallel legislation for patients who suffer from mental illness. Psychiatric Advance Directives is a legitimate document which is valid in Australia, New Zealand, Scotland, England and in 25 countries in the U.S.A. Psychiatric advance directives (PAD's) allow competent persons, through advance instructions, to state their preferences for future mental health treatment in the event of an incapacitating psychiatric crisis. Self Determination Theory, Self Care and Autonomy are dominant supportive approaches in the creation of Psychiatric Advance Directives. Research conducted on psychiatric advance directives shows positive potential benefits for mental health clients, therapists and psychiatrists. More research in that area must be conducted. Psychiatric advance directives are currently developed and implemented with the cooperation of the Tauber Foundation and the Beer Sheva Mental Health Center. This is the first step in learning of effective ways to use this intervention in Israel and change perceptions toward a positive connection between medical efficiency and client preferences.

  15. Integrated medical-psychiatric treatment of the "crisis phase" in severe protein-energy malnutrition secondary to major eating disorders.

    PubMed

    Alfano, V; Bellini, O; De Filippo, E; Alfonsi, L; Pasanisi, F; Contaldo, F

    2004-06-01

    C.A., a 23-year old male was admitted in the clinical nutrition medical ward for severe, complicated protein-energy malnutrition (PEM) [body mass index (BMI) 11.08 kg/m2; body weight kg 35.81 due to major eating disorders. C.A.'s personality was narcissistic, with a rigid psychic structure. During hospitalitation (lasted 72 days) two acute episodes (a possibly self-inflicted damage and a persecution feeling) occurred that we consider as part of the "crisis phase", the period in which the patient's restrictive behaviour is no longer able to keep his personality equilibrium stable. The patient was treated by an integrated medical and psychiatric approach, including periods of never forced parenteral nutrition, nutritional and intensive psychoterapeutic interventions. For a short period the patient received also a pharmacological support (aloperidol orally). Treatment was successful and the patient was discharged completely autonomous and followed up on an outpatient basis. After about one year follow-up he is still in good clinical condition and in sufficient psychological equilibrium.

  16. A Profile of the Newly-Admitted Nursing Home Resident.

    ERIC Educational Resources Information Center

    Erber, Joan T.; Dye, Carol J.

    1982-01-01

    Recently admitted nursing home residents received a battery of psychological tests and were rated on a number of behavioral indices. Results revealed the morale/anxiety dimension was independent of cognitive competency, internally controlled residents were rated high by others in behavioral competency, and self-rating scales measure something…

  17. DISQUALIFIED STUDENTS ADMITTED TO THE FALL, 1965 SEMESTER.

    ERIC Educational Resources Information Center

    BISSIRI, AUGUST

    ANALYSIS OF THE RECORDS OF 387 STUDENTS ADMITTED TO LOS ANGELES CITY COLLEGE (LACC) AFTER DISQUALIFICATION FROM VARIOUS COLLEGES, INCLUDING LACC, PROVIDES GUIDELINES FOR USE IN COUNSELING DISQUALIFIED STUDENTS. AS COMPARED TO THE TOTAL SCHOOL POPULATION, THESE STUDENTS TEND TO BE SLIGHTLY OLDER, THERE ARE MORE MALES, THEY ALL HAVE HAD PREVIOUS…

  18. Admitting Failure (With a Little Help from My Friends)

    ERIC Educational Resources Information Center

    Cooper, Sarah

    2015-01-01

    Teachers who are no longer considered novices can have a difficult time admitting failures. There is an expectation that teachers should be "on" all the time, but disorientation can happen even to veteran teachers--or maybe especially to veteran teachers--if expectations are too high. Sarah Cooper, an experienced teacher and dean of…

  19. [Open trial of sultopride in psychiatric emergencies].

    PubMed

    Kamal, S; Grivois, H

    1983-03-24

    The effectiveness of sultopride in acute psychiatric syndromes with prominent agitation was tested in patients seen in the emergency department of a general hospital. Among 32 patients, 26 were given a single injection of 200 mg and 6 had two injections. Seven items were evaluated at ten minute intervals for one hour. Results showed excellent control of agitation and anxiety but little effect on delirium, hallucinations and depression. Furthermore, the patients' unwillingness to be cared for can be overcome by this agent and diagnosis, therapy and orientation can be established. These good results are partly achieved as early as 20 minutes after the injection. Psychomotor agitation thus appears to be the choice indication of sultopride.

  20. Inpatient Suicide in a Chinese Psychiatric Hospital

    ERIC Educational Resources Information Center

    Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian

    2008-01-01

    Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…

  1. Epigenetic approaches to psychiatric disorders

    PubMed Central

    Ptak, Carolyn; Petronis, Arturas

    2010-01-01

    Psychiatric diseases place a tremendous burden on affected individuals, their caregivers, and the health care system. Although evidence exists for a strong inherited component to many of these conditions, dedicated efforts to identify DNA sequence-based causes have not been exceptionally productive, and very few pharmacologic treatment options are clinically available. Many features of psychiatric diseases are consistent with an epigenetic dysregulation, such as discordance of monozygotic twins, late age of onset, parent-of-origin and sex effects, and fluctuating disease course. In recent years, experimental technologies have significantly advanced, permitting indepth studies of the epigenome and its role in maintenance of normal genomic functions, as well as disease etiopathogenesis. Here, we present an epigenetic explanation for many characteristics of psychiatric disease, review the current literature on the epigenetic mechanisms involved in major psychosis, Alzheimer's disease, and autism spectrum disorders, and describe some future directions in the field of psychiatric epigenomics. PMID:20373664

  2. Psychiatric Emergencies in Pregnant Women.

    PubMed

    Wilson, Michael P; Nordstrom, Kimberly; Shah, Asim A; Vilke, Gary M

    2015-11-01

    Psychiatric emergencies in pregnancy can be difficult to manage. The authors (both practicing psychiatrists and emergency clinicians) review the evaluation and treatment of common mental health diagnoses in pregnancy.

  3. Consent to psychiatric treatment: practical implications of the Mental Health (Amendment) Bill.

    PubMed

    Beedie, M A; Bluglass, R

    1982-05-29

    The case notes of all patients admitted in 1981 to two Birmingham psychiatric hospitals on compulsory orders for treatment were examined to determine whether, had the new "consent to treatment" proposals in the Mental Health (Amendment) Bill been in operation, a second opinion was necessary. This concluded that there will be difficulties in operating the arrangements to provide a second opinion, and the Government should reconsider the range of these proposals.

  4. Lifetime and six-month prevalence of psychiatric disorders among sentenced female offenders.

    PubMed

    Daniel, A E; Robins, A J; Reid, J C; Wilfley, D E

    1988-01-01

    The authors determined the six-month and lifetime prevalence of psychiatric disorders among 100 consecutively admitted female offenders to a prison, using Diagnostic Interview Schedule (DIS Version III) and found high prevalence rates of schizophrenia, major depression, substance use disorders, psychosexual dysfunction, and antisocial personality disorders. The prevalence rates of these disorders were significantly higher than those of the general population. The authors note the implications of their findings for treatment of women within the correctional system.

  5. Psychiatric aspects of Parkinson's disease

    PubMed Central

    Grover, Sandeep; Somaiya, Mansi; Kumar, Santhosh; Avasthi, Ajit

    2015-01-01

    Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the “tip of the iceberg” of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD. PMID:25552854

  6. Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002-11.

    PubMed

    Zhu, Jane M; Singhal, Astha; Hsia, Renee Y

    2016-09-01

    Despite increases in the use of emergency department (EDs) for mental health care, there are limited data on whether psychiatric patients disproportionately contribute to ED crowding. We conducted a retrospective analysis using a national database of ED visits in the period 2002-11 to describe trends in median and ninetieth-percentile length-of-stay for patients with psychiatric versus nonpsychiatric primary diagnoses. Psychiatric patients who visited the ED were transferred to another facility at six times the rate of nonpsychiatric patients. Median lengths-of-stay were similar for psychiatric and nonpsychiatric patients among those who were admitted to the hospital (264 versus 269 minutes) but significantly different for those who were admitted for observation (355 versus 279 minutes), transferred (312 versus 195 minutes), or discharged (189 versus 144 minutes). Overall, differences in ED length-of-stay between psychiatric and nonpsychiatric patients did not narrow over time. These findings suggest deficiencies in ED capacity for psychiatric care, which may necessitate improvements in both throughput and alternative models of care. PMID:27605653

  7. A comparison of studies from the United States and western Europe on psychiatric hospitalization referrals for youths exhibiting suicidal behavior.

    PubMed

    Safer, D J

    1996-09-01

    A comprehensive literature review that rates of adolescent suicide-behavior based referrals from emergency rooms (ER) to psychiatric impatient facilities in the United States (U.S.) and in Western Europe (WE). Also compared on both sides of the Atlantic were the characteristics of suicidal youths seen at the ER and those admitted to psychiatric hospital units. The major findings were as follows. (1) Youths at both geographical locations who were seen at the ERs for suicidal behavior were very similar with respect to age and gender. (2) A median of 39% of youths seen in U.S. ERs for suicidal behavior were referred for inpatient psychiatric treatment; in WE, the median was 12%. (3) In the U.S., suicidal youths referred from the ER to psychiatric inpatient care were predominantly female (2.5:1) and mainly midadolescent in age (median age = 15). (4) In WE, the majority of those suicidal youths referred for psychiatric hospitalization were male (1:1.2) and in their late adolescent years (median age = 17). Thus, far fewer but more at risk youths presenting with suicidal behavior were admitted to psychiatric hospitals in WE than in the U.S. Presumably this is due largely to cross-Atlantic differences in malpractice patterns, academic perspectives, and medical care financing. PMID:8899134

  8. Acute mastoiditis--revisited.

    PubMed

    Luntz, M; Keren, G; Nusem, S; Kronenberg, J

    1994-09-01

    The clinical course and causative organisms were studied in 18 patients with acute mastoiditis, 13 of whom (72%) had no previous history of middle ear disease. Their age ranged from 5 months to 21 years, and duration of middle ear symptoms immediately prior to admission ranged from 1 to 45 days (average 9.7 days). None had undergone a myringotomy prior to admission, while 13 (72%) had been receiving antibiotic treatment for acute otitis media. Three were admitted with intracranial complications. Bacteria were isolated in 10 of the 16 patients in whom samples were available for bacterial culture, and included Streptococcus pneumonia (2), Streptococcus pyogenes (2), Staphylococcus aureus (2), Staphlococcus coagulase negative (2), Klebsiella pneumonia (1), and Pseudomonas aeruginosa (1). Of the 17 patients treated by us, 11 received surgery. Acute otitis media, secretory otitis media, acute mastoiditis, subacute mastoiditis and masked mastoiditis create a continuum. Antibiotic treatment for acute otitis media cannot be considered as an absolute safeguard against acute mastoiditis. When antibiotics are prescribed for acute mastoiditis before culture result is available, an anti-staphylococcal agent should be included. At least some patients with acute mastoiditis develop a primary infection of the bony framework of the middle ear cleft. The prevalence of the intracranial complications in acute mastoiditis is still high and may appear soon after or concomitant with the first sign of acute mastioditis.

  9. Pharmacological treatment of psychiatric comorbidity in patients with refractory epilepsy.

    PubMed

    Karouni, Mohamad; Henning, Oliver; Larsson, Pål G; Johannessen, Svein I; Johannessen Landmark, Cecilie

    2013-10-01

    The purpose of the present study was to describe the use of psychopharmacological drugs for the treatment of a stated or presumed psychiatric comorbid condition in patients with refractory epilepsy and discuss the clinical implications of such treatment. The study was a retrospective descriptive study in patients admitted to the National Center for Epilepsy in Norway based on medication described in medical records. The mean age was 40 years (range: 9-90), and the gender ratio was 56/44% female/male. Psychotropic drugs (antidepressants and antipsychotics) were used to a lower extent than in the general population in Norway. Drugs for ADHD were predominantly used in children. The prevalence of patients treated with psychiatric comedication was 13% (143 of 1139 patients). The patients used two to eight concomitant CNS-active drugs, which calls for the close monitoring of potential pharmacodynamic and pharmacokinetic interactions and should challenge clinicians to achieve a less complex pharmacotherapy. Psychiatric comorbidity is an important concern in patients with refractory epilepsy and may be undertreated.

  10. Psychiatric manifestations in cerebrotendinous xanthomatosis

    PubMed Central

    Fraidakis, M J

    2013-01-01

    Cerebrotendinous xanthomatosis (CTX) is a rare and severe, but treatable, inborn disorder of bile acid biosynthesis and sterol storage with autosomal recessive inheritance and variable clinical presentation. CTX treatment consists of chenodeoxycholic acid and must be started as early as possible to prevent permanent disability. Psychiatric manifestations are rare and non-specific, and often lead to significant diagnostic and treatment delay. Therefore, better recognition of the gamut of psychiatric manifestations in CTX can diminish the risk of misdiagnosis and irreversible neurological deterioration. We hereby describe the psychiatric features in CTX. A complete review of all published cases of CTX in the medical literature was undertaken and the case reports with psychiatric presentation were collected and analyzed. We also describe the psychiatric features in relation to the neurological semeiology in six patients with CTX diagnosed at the La Salpêtrière Hospital. We conclude that psychiatric manifestations in CTX follow a bimodal/bitemporal pattern, appearing early in the disease course in the form of a behavioral/personality disorder associated with learning difficulties or mental retardation, or manifesting in advanced disease in the setting of dementia as rich neuropsychiatric syndromes, such as frontal, orbitofrontal or frontotemporal syndromes of cortico-subcortical dementia encompassing behavioral/personality disturbance, affective/mood disorders or psychotic disorders. Behavioral/personality disturbance in childhood or adolescence, especially when accompanied by learning difficulties, should therefore lead to further investigation to exclude CTX, as early diagnosis and treatment is critical for prognosis. PMID:24002088

  11. Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh.

    PubMed

    Das, Rina; Sarker, Anupam; Saha, Haimanti; Bin Shahid, Abu Sadat Mohammad Sayeem; Shahunja, K M; Chisti, Mohammod Jobayer

    2015-01-01

    There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0-59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p < 0.05). Thus, diarrheal children with clinically diagnosed Down syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay.

  12. Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh

    PubMed Central

    Das, Rina; Sarker, Anupam; Saha, Haimanti; Bin Shahid, Abu Sadat Mohammad Sayeem; Chisti, Mohammod Jobayer

    2015-01-01

    There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0–59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p < 0.05). Thus, diarrheal children with clinically diagnosed Down syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay. PMID:27351021

  13. Short- and long-term outcomes of AL amyloidosis patients admitted into intensive care units.

    PubMed

    Guinault, Damien; Canet, Emmanuel; Huart, Antoine; Jaccard, Arnaud; Ribes, David; Lavayssiere, Laurence; Venot, Marion; Cointault, Olivier; Roussel, Murielle; Nogier, Marie-Béatrice; Pichereau, Claire; Lemiale, Virginie; Arnulf, Bertrand; Attal, Michel; Chauveau, Dominique; Azoulay, Elie; Faguer, Stanislas

    2016-09-01

    Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit-related organ dysfunction or therapy-related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units (ICUs) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL (n = 52) or AA (n = 14) amyloidosis patients, with similar causes of admission to an ICU, the 28-d and 6-month survival rates of AA patients were significantly higher compared to AL patients (93% vs. 60%, P = 0·03; 71% vs. 45%, P = 0·02, respectively). In AL patients, the simplified Index of Gravity Score (IGS2) was the only independent predictive factor for death by day 28, whereas the Mayo-Clinic classification stage had no influence. In Cox's multivariate regression model, only cardiac arrest and on-going chemotherapy at ICU admission significantly predicted death at 6 months. Short-term outcomes of AL patients admitted into an ICU were mainly related to the severity of the acute medical condition, whereas on-going chemotherapy for active amyloidosis impacted on long-term outcomes.

  14. The interplay of infections, function and length of stay (LOS) in newly admitted geriatric psychiatry patients.

    PubMed

    Malyuk, Rhonda E; Wong, Carol; Buree, Barbara; Kang, Arvind; Kang, Nirmal

    2012-01-01

    The purpose of this study was to determine the impact of identifying and treating infections on functional outcomes and length of stay (LOS). Our retrospective naturalistic study reviewed all new admissions to a tertiary geriatric psychiatry teaching hospital from 2003 to 2007. Over this four-year period, 390 patients were admitted and discharged with 21% (85) of patients identified as having infections on admission. Those with infections were compared to the group without to determine and compare clinical characteristics. Factors included in analysis were: age, gender, diagnoses, medical comorbidity, neuropsychiatric symptoms, functional outcomes, medications and LOS. Both groups were similar in gender, psychiatric diagnoses and severity of dementia. Those requiring antibiotics for treatment of infections on admission, were older (p=0.003), had poorer baseline function (p=0.005) and higher medical comorbidity (p<0.001). At discharge, the group with infections showed greater functional improvement (p<0.001), particularly in mobility (p=0.005) and cognition (p=0.046), and had a shorter LOS (p=0.02). We conclude that a significant number of patients in tertiary geriatric services continue to have infections on admission. Early identification and treatment of infections can result in improved function and decreased LOS. PMID:21377222

  15. Accountability and psychiatric disorders: how do forensic psychiatric professionals think?

    PubMed

    Höglund, Pontus; Levander, Sten; Anckarsäter, Henrik; Radovic, Susanna

    2009-01-01

    Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.

  16. Clinical Presentation of General Paralysis of the Insane in a Dutch Psychiatric Hospital, 1924-1954.

    PubMed

    Daey Ouwens, Ingrid M; Lens, C Elisabeth; Fiolet, Aernoud T L; Ott, Alewijn; Koehler, Peter J; Verhoeven, Willem M A

    2015-01-01

    General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail.

  17. A validation of the test of memory malingering in a forensic psychiatric setting.

    PubMed

    Weinborn, Michael; Orr, Tamara; Woods, Steven Paul; Conover, Emily; Feix, Jeffrey

    2003-10-01

    The Test of Memory Malingering (TOMM) has not been adequately validated in a forensic psychiatric setting. Dissimulation of cognitive impairment, as assessed by the TOMM, was evaluated in a group of 25 forensic inpatients admitted for evaluation of Competency to Stand Trial (CST/MSO group), and hypothesized to be at higher risk for feigning cognitive impairment. A comparison group of 36 patients, who were either civilly committed or adjudicated Not Guilty by Reason of Insanity (CIVIL/NGRI group), were hypothesized to be less likely to feign cognitive impairment. Groups were comparable in age, education, premorbid intelligence, and psychiatric symptom severity. Significantly more CST/MSO patients (36%) scored below a recommended TOMM cutoff score relative to CIVIL/NGRI patients (6%). Findings indicate excellent specificity and modest sensitivity, and generally support the validity of the TOMM in a forensic psychiatric population. The utility of different cutoff scores and need for multiple indicators of effort are discussed.

  18. Psychiatric comorbidity in forensic psychiatry.

    PubMed

    Palijan, Tija Zarković; Muzinić, Lana; Radeljak, Sanja

    2009-09-01

    For the past several years a numerous studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse. The comorbid substance abuse in violent offenders was usually unrecognized and misdiagnosed. Furthermore, comorbidity in forensic psychiatry describes the co-occurrence of two or more conditions or psychiatric disorder known in the literature as dual diagnosis and defined by World Health Organization (WHO). In fact, many violent offenders have multiple psychiatric diagnoses. Recent studies have confirmed causal relationship between major psychiatric disorders and concomitant substance abuse (comorbidity) in 50-80% of forensic cases. In general, there is a high level of psychiatric comorbidity in forensic patients with prevalence of personality disorders (50-90%), mood disorders (20-60%) and psychotic disorders (15-20%) coupled with substance abuse disorders. Moreover, the high prevalence of psychiatric comorbidities could be found in mentally retarded individuals, as well as, in epileptic patients. Drugs and alcohol abuse can produce serious psychotoxic effects that may lead to extreme violent behavior and consequently to serious criminal offence such as physical assault, rape, armed robbery, attempted murder and homicide, all due to an altered brain function and generating psychotic-like symptoms. Studies have confirmed a significant statistical relevance in causal relationship between substance abuse and violent offences. In terms of forensic psychiatry, the comorbidity strongly contributes in the process of establishing psychiatric diagnosis of diminished mental capacity or insanity at the time of the offence in the course of clinical assessment and evaluation of violent offenders. Today, the primary focus of forensic psychiatry treatment services (in-patient or community) is management of the violent offenders with psychiatric comorbidity which requires a multilevel, evidence based approach to

  19. Psychiatric Comorbidity in Alcohol Dependence.

    PubMed

    Fein, George

    2015-12-01

    We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than non-alcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls. PMID:26590836

  20. Severe metapneumovirus infections among immunocompetent and immunocompromised patients admitted to hospital with respiratory infection.

    PubMed

    Souza, Juliana Sinohara; Watanabe, Aripuana; Carraro, Emerson; Granato, Celso; Bellei, Nancy

    2013-03-01

    Human metapneumovirus (hMPV) is considered an important cause of acute respiratory infections. hMPV can cause morbidity in hematopoietic stem cell transplant recipients and recent research has demonstrated that it is an important virus in patients admitted to hospital with respiratory infections and suspected of having pandemic 2009 influenza A (H1N1pdm09) virus. The purpose of this study was to investigate infections caused by hMPV in two groups of patients admitted to hospital: Immunocompromized patients with a potential risk of severe outcomes and immunocompetent patients with severe acute respiratory syndrome. A total of 288 samples were tested: 165 samples were collected from patients with suspected influenza A (H1N1) pdm09 infection during the first pandemic wave in 2009; and 123 samples were collected from patients of a hematopoietic stem cell transplantation program in 2008-2009. Amplification of the hMPV genes was performed by polymerase chain reaction. This was followed by sequencing and phylogenetic analysis. hMPV was detected in 14.2% (41/288) of all samples: 17% (28/165) of immunocompetent patients with suspected H1N1 infection and 10.6% (13/123) among hematopoietic stem cell transplant recipients. hMPV accounted for 12.1% (8/66) of immunocompetent adults patients with severe respiratory infections (median age, 55.9 years). Two hMPV subtypes were identified, A2 (26.9%; 7/26) and B2 (73.1%; 19/26) but no difference was observed between the patient groups in terms of age or immunosuppression level. This study highlights the significance of hMPV in immunocompetent adult patients with severe infections and further investigations are recommended for understanding the impact of this virus.

  1. The Reliability of Psychiatric Diagnosis Revisited

    PubMed Central

    Rankin, Eric; France, Cheryl; El-Missiry, Ahmed; John, Collin

    2006-01-01

    Background: The authors reviewed the topic of reliability of psychiatric diagnosis from the turn of the 20th century to present. The objectives of this paper are to explore the reasons of unreliability of psychiatric diagnosis and propose ways to improve the reliability of psychiatric diagnosis. Method: The authors reviewed the literature on the concept of reliability of psychiatric diagnosis with emphasis on the impact of interviewing skills, use of diagnostic criteria, and structured interviews on the reliability of psychiatric diagnosis. Results: Causes of diagnostic unreliability are attributed to the patient, the clinician and psychiatric nomenclature. The reliability of psychiatric diagnosis can be enhanced by using diagnostic criteria, defining psychiatric symptoms and structuring the interviews. Conclusions: The authors propose the acronym ‘DR.SED,' which stands for diagnostic criteria, reference definitions, structuring the interview, clinical experience, and data. The authors recommend that clinicians use the DR.SED paradigm to improve the reliability of psychiatric diagnoses. PMID:21103149

  2. Addressing psychiatric comorbidity.

    PubMed

    Woody, G E; McLellan, A T; O'Brien, C P; Luborsky, L

    1991-01-01

    Research studies indicate that addressing psychiatric comorbidity can improve treatment for selected groups of substance-abusing patients. However, the chances for implementing the necessary techniques on a large scale are compromised by the absence of professional input and guidance within programs. This is especially true in public programs, which treat some of the most disadvantaged, disturbed, and socially destructive individuals in the entire mental health system. One starting point for upgrading the level of knowledge and training of staff members who work in this large treatment system could be to develop a better and more authoritative information dissemination network. Such a system exists in medicine; physicians are expected to read appropriate journals and to guide their treatment decisions using the data contained in the journals. Standards of practice and methods for modifying current practice are within the tradition of reading new facts, studying old ones, and comparing treatment outcome under different conditions with what is actually being done. No such general system of information-gathering or -sharing exists, particularly in public treatment programs. One of the most flagrant examples of this "educational shortfall" can be found among those methadone programs that adamantly insist on prescribing no more than 30 to 35 mg/day for all patients, in spite of the overwhelming evidence that these dose levels generally are inadequate. In some cases, program directors are unaware of studies that have shown the relationship between dose and outcome. In other cases, they are aware of the studies but do not modify their practices accordingly. This example of inadequate dosing is offered as an example of one situation that could be improved by adherence to a system of authoritative and systematic information dissemination. Many issues in substance abuse treatment do not lend themselves to information dissemination as readily as that of methadone dosing

  3. Substance use disorders in an adolescent inpatient psychiatric population.

    PubMed

    Deas-Nesmith, D; Campbell, S; Brady, K T

    1998-04-01

    This study examined the comorbidity of substance use disorders and other psychiatric disorders in adolescent populations. The study population was comprised of 100 consecutive admissions, ages 13 to 17, to an acute care adolescent psychiatric inpatient unit for substance use disorders. Patients were assessed using the Personal Experience Screening Questionnaire (PESQ) and the substance-use disorder portion of the Structured Clinical Interview for DSM III-R (SCID-R). Thirty-three (33%) patients were identified as having a substance abuse or dependence diagnosis. There was no significant difference in the age between substance users and nonsubstance users. There were significantly more whites in the substance-using group. Sixty percent of all adolescents interviewed had histories of sexual or physical trauma, with trauma being significantly more common in the substance-using group. There were no significant differences in the number or type of other Axis I or Axis II diagnoses between the two groups. While substance users and nonsubstance users had no significant difference in the number of past psychiatric hospitalizations, nonsubstance users had significantly more past medical hospitalizations. These results indicate that high rates of comorbid substance abuse and psychiatric disorders exist in adolescents, and more in-depth study of comorbidity among adolescents is warranted. PMID:9581443

  4. Substance use disorders in an adolescent inpatient psychiatric population.

    PubMed Central

    Deas-Nesmith, D.; Campbell, S.; Brady, K. T.

    1998-01-01

    This study examined the comorbidity of substance use disorders and other psychiatric disorders in adolescent populations. The study population was comprised of 100 consecutive admissions, ages 13 to 17, to an acute care adolescent psychiatric inpatient unit for substance use disorders. Patients were assessed using the Personal Experience Screening Questionnaire (PESQ) and the substance-use disorder portion of the Structured Clinical Interview for DSM III-R (SCID-R). Thirty-three (33%) patients were identified as having a substance abuse or dependence diagnosis. There was no significant difference in the age between substance users and nonsubstance users. There were significantly more whites in the substance-using group. Sixty percent of all adolescents interviewed had histories of sexual or physical trauma, with trauma being significantly more common in the substance-using group. There were no significant differences in the number or type of other Axis I or Axis II diagnoses between the two groups. While substance users and nonsubstance users had no significant difference in the number of past psychiatric hospitalizations, nonsubstance users had significantly more past medical hospitalizations. These results indicate that high rates of comorbid substance abuse and psychiatric disorders exist in adolescents, and more in-depth study of comorbidity among adolescents is warranted. PMID:9581443

  5. Moral learning in psychiatric rehabilitation.

    PubMed

    Sitvast, J E; Widdershoven, G A M; Abma, T A

    2011-07-01

    The purpose of this article is to illustrate moral learning in persons with a psychiatric disability who participated in a nursing intervention, called the photo-instrument. This intervention is a form of hermeneutic photography. The findings are based on a multiple case study of 42 patients and additional interviews with eight of them. Photo groups were organized within three settings of psychiatric services: ambulatory as well as clinical, all situated in the Netherlands. Data were analysed according to hermeneutic and semiotic principles. Two cases are presented. Findings show that voice and face are concepts that help to identify elements of moral learning in the rehabilitation process of persons with a psychiatric disability. During the process patients become more aware of their responsibilities towards themselves and others.

  6. [Movement disorders is psychiatric diseases].

    PubMed

    Hidasi, Zoltan; Salacz, Pal; Csibri, Eva

    2014-12-01

    Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.

  7. Family violence and psychiatric disorder.

    PubMed

    Bland, R; Orn, H

    1986-03-01

    The relationship between family violence and psychiatric disorders was examined using standardized diagnostic interviews of 1200 randomly selected residents of a large Canadian city. The results showed that higher than expected proportions of those exhibiting violent behavior had a psychiatric diagnosis and the rate of violent behaviors in those with diagnoses (54.4%) significantly (p less than .0001) exceeds the rate in the remainder of the sample (15.5%). Particularly high rates of violence are found in those where alcoholism is combined with antisocial personality disorder and/or recurrent depression (80-93%). Also at high risk for violence are those who have made suicide attempts (over 50%) and those who have been arrested for non-traffic offences (two-thirds). These data suggest that psychiatric disorders have a strong relationship to violent behavior, and are not in agreement with the predominantly sociological explanations of family violence.

  8. [Movement disorders is psychiatric diseases].

    PubMed

    Hidasi, Zoltan; Salacz, Pal; Csibri, Eva

    2014-12-01

    Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases. PMID:25577484

  9. Managing acute invasive fungal sinusitis.

    PubMed

    Dwyhalo, Kristina M; Donald, Carrlene; Mendez, Anthony; Hoxworth, Joseph

    2016-01-01

    Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis and can be fatal, especially in patients who are immunosuppressed. Early diagnosis and intervention are crucial and potentially lifesaving, so primary care providers must maintain a high index of suspicion for this disease. Patients may need to be admitted to the hospital for IV antifungal therapy and surgical debridement.

  10. Religious ideas and psychiatric disorders.

    PubMed

    Beit-Hallahmi, B; Argyle, M

    1977-01-01

    The evidence presented above points to the need for considering factors other than purely religious ones in determining the role of religious ideas in psychiatric disorders. The occurrence of religious ideas as part of the content of individual delusional systems in psychiatric patients can be explained on the basis of exposure to religious ideas through the social environment. It may be also related to the prominence of religion, vis-a-vis other belief systems, in the social envirnment. When considering psychopathological explanations for intense religious experiences, one has to be conscious again of the social factors involved. When an unusual experience having religious content becomes normative in a certain group (for whatever reasons), trying to explain its appearance on the basis of individual psychodynamics or psychopathology becomes very difficult. There seems to be an inverse relationship between the social nature of a religious experience and its psychopathological nature, i.e., there is more psychopathology in individuals reporting solitary religious experiences, or individual religious ideas. Thus the solitary experience seems to be more influenced by disturbed individual dynamics, but in other cases social factors seem to be crucial. Our overall conclusion is that a psychiatric analysis of the role of religious factors in psychopathology has to be first a social-psychiatric analysis. An individual presenting psychiatric symptoms and religious ideas has to be evaluated in light of his social background, since the specific content of psychiatric symptoms seems to be determined by social background factors. Individual psychodynamics determine the appearance of symptoms, but their particular form will be the result of these background factors, one of which is religion. PMID:863602

  11. Psychiatric pharmacogenomics in pediatric psychopharmacology.

    PubMed

    Wall, Christopher A; Croarkin, Paul E; Swintak, Cosima; Koplin, Brett A

    2012-10-01

    This article provides an overview of where psychiatric pharmacogenomic testing stands as an emerging clinical tool in modern psychotropic prescribing practice, specifically in the pediatric population. This practical discussion is organized around the state of psychiatric pharmacogenomics research when choosing psychopharmacologic interventions in the most commonly encountered mental illnesses in youth. As with the rest of the topics on psychopharmacology for children and adolescents in this publication, a clinical vignette is presented, this one highlighting a clinical case of a 16 year old genotyped during hospitalization for recalcitrant depression.

  12. Optogenetics in psychiatric animal models.

    PubMed

    Wentz, Christian T; Oettl, Lars-Lennart; Kelsch, Wolfgang

    2013-10-01

    Optogenetics is the optical control of neuronal excitability by genetically delivered light-activated channels and pumps and represents a promising tool to fuel the study of circuit function in psychiatric animal models. This review highlights three developments. First, we examine the application of optogenetics in one of the neuromodulators central to the pathophysiology of many psychiatric disorders, the dopaminergic system. We then discuss recent work in translating functional magnetic resonance imaging in small animals (in which optogenetics can be employed to reveal physiological mechanisms underlying disease-related alterations in brain circuits) to patients. Finally, we describe emerging technological developments for circuit manipulation in freely behaving animals.

  13. Suicide attempts and related factors in patients admitted to a general hospital: a ten-year cross-sectional study (1997-2007)

    PubMed Central

    2011-01-01

    Background Suicide and suicide attempts represent a severe problem for public health services. The aim of this study is to determine the socio-demographic and psychopathological variables associated with suicide attempts in the population admitted to a General Hospital. Methods An observational-descriptive study of patients admitted to the A Coruña University Hospital (Spain) during the period 1997-2007, assessed by the Consultation and Liaison Psychiatric Unit. We include n = 5,234 admissions from 4,509 patients. Among these admissions, n = 361 (6.9%) were subsequent to a suicide attempt. Admissions arising from a suicide attempt were compared with admissions occurring due to other reasons. Multivariate generalised estimating equation logistic regression models were used to examine factors associated with suicide attempts. Results Adjusting by age, gender, educational level, cohabitation status, being employed or unemployed, the psychiatric diagnosis at the time of the interview and the information on previous suicide attempts, we found that the variables associated with the risk of a suicide attempt were: age, psychiatric diagnosis and previous suicide attempts. The risk of suicide attempts decreases with age (OR = 0.969). Psychiatric diagnosis was associated with a higher risk of suicide attempts, with the highest risk being found for Mood or Affective Disorders (OR = 7.49), followed by Personality Disorders (OR = 7.31), and Schizophrenia and Other Psychotic Disorders (OR = 5.03). The strongest single predictive factor for suicide attempts was a prior history of attempts (OR = 23.63). Conclusions Age, psychopathological diagnosis and previous suicide attempts are determinants of suicide attempts. PMID:21453478

  14. Teaching Psychodynamics to Psychiatric Residents through Psychiatric Outpatient Interviews

    ERIC Educational Resources Information Center

    Cardoso Zoppe, Eva Helena C.; Schoueri, Patricia; Castro, Monica; Neto, Francisco Lotufo

    2009-01-01

    Objective: This study evaluates whether a course that was designed for first-year psychiatric residents and that specifically addressed psychodynamic principles fostered residents' progress in knowledge, skills, and attitudes regarding these concepts. Methods: The course was given in the 2005 academic year to all residents (N=18) in their first…

  15. Girl scouts face complaints over reluctance to admit girl.

    PubMed

    1999-04-01

    A claim filed by the Legal Action Center alleges that the Girl Scouts USA and the Adirondack Girl Scout Council discriminated against 8-year-old [name removed] [name removed] by refusing to admit her because she has HIV. One complaint, filed in the New York State's Division of Human Rights, alleged that the Adirondack Council denied the girl equal access based on New York's human rights law. A second complaint alleged that the Girl Scouts USA aided and abetted in the discrimination by not requiring the Adirondack unit to comply with national organization policy barring discrimination based on disability. The girl has been successfully placed in another troop.

  16. Girl scouts face complaints over reluctance to admit girl.

    PubMed

    1999-04-01

    A claim filed by the Legal Action Center alleges that the Girl Scouts USA and the Adirondack Girl Scout Council discriminated against 8-year-old [name removed] [name removed] by refusing to admit her because she has HIV. One complaint, filed in the New York State's Division of Human Rights, alleged that the Adirondack Council denied the girl equal access based on New York's human rights law. A second complaint alleged that the Girl Scouts USA aided and abetted in the discrimination by not requiring the Adirondack unit to comply with national organization policy barring discrimination based on disability. The girl has been successfully placed in another troop. PMID:11366636

  17. Patients with hypertensive crises who are admitted to a coronary care unit: clinical characteristics and outcomes.

    PubMed

    González Pacheco, Héctor; Morales Victorino, Neisser; Núñez Urquiza, Juan Pablo; Altamirano Castillo, Alfredo; Juárez Herrera, Ursulo; Arias Mendoza, Alexandra; Azar Manzur, Francisco; Briseño de la Cruz, Jose Luis; Martínez Sánchez, Carlos

    2013-03-01

    Patients with hypertensive crises, especially hypertensive emergencies, require immediate admittance to an intensive care unit for rapid blood pressure (BP) control. The authors analyzed the prevalence of hypertensive crisis, the clinical characteristics, and the evolution of patients with hypertensive emergencies and urgencies. Patients were divided into 3 groups according to their BP values: group I, predominant systolic hypertension (≥180/≤119 mm Hg); group II, severe systolic and diastolic hypertension (≥180/≥120 mm Hg); and group III, predominant diastolic hypertension (≤179/≥120 mm Hg). Of all of the patients admitted to a coronary care unit, 538 experienced a hypertensive crisis, which represented 5.08% of all admissions. Hypertensive emergency was predominant in 76.6% of the cases, which corresponded to acute coronary syndrome and acute decompensated heart failure in 59.5% and 25.2% of the cases, respectively. A pattern of predominant systolic hypertension (≥180/≤119 mm Hg) was most commonly observed in the hypertensive crisis group (71.4%) and the hypertensive emergency group (72.1%). The medications that were most commonly used at onset included intravenous vasodilators (nitroglycerin in 63.4% and sodium nitroprusside in 16.4% of the patients). The overall mortality rate was 3.7%. The mortality rate was 4.6% for hypertensive emergency cases and 0.8% for hypertensive urgencies cases.

  18. A theoretical framework for psychiatric nursing practice.

    PubMed

    Onega, L L

    1991-01-01

    Traditionally, specific theoretical frameworks which are congruent with psychiatric nursing practice have been poorly articulated. The purpose of this paper is to identify and discuss a philosophical base, a theoretical framework, application to psychiatric nursing, and issues related to psychiatric nursing knowledge development and practice. A philosophical framework that is likely to be congruent with psychiatric nursing, which is based on the nature of human beings, health, psychiatric nursing and reality, is identified. Aaron Antonovsky's Salutogenic Model is discussed and applied to psychiatric nursing. This model provides a helpful way for psychiatric nurses to organize their thinking processes and ultimately improve the health care services that they offer to their clients. Goal setting and nursing interventions using this model are discussed. Additionally, application of the use of Antonovsky's model is made to nursing research areas such as hardiness, uncertainty, suffering, empathy and literary works. Finally, specific issues related to psychiatric nursing are addressed.

  19. Test of Treatment in Psychiatric Practice

    PubMed Central

    Mustafa, Feras Ali

    2011-01-01

    Due to lack of laboratorial investigations in psychiatric practice, tests of treatment are often used to aid diagnosis. This article provides examples of test of treatment in psychiatric practice and outlines their limitations. PMID:22506439

  20. Psychiatric morbidity associated with motor vehicle accidents.

    PubMed

    Blanchard, E B; Hickling, E J; Taylor, A E; Loos, W

    1995-08-01

    The primary purpose of this report was to determine the extent of psychiatric morbidity and comorbidity among a sample of recent victims of motor vehicle accidents (MVAs) in comparison to a nonaccident control population. Victims of recent MVAs (N = 158), who sought medical attention as a result of the MVA, were assessed in a University-based research clinic, 1 to 4 months after the accident for acute psychiatric and psychosocial consequences as well as for pre-MVA psychopathology using structured clinical interviews (Clinician-Administered PTSD Scale, SCID, SCID-II, LIFE Base). Age- and gender-matched controls (N = 93) who had had no MVAs in the past year served as controls. Sixty-two MVA victims (39.2%) met DSM-III-R criteria for posttraumatic stress disorder (PTSD), and 55 met DSM-IV criteria. The MVA victims who met the criteria for PTSD were more subjectively distressed and had more impairment in role function (performance at work/school/homemaking, relationships with family or friends) than the MVA victims who did not meet the PTSD criteria or the controls. A high percentage (53%) of the MVA-PTSD group also met the criteria for current major depression, with most of that developing after the MVA. A prior history of major depression appears to be a risk factor for developing PTSD after an MVA (p = .0004): 50% of MVA victims who developed PTSD had a history of previous major depression, as compared with 23% of those with a less severe reaction to the MVA. A prior history of PTSD from earlier trauma also is associated with developing PTSD or a subsyndromal form of it (25.2%) (p = .0012). Personal injury MVAs exact substantial psychosocial costs on the victims. Early intervention, especially in vulnerable populations, might prevent some of this.

  1. [THE CLINICAL ORGANIZATIONAL SUBSTANTIATION OF NEW TECHNOLOGY OF HOSPITAL PSYCHIATRIC CARE].

    PubMed

    Podsevatkin, V G; Blinov, D S; Podsevatkin, D V; Podsevatkina, S V; Smirnova, O A

    2015-01-01

    The new technology of hospital psychiatric care, developed and implemented in the Mordovia republican clinical hospital, permits resolving problems of hospitalism, lethality, pharmaceutical resistance and others. The essence of this technology is in staging of hospital care under condition of intensification and standardization of curative diagnostic process, implementation of complex approach to treatment of psychiatric disorders. The patient sequentially passes through three stages: intensive diagnostics and intensive treatment (intensive care department, intensive therapy department), supportive therapy (general psychiatric department); rehabilitation measures (curative rehabilitative department). The concentration of resources at the first stage, application of intensive therapy techniques permit in the shortest period to arrest acute psychotic symptomatic. The described new technology of hospital psychiatric care permits enhancing effectiveness of treatment, significantly shorten period of hospitalization (37.5 days), to obtain lasting and qualitative remission, to rehabilitate most fully social working status of patient and to significantly decrease lethality.

  2. The Psychoactive Effects of Psychiatric Medication: The Elephant in the Room

    PubMed Central

    Cohen, David; Porter, Sally

    2013-01-01

    The psychoactive effects of psychiatric medications have been obscured by the presumption that these medications have disease-specific actions. Exploiting the parallels with the psychoactive effects and uses of recreational substances helps to highlight the psychoactive properties of psychiatric medications and their impact on people with psychiatric problems. We discuss how psychoactive effects produced by different drugs prescribed in psychiatric practice might modify various disturbing and distressing symptoms, and we also consider the costs of these psychoactive effects on the mental well-being of the user. We examine the issue of dependence, and the need for support for people wishing to withdraw from psychiatric medication. We consider how the reality of psychoactive effects undermines the idea that psychiatric drugs work by targeting underlying disease processes, since psychoactive effects can themselves directly modify mental and behavioral symptoms and thus affect the results of placebo-controlled trials. These effects and their impact also raise questions about the validity and importance of modern diagnosis systems. Extensive research is needed to clarify the range of acute and longer-term mental, behavioral, and physical effects induced by psychiatric drugs, both during and after consumption and withdrawal, to enable users and prescribers to exploit their psychoactive effects judiciously in a safe and more informed manner. PMID:24592667

  3. Poetry Therapy in Psychiatric Nursing.

    ERIC Educational Resources Information Center

    Anderson, Catherine J.

    Poetry therapy has been in use with adult psychiatric patients at Saint Elizabeths Hospital, Washington, D.C, for 10 years. The treatment used involves reading poetry, listening to recordings, studying poets, and writing poetry. The patients' choice of poems is not restricted by the staff, but different types of poetry appeal to different types of…

  4. Functional and psychiatric vestibular disorders.

    PubMed

    Staab, J P

    2016-01-01

    Behavioral factors have long been recognized as affecting spatial orientation and balance function. Neuroanatomic and neurophysiologic studies conducted worldwide over the last 30 years have substantially advanced our knowledge about the inherently strong connectivity among threat/anxiety, vestibular, visual, and somatosensory systems in the brain. Clinical investigations have shed greater light on the nature of functional and psychiatric disorders that manifest or magnify vestibular morbidity. Concepts of these syndromes have changed over 150 years. Even their nomenclature has had different meanings in different eras. This chapter will review functional and psychiatric vestibular disorders. Terminology will follow the International Classification of Diseases, 11th edition, beta draft and the International Classification of Vestibular Disorders. Anxiety plays a central role in behavioral vestibular morbidity. Anxiety, traumatic stress, obsessive, and depressive disorders may be primary causes of episodic and chronic vestibular symptoms or secondary complications of other vestibular disorders. These psychiatric illnesses affect 30-50% of patients who consult neurologists or otologists for vestibular symptoms. Coexisting psychiatric disorders adversely affect treatment for patients with structural vestibular diseases, especially when unrecognized. Persistent postural-perceptual dizziness is the leading cause of long-term vestibular disability. Fortunately, pharmacologic, psychotherapeutic, and rehabilitative treatments of these illnesses have improved in recent years. PMID:27638082

  5. Associations among Major Psychiatric Diagnoses.

    ERIC Educational Resources Information Center

    Wolf, Abraham W.; And Others

    1988-01-01

    Examined the frequency and associations of multiple diagnoses in 205 psychiatric inpatients, assessing past and current episodes of illness. Over one-half of the sample received more than one diagnosis. Alcoholism, antisocial personality, and drug dependence formed one group; primary depression, primary mania, and secondary affective disorder,…

  6. PSYCHIATRIC CLINICS IN THE SCHOOLS.

    PubMed

    Maccurdy, J T

    1916-12-01

    The purpose of this important paper by Doctor MacCurdy is to point out why psychiatric clinics in the schools may offer reasonable hope of reducing insanity in the later life of the pupils. And since it is undoubtedly true that the next problem of public health administration will be concerned with mental disorders, where better to begin than with the school child?

  7. Job satisfaction in psychiatric nursing.

    PubMed

    Ward, M; Cowman, S

    2007-08-01

    In recent years, mental health services across Europe have undergone major organizational change with a move from institutional to community care. In such a context, the impact of change on the job satisfaction of psychiatric nurses has received little attention in the literature. This paper reports on the job satisfaction of psychiatric nurses and data were collected in 2003. The population of qualified psychiatric nurses (n = 800) working in a defined geographical health board area was surveyed. Methodological triangulation with a between-methods approach was used in the study. Data were collected on job satisfaction using a questionnaire adopted from the Occupational Stress Indicator. A response rate of 346 (43%) was obtained. Focus groups were used to collect qualitative data. Factors influencing levels of job satisfaction predominantly related to the nurses work location. Other factors influencing job satisfaction included choice of work location, work routine, off duty/staff allocation arrangements, teamwork and working environment. The results of the study highlight to employers of psychiatric nurses the importance of work location, including the value of facilitating staff with choices in their working environment, which may influence the recruitment and retention of nurses in mental health services. PMID:17635253

  8. Comorbidity of Psychiatric Disorders and Parental Psychiatric Disorders in a Sample of Iranian Children with ADHD

    ERIC Educational Resources Information Center

    Ghanizadeh, Ahmad; Mohammadi, Mohammad Reza; Moini, Rozita

    2008-01-01

    Objective: To study the psychiatric comorbidity of a clinical sample of children with ADHD and the psychiatric disorders in their parents. Method: Structured psychiatric interviews assessing lifetime psychiatric disorders by "DSM-IV" criteria, using the Farsi version of the Schedule for Affective Disorders and Schizophrenia. Results: The mean age…

  9. Serotonin uptake in blood platelets of psychiatric patients

    SciTech Connect

    Meltzer, H.Y.; Arora, R.C.; Baber, R.; Tricou, B.J.

    1981-12-01

    Platelet serotonin (5-HT) uptake was determined in 72 newly admitted, unmedicated psychiatric patients. Decreased maximum velocity (Vmax) of 5-HT uptake was present in unipolar and bipolar depressed patients as well as schizoaffective depressed patients. The apparent Michaelis constant (km) of 5-HT uptake was normal in these groups, as was Vmax and Km in manic-depressive and chronic schizophrenic patients. Treatment of depressed patients with notriptyline hydrochloride or imipramine hydrochloride increased Km significantly. There was a trend for the increase in Km in the nortriptyline-treated patients to correlate with clinical improvement. Decreased 5-HT uptake in platelets provides additional evidence for the role of 5-HT in the pathophysiologic process of some forms of depression.

  10. Low self-esteem and psychiatric patients: Part II – The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients

    PubMed Central

    Salsali, Mahnaz; Silverstone, Peter H

    2003-01-01

    Background The objective of the present study was to identify the effects and relative importance of demographic factors and psychosocial stressors on self-esteem of psychiatric patients. Method The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, patients and controls completed two self-esteem questionnaires, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. In addition, a large amount of demographic and psychosocial data was collected on all patients. Results Significantly increased self-esteem was observed with an increase in age, educational achievement and income. Employed patients showed significantly higher self-esteem compared to unemployed patients. Female patients had a significantly lower self-esteem compared to male patients. The self-esteem of psychiatric patients did not vary significantly with their marital status. No relationship was detected between acute stressors and the self-esteem of psychiatric patients, although severe enduring stressors were associated with lower self-esteem in psychiatric patients. Conclusion The results of this large study demonstrate that the self-esteem of adult psychiatric patients is affected by a number of demographic and psychosocial factors including age, sex, educational status, income, employment status, and enduring psychosocial stressors. PMID:12622872

  11. The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective.

    PubMed

    Abou-Saleh, M T; Ghubash, R

    1997-05-01

    There have been numerous studies of the prevalence of postpartum psychiatric illness and its putative risk factors in Western Europe and North America, but very few studies have been undertaken in developing countries, including the Arab world. A total of 95 women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments, namely the Self-Reporting Questionnaire (SRQ) on day 2 and the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery. The prevalence of psychiatric morbidity was 24% according to the SRQ and 18% according to the EPDS. A number of psychosocial factors emerged as putative risk factors for postpartum psychiatric disturbance, including depressive illness. It is concluded that the prevalence of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies conducted in industrialized countries. These findings have implications for the early detection and care of women at risk for postpartum psychiatric illness.

  12. The relation between poor sleep, impulsivity and aggression in forensic psychiatric patients.

    PubMed

    Kamphuis, Jeanine; Dijk, Derk-Jan; Spreen, Marinus; Lancel, Marike

    2014-01-17

    Psychiatric disorders are often associated with disturbed sleep. Poor sleep can attenuate emotional control, including the regulation of aggression, and thus, may increase the risk of impulsive, aggressive acts. This cross-sectional study aimed to investigate the potential contribution of sleep problems to subjective and objective aggressiveness and impulsivity in a forensic psychiatric population. Questionnaires on sleep quality (Pittsburgh Sleep Quality Index), chronic severe insomnia (Sleep Diagnosis List), aggressiveness (Aggression Questionnaire) and impulsivity (Barratt Impulsiveness Scale-11) were completed by 96 forensic psychiatric inpatients, admitted to two forensic facilities in the Netherlands. To obtain more objective measurements of aggression and impulsivity, observational scores on a professional instrument to assess the risk of future aggression (Historical Clinical Future-30) and reported aggressive incidents were collected from files. Results showed that a worse sleep quality and higher insomnia scores were significantly associated with self-reported aggression and impulsivity, clinician-rated hostility and involvement in aggressive incidents within the facility. Whether a participant was professionally judged as impulsive could not be predicted by sleep quality or the insomnia score. To a large extent the results of this study support the hypothesis that poor sleep is related to impulsive, aggressive behavior in forensic psychiatric patients. It is worthwhile to examine the protective effect of treatment of sleep difficulties on aggressive reactivity in (forensic) psychiatric populations. PMID:24184508

  13. Psychiatric comorbidity and mortality among veterans hospitalized for congestive heart failure.

    PubMed

    Banta, Jim E; Andersen, Ronald M; Young, Alexander S; Kominski, Gerald; Cunningham, William E

    2010-10-01

    A Behavioral Model of Health Services Utilization approach was used to examine the impact of comorbid mental illness on mortality of veterans admitted to Veterans Affairs medical centers in fiscal year 2001 with a primary diagnosis of congestive heart failure (n = 15,497). Thirty percent had a psychiatric diagnosis, 4.7% died during the index hospitalization, and 11.5% died during the year following discharge. Among those with mental illness, 23.6% had multiple psychiatric disorders. Multivariable logistic regression models found dementia to be positively associated with inpatient mortality. Depression alone (excluding other psychiatric disorders) was positively associated with one-year mortality. Primary care visits were associated with a reduced likelihood of both inpatient and one-year mortality. Excepting dementia, VA patients with a mental illness had comparable or higher levels of primary care visits than those having no mental illness. Patients with multiple psychiatric disorders had more outpatient care than those with one psychiatric disorder. PMID:20968262

  14. Vulnerabilities of children admitted to a pediatric inpatient care unit☆

    PubMed Central

    de Oliveira, Larissa Natacha; Breigeiron, Márcia Koja; Hallmann, Sofia; Witkowski, Maria Carolina

    2014-01-01

    OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital. METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics. RESULTS: Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability. CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family. PMID:25511001

  15. Internees in Poland: psychiatric abuse claim.

    PubMed

    Rich, Vera

    1982-09-30

    The World Psychiatric Association has been asked to intervene on behalf of four Polish internees who are claiming to be victims of psychiatric repression for political reasons. Under martial law, Poland's security forces have shown a renewed interest in psychiatric internment of disruptive persons. PMID:11643799

  16. Psychiatric disorders, spouse abuse and child abuse.

    PubMed

    Bland, R C; Orn, H

    1986-01-01

    The results of 2000 standardized psychiatric diagnostic interviews of randomly selected adult household residents of Edmonton showed that having had any psychiatric diagnosis increased the risk for being involved in spouse and child abuse, particularly for those with alcohol abuse/dependence plus anti-social personality or depression. Altogether 56% of spouse abusers and 69% of child abusers had a lifetime psychiatric diagnosis.

  17. Academic Accommodations for Students with Psychiatric Disabilities.

    ERIC Educational Resources Information Center

    Souma, Alfred; Rickerson, Nancy; Burgstahler, Sheryl

    This brief paper summarizes the literature on academic accommodations for students with psychiatric disabilities. A definition of psychiatric disability precedes a brief summary of the following specific psychiatric diagnoses: depression, bipolar affective disorder; borderline personality disorder; schizophrenia; and anxiety disorders. Also noted…

  18. The Banner Psychiatric Center: A Model for Providing Psychiatric Crisis Care to the Community while Easing Behavioral Health Holds in Emergency Departments

    PubMed Central

    Little-Upah, Pat; Carson, Chris; Williamson, Robert; Williams, Tom; Cimino, Michael; Mehta, Neena; Buehrle, Jeff; Kisiel, Steve

    2013-01-01

    Banner Health in the Phoenix, AZ, metropolitan area provides individuals in a behavioral health crisis with an alternative to presenting to an Emergency Department (ED). By implementing a process to quickly move patients out of our ED, our health care system has been able to greatly reduce the hold time for behavioral health patients. Through access to psychiatric clinicians around the clock at the Banner Psychiatric Center, patients now receive the appropriate treatment and needed care in a timely manner. Finally, disposition of patients into appropriate levels of care has freed up acute care Level 1 beds to be available to patients who meet those criteria. PMID:23596368

  19. Symptom, Family, and Service Predictors of Children's Psychiatric Rehospitalization within One Year of Discharge.

    ERIC Educational Resources Information Center

    Blader, Joseph C.

    2004-01-01

    Objective: To investigate predictors of readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care hospitalization. Method: One hundred nine children were followed for 1 year after discharge from inpatient care. Time to rehospitalization was the outcome of interest. Predictors of readmission, examined via…

  20. The diagnosis and management of patients admitted to hospital with acute breathlessness.

    PubMed

    Pearson, S B; Pearson, E M; Mitchell, J R

    1981-07-01

    The authors have studied 352 emergency medical admissions during a summer period and 355 during the winter months to identify 177 patients who had been treated for breathlessness. Multiple and rapidly changing treatments have been taken to indicate diagnostic uncertainty. Using this model, the authors have shown that there is much more uncertainty in winter than in summer and that the working diagnosis of chest infection or asthma is particularly likely to be associated with multiple treatment. It is questionable whether the stereotyped descriptions of diseases in standard text books provide an adequate basis for emergency treatment decisions and it is considered that the diagnostic value of investigations such as chest radiography needs further careful scrutiny. PMID:7312736

  1. Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit.

    PubMed

    Theocharidou, E; Agarwal, B; Jeffrey, G; Jalan, R; Harrison, D; Burroughs, A K; Kibbler, C C

    2016-02-01

    Bacterial infections in cirrhosis are common and associated with increased mortality, but little is known about fungal infections. The aim of this study, a sub-analysis of the Fungal Infection Risk Evaluation study, was to assess the incidence and implications of early invasive fungal disease (IFD) in patients with cirrhosis admitted to intensive care units (ICU). Clinical and laboratory parameters collected in the first 3 days of ICU stay for 782 patients with cirrhosis and/or portal hypertension were analysed and compared with those of 273 patients with very severe cardiovascular disease (CVD). The CVD patients had more co-morbidities and higher APACHE II scores. The overall incidence of IFD was similar in the two groups, but the incidence of IFD in ICU was higher in liver patients (1% versus 0.4%; p 0.025) as was fungal colonization (23.8% versus 13.9%; p 0.001). The ICU and in-hospital mortality, and length of stay were similar in the two groups. A higher proportion of liver patients received antifungal therapy (19.2% versus 7%; p <0.0005). There was no difference in mortality between colonized patients who received antifungal therapy and colonized patients who did not. The incidence of IFD in patients with cirrhosis in ICU is higher compared with another high-risk group, although it is still very low. This risk might be higher in patients with advanced liver disease admitted with acute-on-chronic liver failure, and this should be investigated further. Our data do not support prophylactic use of antifungal therapy in cirrhosis. PMID:26551838

  2. Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive care unit: a multicenter study

    PubMed Central

    2012-01-01

    Introduction Community-acquired pneumonia (CAP) account for a high proportion of ICU admissions, with Streptococcus pneumoniae being the main pathogen responsible for these infections. However, little is known on the clinical features and outcomes of ICU patients with pneumococcal pneumonia. The aims of this study were to provide epidemiological data and to determine risk factors of mortality in patients admitted to ICU for severe S. pneumoniae CAP. Methods We performed a retrospective review of two prospectively-acquired multicentre ICU databases (2001-2008). Patients admitted for management of severe pneumococcal CAP were enrolled if they met the 2001 American Thoracic Society criteria for severe pneumonia, had life-threatening organ failure and had a positive microbiological sample for S. pneumoniae. Patients with bronchitis, aspiration pneumonia or with non-pulmonary pneumococcal infections were excluded. Results Two hundred and twenty two patients were included, with a median SAPS II score reaching 47 [36-64]. Acute respiratory failure (n = 154) and septic shock (n = 54) were their most frequent causes of ICU admission. Septic shock occurred in 170 patients (77%) and mechanical ventilation was required in 186 patients (84%); renal replacement therapy was initiated in 70 patients (32%). Bacteraemia was diagnosed in 101 patients. The prevalence of S. pneumoniae strains with decreased susceptibility to penicillin was 39.7%. Although antibiotherapy was adequate in 92.3% of cases, hospital mortality reached 28.8%. In multivariate analysis, independent risk factors for mortality were age (OR 1.05 (95% CI: 1.02-1.08)), male sex (OR 2.83 (95% CI: 1.16-6.91)) and renal replacement therapy (OR 3.78 (95% CI: 1.71-8.36)). Co-morbidities, macrolide administration, concomitant bacteremia or penicillin susceptibility did not influence outcome. Conclusions In ICU, mortality of pneumococcal CAP remains high despite adequate antimicrobial treatment. Baseline demographic data

  3. Clinical Factors Associated with Morbidity and Mortality in Patients Admitted with Sickle Cell Disease

    PubMed Central

    Galloway-Blake, K; Reid, M; Walters, C; Jaggon, J; Lee, MG

    2014-01-01

    ABSTRACT Objective: To determine the clinical factors associated with the length of hospitalization and mortality in patients with sickle cell disease (SCD). Methods: All patients with SCD admitted to the medical wards of the University Hospital of the West Indies, Jamaica, over a five-year period, January 1, 2005 to December 31, 2010, were reviewed. Data were extracted from hospital charts and comprised demographic and clinical information, investigations, interventions, duration of stay, pathological data and outcomes. Results: There were 105 patients reviewed; 84% were genotype Hb SS. Females accounted for 59% and males 41%. Overall mean age was 32.5 years (SD 13.7, range 12–66 years). The mean length of hospitalization was 10.2 days (SD 10.9, range 1–84 days). The main admission diagnoses were painful crisis, acute chest syndrome, severe anaemia, sepsis, hepatic sequestration, congestive cardiac failure and renal failure. The mean values for the following laboratory investigations were: haemoglobin 7.7 g/dL (SD 2.8), total white blood cell count 21.7 × 109/L (SD 14.2), platelet count 320 × 109/L (SD 191.9), blood urea 9.8 mmol/L (SD 11.9) and serum creatinine 198 umol/L (SD 267.9). Medical interventions included: blood transfusions in 20.9%, 55% received antibiotics and 74% received narcotic analgesia. There were 40 deaths with four autopsies done. The mortality rate for SCD was 38%. There were 189 repeat SCD admissions. Conclusion: Sickle cell disease still carries a high morbidity and mortality in patients admitted to hospital. Recurrent admissions are a concern, as they impact on patient's morbidity and quality of life. PMID:25867578

  4. Psychiatric issues in solid organ transplantation.

    PubMed

    Heinrich, Thomas W; Marcangelo, Michael

    2009-01-01

    The identification and treatment of psychiatric comorbidity in patients undergoing solid organ transplantation present a unique opportunity for psychiatric involvement in the care of medically complex patients. The burden of psychiatric illness in patients awaiting transplant and following transplant is significant and associated with potential morbidity and mortality. Possibilities for psychiatric liaison with our colleagues in transplant medicine and surgery start with the comprehensive psychiatric evaluation that is often performed with potential organ recipients and donors. The vital role of the psychiatrist continues following transplantation, as adjustment is often a stressful experience with associated psychiatric comorbidity. The treatment of psychiatric illness in patients following transplantation requires an understanding of the immunosuppressant medications that patients may be taking, coupled with an awareness of the associated risks of adverse effects and drug-drug interactions.

  5. Nosocomial transmission of rotavirus from patients admitted with diarrhea.

    PubMed Central

    Gaggero, A; Avendaño, L F; Fernández, J; Spencer, E

    1992-01-01

    We studied the transmission of rotavirus (RV) in 950 patients under 2 years of age hospitalized for diarrhea in Santiago, Chile. Stool samples were collected every other day from all patients during their entire hospital stay. To trace nosocomial transmission, we mapped the ward at the time of detection of RV. Comparative study by polyacrylamide gel electrophoresis of 315 RV isolates (180 detected upon admission of patients and 135 attributed to nosocomial transmission) allowed the identification of 18 different electropherotypes. An electropherotype similar to that of a community-acquired case was found in the same room in 81% of nosocomial cases and in the ward in 92% of nosocomial cases. It was concluded that the infants admitted shedding RV are the major source of nosocomial transmission and there was not a RV strain that was particularly transmissible. Images PMID:1333491

  6. Gravitational instantons admit hyper-Kähler structure

    NASA Astrophysics Data System (ADS)

    Aliev, A. N.; Nutku, Y.

    1999-01-01

    We construct the explicit form of three almost-complex structures that a Riemannian manifold with self-dual curvature admits and show that their Nijenhuis tensors vanish so that they are integrable. This proves that gravitational instantons with self-dual curvature admit hyper-Kähler structure. In order to arrive at the three vector-valued 1-forms defining almost-complex structure, we give a spinor description of real four-dimensional Riemannian manifolds with Euclidean signature in terms of two independent sets of two-component spinors. This is a version of the original Newman-Penrose formalism that is appropriate to the discussion of the mathematical, as well as physical properties of gravitational instantons. We shall build on the work of Goldblatt who first developed an NP formalism for gravitational instantons but we shall adopt it to differential forms in the NP basis to make the formalism much more compact. We shall show that the spin coefficients, connection 1-form, curvature 2-form, Ricci and Bianchi identities, as well as the Maxwell equations naturally split up into their self-dual and anti-self-dual parts corresponding to the two independent spin frames. We shall give the complex dyad as well as the spinor formulation of the almost-complex structures and show that they reappear under the guise of a triad basis for the Petrov classification of gravitational instantons. Completing the work of Salamon on hyper-Kähler structure, we show that the vanishing of the Nijenhuis tensor for all three almost-complex structures depends on the choice of a self-dual gauge for the connection which is guaranteed by virtue of the fact that the curvature 2-form is self-dual for gravitational instantons.

  7. Vitamin D status of adolescent inpatients in a secure psychiatric hospital

    PubMed Central

    Hill, Simon A.; Riordan-Eva, Elliott; Bhandari, Bharathi; Ferdinandez, Uresh

    2016-01-01

    Objective: The objective of the study was to use routinely collected data on vitamin D levels of adolescents detained in a secure psychiatric hospital to see if this at-risk group for vitamin D deficiency do in fact have low vitamin D levels. Methods: Vitamin D blood levels were collated from clinical records of inpatients admitted to Bluebird House, a medium secure adolescent unit, since 2012. Corresponding data were gathered to include gender, ethnic status and age. Blood levels were assessed on admission to the unit and after treatment with vitamin D supplementation, if indicated. Results: Only 3 out of the 35 patients (8.6%) had adequate vitamin D levels (serum 25-hydroxyvitamin D [25-OHD] > 50 nmol/l). A total of 23 patients (65.7%) had levels consistent with deficiency (25-OHD < 30 nmol/l) with the remaining 9 patients (25.7%) showing levels indicating possible deficiency (25-OHD 30–50 nmol/l. Conclusions: Vitamin D levels were low in our sample of young people admitted to a secure psychiatric hospital. This is the first published study of vitamin D levels in a secure adolescent psychiatric hospital. The results point to the need for routine prescription of vitamin D to adolescents held in secure conditions such as hospitals, secure children’s homes and youth offender institutes. PMID:27536343

  8. French perspectives on psychiatric classification.

    PubMed

    Crocq, Marc-Antoine

    2015-03-01

    This article reviews the role of the French schools in the development of psychiatric nosology. Boissier de Sauvages published the first French treatise on medical nosology in 1763. Until the 1880s, French schools held a pre-eminent position in the development of psychiatric concepts. From the 1880s until World War I, German-speaking schools exerted the most influence, featuring the work of major figures such as Emil Kraepelin and Eugen Bleuler. French schools were probably hampered by excessive administrative and cultural centralization. Between the 1880s and the 1930s, French schools developed diagnostic categories that set them apart from international classifications. The main examples are Bouffée Délirante, and the complex set of chronic delusional psychoses (CDPs), including chronic hallucinatory psychosis. CDPs were distinguished from schizophrenia by the lack of cognitive deterioration during evolution. Modern French psychiatry is now coming into line with international classification, such as DSM-5 and the upcoming ICD-11.

  9. Fratricide: a forensic psychiatric perspective.

    PubMed

    Bourget, Dominique; Gagné, Pierre

    2006-01-01

    Analyses of fratricide rates based on national homicide data have provided some general information pertaining to offenders and victims of sibling homicide but are limited by data constraints to examining a few major variables. Exploring fratricide from a forensic psychiatric perspective could uncover other related factors and provide insight into why some individuals murder their siblings. In a retrospective study of data from coroners' files on domestic homicide pertaining to individuals killed by their siblings over a 10-year period in Quebec, Canada, we identified several specific offender and victim characteristics and circumstances surrounding offenses. The impact of mental illness and substance abuse on fratricidal behavior is indicated, underscoring the importance of identifying existing psychopathology. From a forensic psychiatric perspective, we identify characteristic patterns and discuss potential dynamics operating in fratricide. We raise some issues relevant to treatment and prevention, including the fact that most cases are alcohol-related, impulsive, and unpredictable until the moment they occur.

  10. Psychiatric effects of cannabis use.

    PubMed

    Tunving, K

    1985-09-01

    That cannabis use may provoke mental disturbances is well known to Scandinavian psychiatrists today. A review of the psychiatric aspects of cannabis use is given, and the clinical signs of 70 cases of cannabis psychoses collected in Sweden are described. The bluntness and "amotivation" following chronic cannabis use are discussed. Anxiety reactions, flashbacks, dysphoric reactions and an abstinence syndrome are all sequels of cannabis use. Three risk groups begin to emerge: a) Young teenage cannabis users who lose some of their capacity to learn complex functions and who flee from reality to a world of dreams. With its sedative effect, cannabis could modify such emotions as anger and anxiety and slow down the liberation process of adolescence. b) Heavy daily users, often persons who cannot cope with depression or their life circumstances. c) Psychiatric patients whose resistance to relapses into psychotic reactions might be diminished according to the psychotropic effects of cannabis.

  11. Psychiatric Aspects of Organ Transplantation

    PubMed Central

    Kalra, G.; Desousa, A.

    2011-01-01

    Surgical transplantation of human organs from deceased as well as living donors to sick and dying patients began after the Second World War. Over the past 50 years the transplantation of human organs, tissues and cells has become a worldwide practice which has extended, and greatly enhanced the quality of hundreds of thousands of lives. The field of transplantation medicine provides an important chance for liaison between psychiatric professionals and other transplant physicians and surgeons. The discrepancy between the ever-increasing demand for organs but the decreasing supply makes it important to evaluate and prioritize individuals who are in dire need of the organ. However, this also gives rise to certain ethical questions. The following paper discusses various psychiatric aspects of organ transplantation in general. PMID:25013589

  12. Psychiatric morbidity following Hurricane Andrew.

    PubMed

    David, D; Mellman, T A; Mendoza, L M; Kulick-Bell, R; Ironson, G; Schneiderman, N

    1996-07-01

    The nature of psychiatric morbidity in previously non-ill subjects from the area most affected by Hurricane Andrew was investigated at 6-12 months posthurricane. Preliminary associations of morbidity with personal and event-related risk factors were also determined. Fifty one percent (31/61) met criteria for a new-onset disorder, including posttraumatic stress disorder (PTSD) in 36%, major depression (MD) in 30%, and other anxiety disorders in 20%. Thirty four subjects (56%) had significant symptoms persisting beyond 6 months. Having sustained "severe damage" was the risk factor most strongly associated with outcome. Our data underscore the range of psychiatric morbidity related to a natural disaster, and suggest a relationship to chronic stressors.

  13. Imaging Genetics and Psychiatric Disorders

    PubMed Central

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M

    2015-01-01

    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-O-methyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of large-scale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders. PMID:25732148

  14. Imaging genetics and psychiatric disorders.

    PubMed

    Hashimoto, R; Ohi, K; Yamamori, H; Yasuda, Y; Fujimoto, M; Umeda-Yano, S; Watanabe, Y; Fukunaga, M; Takeda, M

    2015-01-01

    Imaging genetics is an integrated research method that uses neuroimaging and genetics to assess the impact of genetic variation on brain function and structure. Imaging genetics is both a tool for the discovery of risk genes for psychiatric disorders and a strategy for characterizing the neural systems affected by risk gene variants to elucidate quantitative and mechanistic aspects of brain function implicated in psychiatric disease. Early studies of imaging genetics included association analyses between brain morphology and single nucleotide polymorphisms whose function is well known, such as catechol-Omethyltransferase (COMT) and brain-derived neurotrophic factor (BDNF). GWAS of psychiatric disorders have identified genes with unknown functions, such as ZNF804A, and imaging genetics has been used to investigate clues of the biological function of these genes. The difficulty in replicating the findings of studies with small sample sizes has motivated the creation of largescale collaborative consortiums, such as ENIGMA, CHARGE and IMAGEN, to collect thousands of images. In a genome-wide association study, the ENIGMA consortium successfully identified common variants in the genome associated with hippocampal volume at 12q24, and the CHARGE consortium replicated this finding. The new era of imaging genetics has just begun, and the next challenge we face is the discovery of small effect size signals from large data sets obtained from genetics and neuroimaging. New methods and technologies for data reduction with appropriate statistical thresholds, such as polygenic analysis and parallel independent component analysis (ICA), are warranted. Future advances in imaging genetics will aid in the discovery of genes and provide mechanistic insight into psychiatric disorders.

  15. Psychiatric Thoughts in Ancient India*

    PubMed Central

    Abhyankar, Ravi

    2015-01-01

    A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry. PMID:25838724

  16. Adult Neurogenesis and Psychiatric Disorders.

    PubMed

    Kang, Eunchai; Wen, Zhexing; Song, Hongjun; Christian, Kimberly M; Ming, Guo-Li

    2016-01-01

    Psychiatric disorders continue to be among the most challenging disorders to diagnose and treat because there is no single genetic or anatomical locus that is causative for the disease. Current treatments are often blunt tools used to ameliorate the most severe symptoms, at the risk of disrupting functional neural systems. There is a critical need to develop new therapeutic strategies that can target circumscribed functional or anatomical domains of pathology. Adult hippocampal neurogenesis may be one such domain. Here, we review the evidence suggesting that adult hippocampal neurogenesis plays a role in emotional regulation and forms of learning and memory that include temporal and spatial memory encoding and context discrimination, and that its dysregulation is associated with psychiatric disorders, such as affective disorders, schizophrenia, and drug addiction. Further, adult neurogenesis has proven to be an effective model to investigate basic processes of neuronal development and converging evidence suggests that aberrant neural development may be an etiological factor, even in late-onset diseases. Constitutive neurogenesis in the hippocampus of the mature brain reflects large-scale plasticity unique to this region and could be a potential hub for modulation of a subset of cognitive and affective behaviors that are affected by multiple psychiatric disorders. PMID:26801682

  17. Chronotherapeutics in a psychiatric ward.

    PubMed

    Benedetti, Francesco; Barbini, Barbara; Colombo, Cristina; Smeraldi, Enrico

    2007-12-01

    Psychiatric chronotherapeutics is the controlled exposure to environmental stimuli that act on biological rhythms in order to achieve therapeutic effects in the treatment of psychiatric conditions. In recent years some techniques (mainly light therapy and sleep deprivation) have passed the experimental developmental phase and reached the status of powerful and affordable clinical interventions for everyday clinical treatment of depressed patients. These techniques target the same brain neurotransmitter systems and the same brain areas as do antidepressant drugs, and should be administered under careful medical supervision. Their effects are rapid and transient, but can be stabilised by combining techniques among themselves or together with common drug treatments. Antidepressant chronotherapeutics target the broadly defined depressive syndrome, with response and relapse rates similar to those obtained with antidepressant drugs, and good results are obtained even in difficult-to-treat conditions such as bipolar depression. Chronotherapeutics offer a benign alternative to more radical treatments of depression for the treatment of severe depression in psychiatric wards, but with the advantage of rapidity of onset.

  18. [The psychiatric illness of Vincent van Gogh].

    PubMed

    Strik, W K

    1997-05-01

    Vincent van Gogh's illness has been the object of much speculation. Explanations as disparate as acute intermittent porphyria, epilepsy and schizophrenia have been proposed. Many of the diagnostic hypotheses, however, are based on partial or incomplete consideration of the biography and of the reports of his subjective experience in his letters to his brother. Karl Leonhard showed, in a detailed analysis of Vincent's biography, that both the course and symptoms of the disorder were consistent with the diagnosis of a cycloid psychosis (anxiety-elation psychosis). In the present paper, the diagnostic judgement of Leonhard is described and discussed in the light of independent research on van Gogh's letters, his works and biography. The bibliographical sources were investigated for information consistent with a cycloid psychosis, but also for information that might contradict this hypothesis. The course and symptoms of the disorder are presented as comprehensively and systematically as possible and are documented with the respective citations. Furthermore, the most important diagnoses proposed in the literature are critically discussed. Based on this investigation, it was possible to show that only the diagnosis of a cycloid psychosis allowed us to connect all the available information to a typical psychiatric syndrome.

  19. [Psychiatric complication of an implanted automatic defibrillator].

    PubMed

    Goëb, J L; Galloyer-Fortier, A; Dupuis, J M; Victor, J; Gohier, B; Garré, J B

    2003-12-01

    The implantable automatic defibrillator has completely changed the prognosis of potentially fatal ventricular arrhythmias by the delivery of an electric shock in the event of ventricular tachycardia or fibrillation. This vital device is sometimes poorly accepted from the psychological point of view by patients having been traumatised by experiences of sudden death from which they have been rescuscitated. Anxiety and depression are common and they have an important effect on the quality of life. The unpredictable occurrence of painful, multiple and uncontrollable electrical shocks may induce a state of acute stress with stunning, the resemblance of which to the model of learned helplessness described experimentally in the animal by Seligman, is discussed. The authors report the case of a 20 year old man whose automatic defibrillator was activated twenty times in one night. His state of stress and impotence was such that he lay prostate in his bed. Suicide seemed to be the only possible way of escaping from the electrical shocks of the device which was perceived as being dangerous. The management of this condition is not standardised but it requires the collaboration of the cardiac rhythmological and psychiatric teams. Medication with antidepressant drugs alone is not sufficient. The regulation of the sensitivity of the defibrillator gives the patient a feeling of mastering the situation: submission is not total! Research along this line should improve the patients' acceptation of the device and their quality of life. PMID:15248453

  20. PSYCHIATRIC ASPECTS OF CLINICAL PRACTICE IN GENERAL HOSPITALS: A SURVEY OF NON-PSYCHIATRIC CLINICIANS

    PubMed Central

    Chadda, R.K.; Shome, S.

    1996-01-01

    The present work was carried out to study the awareness of non-psychiatric clinicians working in a teaching general hospital about the frequency of psychiatric morbidity in their clinical practice, their utilization of psychiatric consultation services, and opinion about utility of liaison psychiatry in general hospitals. A substantial proportion of doctors underestimated the psychiatric morbidity especially about unexplained physical symptoms and specific depressive symptoms in their patients. Psychiatric consultation services were not sufficiently utilised by a large number of clinicians. Most ofthemfelt the need to improve upon undergraduate medical education in psychiatry in India as well as a desire to have consultation - liaison psychiatric units in India. PMID:21584151

  1. Psychiatric and medical management of marijuana intoxication in the emergency department.

    PubMed

    Bui, Quan M; Simpson, Scott; Nordstrom, Kimberly

    2015-05-01

    We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient's psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care.

  2. Psychiatric and medical management of marijuana intoxication in the emergency department.

    PubMed

    Bui, Quan M; Simpson, Scott; Nordstrom, Kimberly

    2015-05-01

    We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient's psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. PMID:25987916

  3. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    PubMed Central

    Bui, Quan M.; Simpson, Scott; Nordstrom, Kimberly

    2015-01-01

    We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. PMID:25987916

  4. [Support for the psychiatric nurse specialist and the psychiatric community nurse in their interactions with the psychiatric patient. Part II].

    PubMed

    van Wyk, S; Poggenpoel, M; Gmeiner, A C

    1998-09-01

    In this article the research is described that had as goal to generate a supportive approach for the psychiatric nurse specialist to the psychiatric community nurse in interaction with the psychiatric patient, to promote, maintain and restore their mental health as an integral part of health. Guidelines for operationalisation of this supportive approach by the psychiatric nurse specialist, are also described. The research design utilised a qualitative, descriptive and contextual design. The exploratory field work was done in phase one of this research (as described in part I of these articles) and consisted of phenomenological interviews and focus groups. Trustworthiness was ensured by utilising Guba's model for trustworthiness.

  5. Pro re nata medication for psychiatric inpatients: time to act.

    PubMed

    Hilton, Michael F; Whiteford, Harvey A

    2008-07-01

    Pro re nata (PRN; 'as needed') medication is an archetypal mainstay for managing acute psychiatric inpatient symptoms and behaviours. Psychiatric and mental health nursing practices have circumnavigated the development of a uniform medical-ethical standard for the administration of PRN psychotropic medication. This paper examines the evidence for administration of PRN psychotropic medications and, in the context of evidence-based best practice, current mental health policy and professional ethics, proposes a standardized Australian PRN administration protocol. The procedures and circumstances leading to a nurse administering psychotropic PRN medication are divided into five simple steps, namely (i) medical prescription; (ii) nurse evaluation of patient indications for an intervention; (iii) nurse consideration of therapeutic options; (iv) obtaining patient informed consent; and (v) documentation of outcomes of PRN administration. The literature associated with each step is reviewed, along with national and international professional ethics, guidelines and patient rights documents pertaining to the care of mental health patients. Recommendations for best-practise care are discussed for each step. There is a lacuna of published evidence supporting the use of PRN medications in psychiatric inpatients. Yet there is published evidence that PRN medications are associated with increased risks of morbidity, inappropriate use, may result in above-recommended dosages or polypharmacy, and complicate the assessment of efficacy of regular scheduled medicines. Alternative non-pharmacological treatment options to PRN medication are effective and associated with fewer side-effects. There are no national explicit standards, operational criteria or quality assurance for the use of PRN medication in inpatient psychiatric units. Contemporary PRN practices are largely unregulated and driven by essentially anecdotal evidence, leaving the clinicians and the service open to claims of poor

  6. Incidence and risk factors of workplace violence on psychiatric staff

    PubMed Central

    Ridenour, Marilyn; Lanza, Marilyn; Hendricks, Scott; Hartley, Dan; Rierdan, Jill; Zeiss, Robert; Amandus, Harlan

    2015-01-01

    BACKGROUND A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older. OBJECTIVE An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units. PARTICIPANTS Two-hundred eighty-four nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010. METHODS Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model. RESULTS Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm – 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am – 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression. CONCLUSION Healthcare workers in psychiatric settings are at high risk for aggression from patients. PMID:24894691

  7. Pattern of ocular trauma admitted in a tertiary hospital.

    PubMed

    Quayum, M A; Akhanda, A H

    2009-01-01

    Ocular trauma is an important cause of ocular morbidity. This prospective study was conducted to identify primarily the population at risk, sources of eye injuries and the common barriers for their early management. Cases were selected randomly during the period Aug/2006 to March/2008 among the patients admitted in the department of ophthalmology, Mymensingh Medical College Hospital, with the history of ocular injury. A total of 100 eyes in 97 patients were included in the study. Age ranges were 1.5 years to 75 years. Male were 78.35% (n=76) & female were 21.65% (n=21). 56.00% (n=56) injuries were accidental occupational injuries. Common sources of eye injury included sharp objects used in occupational activities 43% (n=43), blunt objects 23% (n=23), Chemicals 7% (n=7), Projectile objects 8%, (n=8), Bird-beak 5% (n=5), agricultural trauma 3% (n=3) and miscellaneous 11% (n=11). Young adult males engaged in industrial, mechanical, agricultural or domestic works are at particular risk for ophthalmic trauma. Poverty, ignorance, indigenous treatment, remote communications and lack of supervised and collaborative management seems to be the possible barriers for the early management of ocular injuries. Preventive measures are recommended to adopt not only in the workplaces but also in domestic, recreational, sports and transport settings.

  8. Refining a relativistic, hydrodynamic solver: Admitting ultra-relativistic flows

    NASA Astrophysics Data System (ADS)

    Bernstein, J. P.; Hughes, P. A.

    2009-09-01

    We have undertaken the simulation of hydrodynamic flows with bulk Lorentz factors in the range 102-106. We discuss the application of an existing relativistic, hydrodynamic primitive variable recovery algorithm to a study of pulsar winds, and, in particular, the refinement made to admit such ultra-relativistic flows. We show that an iterative quartic root finder breaks down for Lorentz factors above 102 and employ an analytic root finder as a solution. We find that the former, which is known to be robust for Lorentz factors up to at least 50, offers a 24% speed advantage. We demonstrate the existence of a simple diagnostic allowing for a hybrid primitives recovery algorithm that includes an automatic, real-time toggle between the iterative and analytical methods. We further determine the accuracy of the iterative and hybrid algorithms for a comprehensive selection of input parameters and demonstrate the latter’s capability to elucidate the internal structure of ultra-relativistic plasmas. In particular, we discuss simulations showing that the interaction of a light, ultra-relativistic pulsar wind with a slow, dense ambient medium can give rise to asymmetry reminiscent of the Guitar nebula leading to the formation of a relativistic backflow harboring a series of internal shockwaves. The shockwaves provide thermalized energy that is available for the continued inflation of the PWN bubble. In turn, the bubble enhances the asymmetry, thereby providing positive feedback to the backflow.

  9. Meningitis admitted to a military hospital: a retrospective case series.

    PubMed

    Harrell, Travis; Hammes, John S

    2012-10-01

    Meningitis is a common admission diagnosis. No case series or descriptive studies on meningitis have recently been published. Additionally, no recent data exist on meningitis in the U.S. Military Health System. We reviewed charts of adult patients admitted to Naval Medical Center San Diego between January 2004 and December 2008 with an admission diagnosis of meningitis. Charts were excluded if they did not meet our case definition of meningitis, if missing data, or if meningitis was nosocomial or iatrogenic. We reviewed results of cerebrospinal fluid cultures during this period. We compared rates and characteristics, and outcomes of bacterial and aseptic meningitis. Two hundred twenty-one cases met our criteria. Of these, 208 were aseptic. Cerebrospinal fluid polymerase chain reaction testing was positive for enteroviruses and herpes simplex viruses in 42 (20.2%) and 17 (8.2%) cases, respectively. Of culture/polymerase chain reaction/serologically positive cases, the pathogens were Neisseria meningitidis (3), Streptococcus pneumoniae (3), viridans streptococci (2), Cryptococcus neoformans (2), Coccidioides immitis (2), and Mycobacterium tuberculosis (1). Three patients had poor outcomes: one died from S. pneumoniae and two had long-term neurologic deficits. Meningitis is a common admission diagnosis, but serious virulent pathogens are uncommon and adverse outcomes are rare.

  10. Psychophysiologic testing for post-traumatic stress disorder: forensic psychiatric application.

    PubMed

    Pitman, R K; Orr, S P

    1993-01-01

    The validity of the post-traumatic stress disorder (PTSD) diagnosis is limited by both the illusory objectivity of the traumatic event and the subjectivity of the ensuing syndrome. These limitations are especially problematic in the forensic setting. Psychophysiologic measurements may strengthen PTSD's forensic value by offering a more objective assessment technique for cases that find their way into the courtroom. Based upon the results of published research studies conducted in a range of military and civilian, PTSD and non-PTSD subjects, psychophysiologic data can provide evidence helping to establish or refute the presence of the DSM-III-R PTSD arousal criteria, as well as aid psychiatric experts in estimating the probability of the disorder's presence in a given claimant. Psychophysiologic testing should be viewed as one component of a multimethod forensic psychiatric evaluation for PTSD. It is likely that it will soon be offered and, given current legal standards, admitted as evidence in civil and criminal litigation.

  11. Psychiatric aspects of therapeutic abortion.

    PubMed

    Doane, B K; Quigley, B G

    1981-09-01

    A search of the literature on the psychiatric aspects of abortion revealed poor study design, a lack of clear criteria for decisions for or against abortion, poor definition of psychologic symptoms experienced by patients, absence of control groups in clinical studies, and indecisiveness and uncritical attitudes in writers from various disciplines. A review of the sequelae of therapeutic abortion revealed that although the data are vague, symptoms of depression were reported most frequently, whereas those of psychosis were rare. Positive emotional responses and a favourable attitude toward therapeutic abortion were often reported, although again the statistical bases for these reports were inadequate. There was a lack of evidence that the reported effects were due to having an abortion rather than to other variables.Other areas dealt with inadequately in most of the articles reviewed included analyses of symptoms and of the evidence on the duration of sequelae, descriptions of the criteria for approving abortions, investigation of the psychiatric histories of the patients, presentation of data on the effects of refusing abortion requests, systematic study of a number of epidemiologic factors, and analyses of the circumstances leading to pregnancy in patients having abortions. The evidence was found to be sparse on the effects of supportive relationships, different abortion techniques and the length of gestation on the psychologic status of patients. Little attention was paid to the consequences of psychiatric labelling of patients, or to the effect of having an abortion on factors that may influence future pregnancies.The potential roles of health care professionals appear to deserve more study, and little research seems to have been done to compare the psychologic factors associated with abortion and those associated with live birth. As well, there is little evidence that differences in abortion legislation account for significant differences in the psychologic

  12. Psychiatric stigma in correctional facilities.

    PubMed

    Miller, R D; Metzner, J L

    1994-01-01

    While legislatively sanctioned discrimination against the mentally ill in general society has largely disappeared, it persists in correctional systems where inmates are denied earn-time reductions in sentences, parole opportunities, placement in less restrictive facilities, and opportunities to participate in sentence-reducing programs because of their status as psychiatric patients or their need for psychotropic medications. The authors discuss the prevalence of such problems from detailed examinations of several correctional systems and from the results of a national survey of correctional medical directors.

  13. Psychiatric Emergencies in the Elderly.

    PubMed

    Sikka, Veronica; Kalra, S; Galwankar, Sagar; Sagar, Galwankar

    2015-11-01

    With the increasing life expectancy, the geriatric population has been increasing over the past few decades. By the year 2050, it is projected to compose more than a fifth of the entire population, representing a 147% increase in this age group. There has been a steady increase in the number of medical and psychiatric disorders, and a large percentage of geriatric patients are now presenting to the emergency department with such disorders. The management of our progressively complex geriatric patient population will require an integrative team approach involving emergency medicine, psychiatry, and hospitalist medicine.

  14. Psychiatric intervention and repeated admission to emergency centres due to drug overdose

    PubMed Central

    Yamana, Hayato; Yasunaga, Hideo; Matsui, Hiroki; Ando, Shuntaro; Okamura, Tsuyoshi; Kumakura, Yousuke; Fushimi, Kiyohide; Kasai, Kiyoto

    2015-01-01

    Background Repeated drug overdose is a major risk factor for suicide. Data are lacking on the effect of psychiatric intervention on preventing repeated drug overdose. Aims To investigate whether psychiatric intervention was associated with reduced readmission to emergency centres due to drug overdose. Method Using a Japanese national in-patient database, we identified patients who were first admitted to emergency centres for drug overdose in 2010–2012. We used propensity score matching for patient and hospital factors to compare readmission rates between intervention (patients undergoing psychosocial assessment) and unexposed groups. Results Of 29 564 eligible patients, 13 035 underwent psychiatric intervention. In the propensity-matched 7938 pairs, 1304 patients were readmitted because of drug overdose. Readmission rate was lower in the intervention than in the unexposed group (7.3% v. 9.1% respectively, P<0.001). Conclusions Psychiatric intervention was associated with reduced readmission in patients who had taken a drug overdose. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703741

  15. Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic.

    PubMed

    Gast, U; Rodewald, F; Nickel, V; Emrich, H M

    2001-04-01

    The aim of the study was to determine the frequency of dissociative disorders among psychiatric inpatients in Germany and to investigate the relationship between childhood trauma and dissociation. The German version of the Dissociative Experiences Scale (DES), the Fragebogen für Dissoziative Symptome (FDS), was used to screen 115 consecutive inpatients admitted to the psychiatric clinic of a university hospital. Patients with FDS scores higher than 20 were interviewed by a trained clinician, using the German translation of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). The German version of the Childhood Trauma Questionnaire (CTQ) was administered to investigate prevalence of childhood trauma and relations between childhood trauma and dissociation in adult life. Twenty-five of the 115 patients (21.7%) had a score higher than 20 on the FDS. Of these, 15 patients were interviewed with the SCID-D-R. One patient was diagnosed with a dissociative identity disorder, three with dissociative disorders not otherwise specified, and one patient with depersonalization disorder. All diagnoses were confirmed clinically. A significant positive relationship was found between the severity of childhood trauma and dissociation. Dissociative disorders are common among German psychiatric inpatients. Clinicians who work in psychiatric inpatient units should be mindful of these disorders.

  16. An audit study of defaulters of regular psychiatric outpatient appointments in Hong Kong.

    PubMed

    Pang, A H; Tso, S; Ungvari, G S; Chiu, H; Leung, T

    1995-01-01

    This paper describes an audit study of general psychiatric outpatient defaulters in Hong Kong. Defaulters were increased among those who were married, unemployed, housewives, seen within one year, receiving medications and previously admitted to hospital. Clinical diagnoses (ICD-10 Axis-1) of the F1, F2, F3 and F7 groups were also associated with increased defaulting behaviour. However, fewer defaulters were found among those who were aged below 19, single, employed, students, and had diagnostic groups of F4 and F9. These results added new information on the non-attendance behavioral pattern of Chinese patients.

  17. Prevalence of childhood physical and sexual abuse in veterans with psychiatric diagnoses.

    PubMed

    Koola, Maju Mathew; Qualls, Clifford; Kelly, Deanna L; Skelton, Kelly; Bradley, Bekh; Amar, Richard; Duncan, Erica J

    2013-04-01

    We examined the prevalence of childhood (≤ 18 years) physical and sexual abuse reported among patients admitted to the psychiatric inpatient service and the differential rates of this abuse associated with psychiatric diagnoses. This study consisted of a retrospective chart review of 603 patients admitted to a psychiatric ward during a period of 1 year at Atlanta Veterans Affairs Medical Center who had data on childhood physical and sexual abuse. The prevalence of reported childhood physical or sexual abuse in this inpatient clinical population was 19.4% (117/603). The prevalence of reported physical abuse was 22.6% (19/84) in the women and 12.0% (62/519) in the men (p = 0.008); the prevalence of sexual abuse was 33.3% (28/84) in the women and 7.7% (40/519) in the men (p < 0.0001). More patients with depressive disorders reported sexual abuse than did those without these disorders. More patients with posttraumatic stress disorder (PTSD) reported physical and sexual abuse than did those without these disorders. Stratifying by race, sex, and diagnoses, multivariate analyses showed that the women with PTSD had a greater likelihood to report physical abuse (p = 0.03) and sexual abuse histories (p = 0.008) than did the women without PTSD. The men with substance-induced mood disorder (p = 0.01) were more likely to report physical abuse compared with the men without substance-induced mood disorder. Screening for abuse in patients with depressive disorders and PTSD is warranted to tailor individualized treatments for these patients. More research is needed to better understand the potential implications of childhood abuse on psychiatric diagnoses.

  18. Cystitis - acute

    MedlinePlus

    Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 ...

  19. Prevalence of victims of violence admitted to an emergency department

    PubMed Central

    Hofner, M; Python, N; Martin, E; Gervasoni, J; Graz, B; Yersin, B

    2005-01-01

    Objective: To collect data on the consultation frequency and demographic profile of victims of violence attending an emergency department (ED) in Switzerland. Methods: We undertook screening of all admitted adult patients (>16 years) in the ED of the CHUV, Lausanne, Switzerland, over a 1 month period, using a modified version of the Partner Violence Screen questionnaire. Exclusionary criteria were: life threatening injury (National Advisory Committee on Aeronautics score ⩾4), or inability to understand or speak French, to give oral informed consent, or to be questioned without a family member or accompanying person being present. Data were collected on history of physical and/or psychological violence during the previous 12 months, the type of violence experienced by the patient, and if violence was the reason for the current consultation. Sociodemographic data were obtained from the registration documents. Results: The final sample consisted of 1602 patients (participation rate of 77.2%), with a refusal rate of 1.1%. Violence during the past 12 months was reported by 11.4% of patients. Of the total sample, 25% stated that violence was the reason for the current consultation; of these, 95% of patients were confirmed as victims of violence by the ED physicians. Patients reporting violence were more likely to be young and separated from their partner. Men were more likely to be victims of public violence and women more commonly victims of domestic violence. Conclusions: Based on this monthly prevalence rate, we estimate that over 3000 adults affected by violence consult our ED per annum. This underlines the importance of the problem and the need to address it. Health services organisations should establish measures to improve quality of care for victims. Guidelines and educational programmes for nurses and physicians should be developed in order to enhance providers' skills and basic knowledge of all types of violence, how to recognise and interact appropriately

  20. Scientists Admitting to Plagiarism: A Meta-analysis of Surveys.

    PubMed

    Pupovac, Vanja; Fanelli, Daniele

    2015-10-01

    We conducted a systematic review and meta-analysis of anonymous surveys asking scientists whether they ever committed various forms of plagiarism. From May to December 2011 we searched 35 bibliographic databases, five grey literature databases and hand searched nine journals for potentially relevant studies. We included surveys that asked scientists if, in a given recall period, they had committed or knew of a colleague who committed plagiarism, and from each survey extracted the proportion of those who reported at least one case. Studies that focused on academic (i.e. student) plagiarism were excluded. Literature searches returned 12,460 titles from which 17 relevant survey studies were identified. Meta-analysis of studies reporting committed (N = 7) and witnessed (N = 11) plagiarism yielded a pooled estimate of, respectively, 1.7% (95% CI 1.2-2.4) and 30% (95% CI 17-46). Basic methodological factors, including sample size, year of survey, delivery method and whether survey questions were explicit rather than indirect made a significant difference on survey results. Even after controlling for these methodological factors, between-study differences in admission rates were significantly above those expected by sampling error alone and remained largely unexplained. Despite several limitations of the data and of this meta-analysis, we draw three robust conclusions: (1) The rate at which scientists report knowing a colleague who committed plagiarism is higher than for data fabrication and falsification; (2) The rate at which scientists report knowing a colleague who committed plagiarism is correlated to that of fabrication and falsification; (3) The rate at which scientists admit having committed either form of misconduct (i.e. fabrication, falsification and plagiarism) in surveys has declined over time. PMID:25352123

  1. Scientists Admitting to Plagiarism: A Meta-analysis of Surveys.

    PubMed

    Pupovac, Vanja; Fanelli, Daniele

    2015-10-01

    We conducted a systematic review and meta-analysis of anonymous surveys asking scientists whether they ever committed various forms of plagiarism. From May to December 2011 we searched 35 bibliographic databases, five grey literature databases and hand searched nine journals for potentially relevant studies. We included surveys that asked scientists if, in a given recall period, they had committed or knew of a colleague who committed plagiarism, and from each survey extracted the proportion of those who reported at least one case. Studies that focused on academic (i.e. student) plagiarism were excluded. Literature searches returned 12,460 titles from which 17 relevant survey studies were identified. Meta-analysis of studies reporting committed (N = 7) and witnessed (N = 11) plagiarism yielded a pooled estimate of, respectively, 1.7% (95% CI 1.2-2.4) and 30% (95% CI 17-46). Basic methodological factors, including sample size, year of survey, delivery method and whether survey questions were explicit rather than indirect made a significant difference on survey results. Even after controlling for these methodological factors, between-study differences in admission rates were significantly above those expected by sampling error alone and remained largely unexplained. Despite several limitations of the data and of this meta-analysis, we draw three robust conclusions: (1) The rate at which scientists report knowing a colleague who committed plagiarism is higher than for data fabrication and falsification; (2) The rate at which scientists report knowing a colleague who committed plagiarism is correlated to that of fabrication and falsification; (3) The rate at which scientists admit having committed either form of misconduct (i.e. fabrication, falsification and plagiarism) in surveys has declined over time.

  2. Epigenetic Signaling in Psychiatric Disorders

    PubMed Central

    Peña, Catherine J; Bagot, Rosemary C; Labonté, Benoit; Nestler, Eric J

    2014-01-01

    Psychiatric disorders are complex multifactorial illnesses involving chronic alterations in neural circuit structure and function. While genetic factors are important in the etiology of disorders such as depression and addiction, relatively high rates of discordance among identical twins clearly indicate the importance of additional mechanisms. Environmental factors such as stress or prior drug exposure are known to play a role in the onset of these illnesses. Such exposure to environmental insults induces stable changes in gene expression, neural circuit function, and ultimately behavior, and these maladaptations appear distinct between developmental and adult exposures. Increasing evidence indicates that these sustained abnormalities are maintained by epigenetic modifications in specific brain regions. Indeed, transcriptional dysregulation and associated aberrant epigenetic regulation is a unifying theme in psychiatric disorders. Aspects of depression and addiction can be modeled in animals by inducing disease-like states through environmental manipulations (e.g., chronic-stress, drug administration). Understanding how environmental factors recruit the epigenetic machinery in animal models is revealing new insight into disease mechanisms in humans. PMID:24709417

  3. Psychiatric disorders and sexual dysfunction.

    PubMed

    Waldinger, Marcel D

    2015-01-01

    Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties. PMID:26003261

  4. Value-sensitive psychiatric rehabilitation.

    PubMed

    Greenberg, David; Kalian, Moshe; Witztum, Eliezer

    2010-09-01

    Psychiatric rehabilitation contains value-laden concepts that may be unacceptable to certain cultures and many individuals. The concepts of independence and work are examined in a clash between mental health professionals in charge of national policies in psychiatric rehabilitation in Israel and a rehabilitation center for the severely mentally ill within the ultra-orthodox Jewish community. The government professionals considered that having the living quarters and work site in the same building deemed it unsuitable for rehabilitation, and too few progressed to independent living and working. As such, they ordered the center to be closed. Clients' families turned to the Supreme Court and the claims and counter claims reveal value-laden positions. The bases for misunderstanding and lack of cooperation between the government professionals and the rehabilitation center are explained in the context of everyday life and values in the ultra-orthodox Jewish community and attitudes in the general population. Fruitful cooperation is based on appreciating core values, identifying and working with the community's figures of authority, and accepting that the role of the mental health professional is to advise the community, within which the professional has no status.

  5. [150 years of psychiatric therapy].

    PubMed

    von Keyserlingk, H

    1976-06-01

    The treatment of insane persons in the last century is briefly described. A more liberal and unrestrained treatment was introduced at the turn of the century, and chiefly agriculturally oriented insane asylums were established at that time. The question of persons trained to care for subjects afflicted with insanity was increasingly gaining in importance, and the aim was to have available a pool of skilled nursing personnel. Treatment by inducing artificial fever is outlined in addition to a brief description of a more activ treatment of patients by the Simon-Gütersloh method. In 1925, a "neuro-psychiatric dispensary" was established in the Soviet Union. Later, there were introduced such methods as insulin shock treatment and electroconvulsive therapy and, more recently, treatment with psychopharmaceuticals, the latter being drugs used in the treatment of emotional disorders in modern psychiatric hospitals. Inpatient and outpatient treatment is further developed with the establishment of day/night hospitals, and the need is pointed out to develop a system of care for mental patients on the model of that which exists in the Soviet Union.

  6. [Mental capacity of psychiatric patients].

    PubMed

    Wu, Kevin Chien-Chang

    2010-12-01

    Nearly every society maintains legal norms that define those members of society qualified to participate in social affairs. Mental capacity and legal competence are deemed necessary conditions for legal actions to have legal validity. On Nov. 23, 2009, newly revised adult guardianship provisions came into effect in Taiwan. However, there has been lack of discussion with regard to how assessments of mental capacity and legal competence should be conducted on psychiatric patients. This paper reviewed relevant overseas literature on this subject and followed common practice in separating legal mental capacity into causal and functional components. The causal component predicates the diseases and illnesses that render the disability, while the functional component represents legally substantial impairments in terms of cognition, emotion and behavior. The paper explored functional component contents, including finance management, individual health care, independence in daily life, interpersonal relationships and communing. Findings pointed out that in setting up competence standards, a trade-off between respect for autonomy and beneficence is unavoidable. As Taiwan does not have rich empirical data on competence assessments and decisions, collaboration between the legal and psychiatric professions is recommended to engage in relevant research to enhance legal consistencies and the science of competence assessment.

  7. French perspectives on psychiatric classification

    PubMed Central

    Crocq, Marc-Antoine

    2015-01-01

    This article reviews the role of the French schools in the development of psychiatric nosology. Boissier de Sauvages published the first French treatise on medical nosology in 1763. Until the 1880s, French schools held a pre-eminent position in the development of psychiatric concepts. From the 1880s until World War I, German-speaking schools exerted the most influence, featuring the work of major figures such as Emil Kraepelin and Eugen Bleuler. French schools were probably hampered by excessive administrative and cultural centralization. Between the 1880s and the 1930s, French schools developed diagnostic categories that set them apart from international classifications. The main examples are Bouffée Délirante, and the complex set of chronic delusional psychoses (CDPs), including chronic hallucinatory psychosis. CDPs were distinguished from schizophrenia by the lack of cognitive deterioration during evolution. Modern French psychiatry is now coming into line with international classification, such as DSM-5 and the upcoming ICD-11. PMID:25987863

  8. Acute hydrocephalus following cerebellar infarct

    PubMed Central

    Epstein, Elliot; Naqvi, Huma

    2010-01-01

    A 59-year-old man was admitted with a diagnosis of acute cerebellar infarct. The next day his level of consciousness deteriorated (Glasgow Coma Score 5) and repeat computed tomography (CT) brain scan showed subtle signs of hydrocephalus. Following neurosurgical intervention, he recovered and is now walking with a frame and assistance. The CT changes of hydrocephalus were subtle and difficult to spot. Recognition of these signs of hydrocephalus and prompt neurosurgical intervention were lifesaving. PMID:22355298

  9. The reimbursement blues. A psychiatric hospital copes with decreasing reimbursement and declining admissions.

    PubMed

    Hume, S K

    1991-03-01

    Beginning in 1989, Harbor View Mercy Hospital, a freestanding psychiatric facility in Fort Smith, AR, saw a flattening of growth in inpatient days and declines in discharges. In addition to decreasing admissions, it faces the problems of decreasing reimbursement, the need to provide more services with fewer resources, and greater government regulations. The greatest problem is inadequate reimbursement. Psychiatric hospitals fare worse than their acute care counterparts under both Medicaid and Medicare. To fulfill its mission to serve those in need, Harbor View has allocated 43 percent of its revenue budget this year to cover charity care, bad debt, etc. Ron Summerhill, the hospital's chief administrative officer, predicts a slowdown in the growth and profitability of psychiatric services in both the for-profit and not-for-profit sectors. But he is combating this trend by increasing use of managed care arrangements, diversifying, offering more outpatient services, and advocating for change in the reimbursement situation. PMID:10109228

  10. Psychiatric comorbidities of episodic and chronic migraine.

    PubMed

    Buse, Dawn C; Silberstein, Stephen D; Manack, Aubrey N; Papapetropoulos, Spyros; Lipton, Richard B

    2013-08-01

    Migraine is a prevalent disabling neurological disorder associated with a wide range of medical and psychiatric comorbidities. Population- and clinic-based studies suggest that psychiatric comorbidities, particularly mood and anxiety disorders, are more common among persons with chronic migraine than among those with episodic migraine. Additional studies suggest that psychiatric comorbidities may be a risk factor for migraine chronification (i.e., progression from episodic to chronic migraine). It is important to identify and appropriately treat comorbid psychiatric conditions in persons with migraine, as these conditions may contribute to increased migraine-related disability and impact, diminished health-related quality of life, and poor treatment outcomes. Here, we review the current literature on the rates of several psychiatric comorbidities, including depression, anxiety, and post-traumatic stress disorder, among persons with migraine in clinic- and population-based studies. We also review the link between physical, emotional, and substance abuse, psychiatric disorders, and migraine. Finally, we review the data on psychiatric risk factors for migraine chronification and explore theories and evidence underlying the comorbidity between migraine and these psychiatric disorders. PMID:23132299

  11. Cultural Issues in Psychiatric Administration and Leadership.

    PubMed

    Aggarwal, Neil Krishan

    2015-09-01

    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation's largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges.

  12. Cultural Issues in Psychiatric Administration and Leadership.

    PubMed

    Aggarwal, Neil Krishan

    2015-09-01

    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation's largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges. PMID:26071640

  13. Sleep in Children With Psychiatric Disorders.

    PubMed

    Ramtekkar, Ujjwal; Ivanenko, Anna

    2015-06-01

    Sleep disturbances are common in pediatric psychiatric disorders and constitute key elements in diagnostic symptomatology of various primary psychiatric disorders including bipolar disorder, depression, and anxiety disorder. Although sleep is not included in key defining criteria of some impairing illnesses such as obsessive-compulsive disorder and schizophrenia, these disorders present with a very high prevalence of sleep disturbances. The interaction between sleep and psychopathology is very complex with significant interrelationship in development, severity, and prognosis of psychiatric disorders and comorbid sleep disturbances. The research ranging from small intervention case series to large epidemiologic studies have demonstrated the role of specific sleep complaints in specific psychiatric diagnoses. However, the research using objective instruments such as polysomnography and actigraphy remains limited in youth with psychiatric disorders. The intervention studies using pharmaceutical treatment specifically focusing on sleep disturbances in psychiatric disorders are also sparse in the pediatric literature. Early identification of sleep disturbances and behavioral management using cognitive behavior therapy-based tools appear to be the most effective approach for treatment. The use of psychotropic medications such as selective serotonin reuptake inhibitors for the treatment of primary psychiatric disorder often alleviate the psychological barriers for sleep but may lead to emergence of other sleep issues such as restless leg syndrome. The safety and efficacy data of hypnotics for primary sleep disorders are limited in pediatrics and should be avoided or used with extreme caution in children with comorbid sleep and psychiatric problems.

  14. Cultural Issues in Psychiatric Administration and Leadership

    PubMed Central

    Aggarwal, Neil Krishan

    2016-01-01

    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation’s largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges. PMID:26071640

  15. The new Russian law on psychiatric care.

    PubMed

    Kinsey, D

    1994-01-01

    On July 2, 1992, President Boris Yeltsin signed into effect a law that has the potential for advancing human rights of psychiatric clients in the Russian Federation. The author provides a comparative analysis of the U.S. and Russian psychiatric laws, demonstrating a striking similarity of the laws in terms of substance and scope.

  16. Personal Digital Assistants in Psychiatric Education

    ERIC Educational Resources Information Center

    Luo, John S.; Ton, Hendry

    2006-01-01

    Objective: This article describes the various administrative and clinical applications for PDA use in psychiatric care and review the process for implementation in an academic medical center. Method: The authors reviewed the psychiatric literature and tested various hardware and software products. Results: The literature describes various uses of…

  17. Psychiatric Hospitalization after Deliberate Self-Poisoning

    ERIC Educational Resources Information Center

    Carter, Gregory L.; Safranko, Ivan; Lewin, Terry J.; Whyte, Ian M.; Bryant, Jennifer L.

    2006-01-01

    The decision for psychiatric hospitalization after deliberate self-poisoning (DSP) is not well understood. This study, a longitudinal cohort study of 3,148 consecutive DSP patients found 920 (29.2%) subjects were referred for psychiatric hospitalization, 576 (18.3%) on involuntary basis. A logistic regression analysis showed increased risk for:…

  18. Community Mental Health and the Psychiatric Foundation.

    ERIC Educational Resources Information Center

    National Association of Psychiatric Technology, Sacramento, CA.

    The National Association of Psychiatric Technology (NAPT), a non-profit organization, is the outgrowth of local and state organizations of psychiatric attendants, aides, and technicians who had banded together to improve their knowledge and skills and to demonstrate their competence to assume greater responsibilities in the care and treatment of…

  19. Behavioral Interviewing in Psychiatric Rehabilitation Assessment.

    ERIC Educational Resources Information Center

    Davis, Alan

    Psychiatric rehabilitation differs from traditional approaches to mental health, because it places much greater emphasis on the importance of the person's relationship with the environment. In psychiatric rehabilitation, the importance is not placed on finding a cure for the client's mental illness; rather, what matters is the ability to hold a…

  20. Accommodating Faculty and Staff with Psychiatric Disabilities.

    ERIC Educational Resources Information Center

    Lee, Barbara A.; Ruger, Peter H.

    This pamphlet discusses the legal protections for employees with psychiatric disabilities, and analyzes the decisions of federal and state courts in cases where employees who claimed a psychiatric disorder challenged an employment decision under the Americans with Disabilities Act of 1990 (ADA), the Rehabilitation Act of 1973, or state law. It…

  1. A Case Report of Acute Acalculous Cholecystitis and Acute Hemorrhagic Cystitis due to Salmonella Typhi

    PubMed Central

    Beyazal Polat, Hatice; Beyazal Çeliker, Fatma

    2014-01-01

    Acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi are a rare condition. A 24-year-old female patient was admitted to our clinic with abdominal pain, nausea, fever, headache, urinary burning, and bloody urine. Based on clinical, laboratory, and radiological evaluations, the patient was diagnosed with acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi. The patient was treated with intravenous ceftriaxone for two weeks. After the treatment, the patient's clinical and laboratory findings improved. Acute acalculous cholecystitis due to Salmonella Typhi concomitant with acute hemorrhagic cystitis is very rare and might be difficult to diagnose. Infectious agents such as Salmonella Typhi should be considered when acute acalculous cholecystitis and acute hemorrhagic cystitis are detected in adult patients with no underlying diseases. PMID:25161668

  2. Psychiatric advance directives: potential challenges in India.

    PubMed

    Sarin, Alok; Murthy, Pratima; Chatterjee, Sudipto

    2012-01-01

    The advance directive is a statement of an individual's preference for future treatment. The concept initially evolved in the context of end-of-life treatment decision making. Subsequently, in some countries, advance directives have been promoted in the care and treatment of people with serious mental disorders. They have recently been endorsed by the United Nations Convention for the Rights of Persons with Disability. In India, the legal framework related to the care of persons with mental illness is currently being reappraised, and significant changes are being contemplated. Thus, this is an appropriate time to review the existing evidence on psychiatric advance directives and examine the potential challenges involved in making them legally binding. A wide spectrum of mental health 'advance statements' have been developed and implemented in some high-resource countries. Of special interest to mental health contexts is the complex Ulysses contract to accommodate situations where the advance directive can be overridden during phases of acute illness or relapse. There have been mixed experiences with advance directives in the last couple of decades and there is scant evidence to suggest that they are effective in improving actual care. There has been almost no discourse in India on the issue of mental health advance directives. Yet this feature is being considered for implementation in the revised legal framework for the care of persons with mental illness. There are significant barriers to the feasibility and acceptability of legally mandated advance directives. There are logistical barriers to operationalising them in a manner that guarantees quality assurance of the process, and minimises the possibility of misuse. Thus, while the advance directive is a highly desirable clinical tool for collaborative decision making between the person with mental illness and the treatment provider, at this time, more needs to be done before legal enforcement is considered in

  3. Psychiatric diagnosis: the indispensability of ambivalence

    PubMed Central

    Callard, Felicity

    2014-01-01

    The author analyses how debate over the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has tended to privilege certain conceptions of psychiatric diagnosis over others, as well as to polarise positions regarding psychiatric diagnosis. The article aims to muddy the black and white tenor of many discussions regarding psychiatric diagnosis by moving away from the preoccupation with diagnosis as classification and refocusing attention on diagnosis as a temporally and spatially complex, as well as highly mediated process. The article draws on historical, sociological and first-person perspectives regarding psychiatric diagnosis in order to emphasise the conceptual—and potentially ethical—benefits of ambivalence vis-à-vis the achievements and problems of psychiatric diagnosis. PMID:24515564

  4. Response to the NCEPOD report: development of a care bundle for patients admitted with decompensated cirrhosis—the first 24 h

    PubMed Central

    McPherson, Stuart; Dyson, Jessica; Austin, Andrew; Hudson, Mark

    2016-01-01

    Recently, there has been a significant increase in the prevalence of chronic liver disease in the UK, and as a result, hospital admissions and deaths due to liver disease have also increased. The 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) of patients with alcohol-related liver disease (ARLD) found that less than half the number of patients who died from ARLD received ‘good care’, and avoidable deaths were identified. In order to improve the care of patients admitted with ARLD, the NCEPOD report recommended that a ‘toolkit’ for the acute management of patients admitted with decompensated ARLD be developed and made widely available. As a result, we have developed a ‘care bundle’ for patients admitted with decompensated cirrhosis (of all aetiologies) to ensure that effective evidence-based treatments are delivered within the first 24 h. This care bundle provides a checklist to ensure that all appropriate investigations are undertaken when a patient with decompensated cirrhosis presents and provides clinicians with clear guidance on the initial management of alcohol withdrawal, infection, acute kidney injury, gastrointestinal bleeding and encephalopathy. The first 24 h are particularly important, as early intervention can reduce mortality and shorten hospital stay, and specialist gastroenterology/liver advice is not always available during this period. This review will discuss the care bundle and the evidence base behind the treatment recommendations made. PMID:26834955

  5. Bullying behavior in relation to psychiatric disorders and physical health among adolescents: a clinical cohort of 508 underage inpatient adolescents in Northern Finland.

    PubMed

    Luukkonen, Anu-Helmi; Räsänen, Pirkko; Hakko, Helinä; Riala, Kaisa

    2010-06-30

    The aim was to investigate the association of bullying behavior with psychiatric disorders and physical health in a sample of adolescent psychiatric patients, as there have to our knowledge been no previous studies using actual psychiatric diagnoses examining this relationship in boys and girls. We studied 508 Finnish adolescents (age 12-17) admitted to psychiatric inpatient care between April 2001 and March 2006 from the geographically large area of Northern Finland. The Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime (K-SADS-PL) was used to obtain psychiatric diagnoses of adolescents according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and information on bullying behavior. Logistic regression analyses showed that having an externalizing disorder increased the likelihood of being a bully or a bully-victim (i.e. a person who is both a bully and a victim of bullying) among both the boys (odds ratio, OR=14.4, P=0.001) and the girls (OR=10.0, P<0.001). In addition, having an internalizing disorder increased the likelihood of being a victim of bullying among the boys (OR=3.4, P=0.008), but not the girls. Chronic somatic diseases were also significantly associated with being bullied among the boys (OR=2.5, P=0.041). Our results suggest that adolescents who are involved in bullying behavior should be evaluated psychiatrically, as this might be an early marker of psychiatric disorders.

  6. Influenza epidemiology in adults admitted to sentinel Australian hospitals in 2014: the Influenza Complications Alert Network (FluCAN).

    PubMed

    Cheng, Allen C; Holmes, Mark; Senenayake, Sanjaya; Dwyer, Dominic E; Hewagama, Saliya; Korman, Tony; Irving, Louis; Brown, Simon; Waterer, Grant; Hunter, Cameron; Friedman, N Deborah; Wark, Peter; Simpson, Graham; Upman, John; Bowler, Simon; Macartney, Kristine; Blyth, Christopher; Kotsimbos, Tom; Kelly, Paul

    2015-09-01

    The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all states and territories in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2014 influenza season. In this observational study, cases were defined as patients admitted to one of the sentinel hospitals with an acute respiratory illness with influenza confirmed by nucleic acid detection. During the period 3 April to 31 October 2014 (the 2014 influenza season), 1,692 adult patients (>16 years) were admitted with confirmed influenza to one of 15 of 17 FluCAN sentinel hospitals (excluding 2 paediatric hospitals). Of these, 47% were over 65 years of age, 10% were Indigenous Australians, 3.3% were pregnant and 85% had chronic co-morbidities. The majority of cases were due to influenza A. Influenza B was detected in 7% of patients. There were a large number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2014. These are estimated to represent a national annual burden of around 15,000 admissions and almost 100,000 bed-days nationally. PMID:26620349

  7. [Alcohol consumption in patients with psychiatric disorders: assessment and treatment].

    PubMed

    Lang, J-P; Bonnewitz, M-L; Kusterer, M; Lalanne-Tongio, L

    2014-09-01

    consultation teams, specialised in addictology, together with the installation of a addictology care network in supplementary psychiatry of levels 1, 2 and 3 in addictology. This network of specific care would notably permit the integrated management of patients suffering from acute psychiatric disorders or requiring care under constraint. More specific care networks for particular problems (maternity issues, adolescence, HIV and hepatitis, cognitive disorders…) and programs of therapeutic education could reinforce this proposal within a protocol of care that should be legible, coherent and coordinated. The psychiatrist and the addictologist must therefore learn to work together over and above the dogmatic boundaries and positioning in a constructive and efficient partnership, beneficial for the patient.

  8. Acute Thrombo-embolic Renal Infarction.

    PubMed

    Zhou, Haijiang; Yan, Yong; Li, Chunsheng; Guo, Shubin

    2016-07-01

    A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA).

  9. Neuropsychology of acute stroke.

    PubMed

    Sinanović, Osman

    2010-06-01

    Neuropsychology includes both the psychiatric manifestations of neurological illness (primary brain-based disorders) and neurobiology of "idiopathic" psychiatric disorders. Neurological primary brain disorders provoke broad spectrum of brain pathophysiology that cause deficit sin human behaviour, and the magnitude of neurobehavioral-related problems is a world wide health concern. Speech disorders of aphasic type, unilateral neglect, anosognosia (deficit disorders), delirium and mood disorders (productive disorders) in urgent neurology, first of all in acute phase of stroke are more frequent disorders then it verified in routine exam, not only in the developed and large neurological departments. Aphasia is common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with prevalence of one third of all stroke patients in acute phase although exist reports on greater frequency. Unilateral neglect is a disorder that mostly effects the patient after the lesion of the right hemisphere, mostly caused by a cerebrovascular insult (infarct or haemorrhage affecting a large area - up to two thirds of the right hemisphere), and in general the left-side neglect is the most widespread neuropsychological deficit after the lesion of the right cerebral hemisphere. Reports on the incidence of visual neglect vary and they range from 13 to 85%. Anosognosia is on the second place as neuropsychological syndrome of stroke in right hemisphere, characterized by the denial of the motor, visual or cognitive deficit. This syndrome, defined as denial of hemiparesis or hemianopsia, is a common disorder verified in 17-28% of all patents with acute brain stoke. There are different reports on frequency of delirium in acute stroke, from 24 to 48%, and it is more frequent in hemorrhagic then ischemic stoke. Post stroke depression (PSD) is one of the more frequent consequences on the stroke, and the prevalence of PSD has ranged from 5 to 63% of patients in

  10. Psychiatric Aspects of Female Sterilization

    PubMed Central

    Sim, Myre; Emens, J. M.; Jordan, J. A.

    1973-01-01

    Follow-up of 151 women who had been sterilized for social or gynaecological reasons one to three years earlier showed that 146 were completely satisfied with the results of the operation on their health and on their sexual relationships with their husbands. The five who were dissatisfied either wished they could still conceive or found the operation had not produced the effect hoped for. On the basis of this study we believe that adverse psychiatric sequelae of sterilization can be kept to a minimum with careful selection of patients. Women should be over 30 or if younger should have had two or more children, and the operation should not be performed at childbirth, in the neonatal period, or during a postabortive depression. PMID:4718839

  11. Measurement of Psychiatric Treatment Adherence

    PubMed Central

    Sajatovic, Martha; Velligan, Dawn; Weiden, Peter J.; Valenstein, Marcia; Ogedegbe, Gbenga

    2014-01-01

    Objective Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research, but also in clinical trials in which medications are being evaluated, and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on “Methodological Challenges in Psychiatric Treatment Adherence Research” held on September 27-28, 2007 in Bethesda, MD and organized by the National Institute of Mental Health (NIMH). Methods This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed. Results Each of the adherence measures described are imperfect estimates of actual medication ingestion but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures. Conclusion While adherence assessment has become increasingly sophisticated in recent years there remains a need for refinement and expansion on currently available methods and measures. PMID:21109048

  12. Psoriasis and Associated Psychiatric Disorders

    PubMed Central

    Abreu, José Luís Pio Da Costa; Reis, José Pedro Gaspar Dos; Figueiredo, Américo Manuel Da Costa

    2016-01-01

    Introduction and objective: Psoriasis is a chronic skin disease with a high impact on self-esteem and patients’ health-related quality of life. In the last decades some studies have pointed out mental disorders associated with psoriasis and the etiopathogenic mechanisms behind that co-existence. This work compiles psychopathology associated with psoriasis and further analyzes the etiopathogenesis of psoriasis and mental disorders. Methods: A systematic review of the literature was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and using the “5S” levels of organization of evidence from healthcare research, as previously described. Results: Psoriasis is linked with many mental disorders, both in the psychotic and neurotic sprectrum. Chronic stress diminishes hypothalamic-pituitary-adrenal axis and upregulates sympathetic-adrenal-medullary responses, stimulating pro-inflammatory cytokines. Then, it maintains and exacerbates psoriasis and some of its mental disorders. High levels of pro-inflammatory cytokines connect psoriasis, psychiatric conditions, and other comorbidities of psoriasis (such as atherosclerosis) within a vicious cycle. Furthermore, the etiopathogenesis of the link between each psychiatric comorbidity and psoriasis has its own subtleties, including the cooccurrence of other comorbidities, the parts of the body affected by psoriasis, treatments, and biological and psychosocial factors. Conclusion: The study of psychopathology can amplify our understanding about the etiopathogenesis of psoriasis and associated mental disorders. Patients would benefit from a psychodermatologic approach. The adequate treatment should take into account the mental disorders associated with psoriasis as well as the circumstances under which they occur. PMID:27386050

  13. Ethical issues in psychiatric genetics.

    PubMed

    Appelbaum, Paul S

    2004-11-01

    As knowledge grows regarding the genetic bases of psychiatric disorders, a variety of ethical issues will need to be confronted. Current evidence suggests that the etiology of most psychiatric disorders rests on a combination of multiple genes and environmental factors. As tests for the genes involved become more easily available, pressures will arise to use them for prenatal testing, screening of children and adults, selection of potential adoptees, and pre-marital screening. Common problems that will need to be addressed include popular misunderstanding of the consequences of possessing an affected allele, impact of knowledge of one's genetic make-up on one's sense of self, and the discriminatory use of genetic information to deny persons access to insurance and employment. Although most states have some legislation aimed at preventing discrimination, the laws' coverage is spotty and federal rules are lacking. Physicians may find that newly available genetic information creates new duties for them, including warning third parties who may share the patient's genetic endowment. And genetics research itself has raised questions about when to disclose information to subjects and their family members about the genes that are being studied, and how to define the subjects of the research when information is collected about family members other than the proband. Knowledge of these dilemmas is a first step to resolving them, something that the medical profession will need to attend to in the near-term. Neglect will lead others to set the rules that will control medical practice, including the practice of psychiatry, in the new world of genetic medicine. PMID:15583515

  14. Epidemiology, symptoms, and treatment characteristics of hyponatremic psychiatric inpatients.

    PubMed

    Lange-Asschenfeldt, Christian; Kojda, Georg; Cordes, Joachim; Hellen, Florence; Gillmann, Andreas; Grohmann, Renate; Supprian, Tillmann

    2013-12-01

    Hyponatremia is a common phenomenon in psychiatry occurring as an adverse effect to drugs or following polydipsia. We performed a retrospective in-depth analysis of hyponatremia cases in a large unselected population of psychiatric inpatients. During a 3-year period, all cases of hyponatremia were identified among patients admitted to a large psychiatric state and university hospital by the institution's electronic laboratory database. Demographic, treatment-related, and laboratory data were obtained by consecutive chart review, respectively. Hyponatremia occurred in 347 (4.9%) of 7113 cases, of which the majority (78%) displayed only a mild manifestation. Symptoms were recorded in 28.8% of cases, already occurred in mild forms, and comprised gait impairment (45%, including falls), confusion (30%), sedation (26%), and dyspepsia (41%). Age, female sex, nonpsychiatric drug polypharmacy-particularly with thiazides and/or angiotensin-converting enzyme inhibitors-and diagnosis of a mood disorder were associated with more severe hyponatremia, respectively. The proportion of hyponatremic patients treated with venlafaxine, trazodone, carbamazepine, oxcarbazepine, and first-generation antipsychotics, respectively, was significantly higher in the hyponatremia sample than in the normonatremic population. This was, surprisingly, not the case with selective serotonin reuptake inhibitors or any other antidepressant drug class. We found prescription with second-generation antipsychotics to be significantly associated with less severe hyponatremia.Hyponatremia may be mainly attributed to the syndrome of inappropriate antidiuretic hormone secretion, as indicated by decreased serum osmolarity in our sample. Besides old age and female sex, treatment with certain drugs-rather than whole drug classes-carries a substantially increased risk.

  15. Palliative care needs of HIV exposed and infected children admitted to the inpatient paediatric unit in Uganda

    PubMed Central

    Nakawesi, Jane; Kasirye, Ivy; Kavuma, David; Muziru, Benjamin; Businge, Alice; Naluwooza, Jackie; Kabunga, Grace; Karamagi, Yvonne; Akankwasa, Edith; Odiit, Mary; Mukasa, Barbara

    2014-01-01

    Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-limiting conditions and also for their families. It is a response to the suffering and unique needs of such children. Globally there is limited documented data available on the palliative care needs of children with HIV. A retrospective review of data of all the HIV exposed and positive children who were admitted to the ward from January to December 2012 was done to document their palliative care needs. A total of 243 children were admitted to the ward during the stated period. Of these, 139 (57.2%) were female and 104 (42.8%) were male. Among them 131 (54%) were aged five years and below whereas 112 (46%) were above five years. Some of the identified palliative care needs documented included physical needs: pneumonia 46 (19%), severe acute malnutrition 38 (16%), mild and moderate acute malnutrition 23 (9.6%), and respiratory tract infections 22 (9.3%). Social needs: poor social support 21 (41%), financial instability 16 (31%), and child neglect 4 (8%). Psychological needs: antiretroviral treatment (ART) counselling 127 (36%), HIV counselling and testing for the child and family 63 (18%), adherence support 53 (15%), and others 11 (3%). Spiritual needs: discontinuing ART because of belief in spiritual healing 18 (81%), loss of hope because of severe ill health 1 (5%), and others 3 (14%). These results emphasise the need for palliative care in children with HIV even in the era of ART. The needs identified are in keeping with studies done elsewhere and are similar to the palliative care needs of children with other life-limiting illnesses such as cancer. Conclusion HIV positive and exposed children plus their families have vast palliative care needs and a holistic approach is the key in their management. PMID:25624870

  16. Psychiatric Disorders in Children and Adolescents Attending Pediatric Out Patient Departments of Tertiary Hospitals

    PubMed Central

    Jesmin, Akhter; Rahman, Khan Muhammad Zillur; Muntasir, Maruf Mohammad

    2016-01-01

    Objectives Psychiatric disorders are increasingly recognized among children and adolescents in Bangladesh. Psychiatric disorders are more common in children with chronic and acute pediatric disorders. Our study was designed to determine the psychiatric disorders among children and adolescents attending pediatric outpatient departments of tertiary care hospitals. Methods This cross-sectional study was carried out from July 2012 to February 2013 in pediatric outpatient departments of three prime tertiary level hospitals of Dhaka, Bangladesh. A purposive sampling technique was used. A total of 240 male and female children aged 5 to 16 years old were included in the study. We used a semi-structured questionnaire to obtain sociodemographic and other relevant clinical information about the children and their families from their parents or caregivers and a validated parent version of the Bangla Development and Well-Being Assessment (DAWBA) for measuring psychopathology. Results The mean age of the children was 9.0± 2.6 years. The majority (71%) of children were in the 5–10 year age group. The male/female ratio was 1.2:1. Among the respondents, 18% were found to have a psychiatric disorder. Behavioral disorders, emotional disorders, and developmental disorders were found in 9.0%, 15.0% and 0.4% respectively. Hyperkinetic disorder was the single most frequent (5.0%) psychiatric disorder. Conclusions A significant number of children were found to have psychiatric disorders. Our study indicates the importance of identification and subsequent management of psychiatric conditions among the pediatric population. PMID:27403237

  17. Psychiatric disorders in individuals diagnosed with infantile autism as children: a case control study.

    PubMed

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben; Nedergaard, Niels Jørgen

    2008-01-01

    The objective of this study was to compare the prevalence and types of psychiatric disorders in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with psychiatric disorders in 336 matched controls from the general population using data from the nationwide Danish Psychiatric Central Register. The average observation time was 32.5 years, and mean age at follow-up was 40.6 years (range 25-55 years). Of the 118 individuals with IA, 57 (48.3%) had been in contact with psychiatric hospitals (inpatient hospitalization or outpatient visits) during the follow-up period, compared with 20/336 (6.0%) in the control group (p < 0.0001). This observation should alert general psychiatrists to the possibility of additional treatable psychiatric disorders occurring in individuals with IA. Of the 118 individuals in the IA group, 20 individuals (17%) had been given a comorbid psychiatric diagnosis during the observation period, compared with 9 individuals (2.7%) in the control group. Of the subjects with IA, 3.4% had received a diagnosis of schizophrenia (F20) at least once since the index admission in childhood, 0.8% had been diagnosed with delusional disorder (F22), 0.8% with acute psychotic disorder (F23), and 1.6% with unspecified non-organic psychosis (F29). In the control group, 0.9% had been diagnosed with schizophrenia (p = 0.08). In the group with IA, 3.4% had received a diagnosis in the broad category of affective disorders compared with 1.2% in the control group (p = 0.21). Issues associated with using registers in the ascertainment of co-occurring psychiatric disorders in IA are discussed.

  18. Randomised controlled trial of day patient versus inpatient psychiatric treatment.

    PubMed Central

    Creed, F; Black, D; Anthony, P; Osborn, M; Thomas, P; Tomenson, B

    1990-01-01

    OBJECTIVE--To assess the proportion of acutely ill psychiatric patients who can be treated in a day hospital and compare the outcome of day patient and inpatient treatment. DESIGN--Prospective randomised controlled trial of day patient versus inpatient treatment after exclusion of patients precluded by severity of illness or other factors from being treated as day patients. All three groups assessed at three and 12 months. SETTING--Teaching hospital serving small socially deprived inner city area. Day hospital designed to take acute admissions because of few beds. PATIENTS--175 Patients were considered, of whom 73 could not be allocated. Of the remaining 102 patients, 51 were allocated to each treatment setting but only 89 became established in treatment--namely, 41 day patients and 48 inpatients. 73 Of these 89 patients were reassessed at three months and 70 at one year. INTERVENTIONS--Standard day patient and inpatient treatment. MAIN OUTCOME MEASURES--Discharge from hospital and return to previous level of social functioning; reduction of psychiatric symptoms, abnormal behaviour, and burden on relatives. RESULTS--33 Of 48 inpatients were discharged at three months compared with 17 of 41 day patients. But at one year 9 of 48 inpatients and three of 41 day patients were in hospital. 18 Of 35 day patients and 16 of 39 inpatients were at their previous level of social functioning at one year. The only significant difference at three months was a greater improvement in social role performance in the inpatients. At one year there was no significant difference between day patients and inpatients in present state examination summary scores and social role performance, burden, or behaviour. CONCLUSIONS--Roughly 40% of all acutely ill patients presenting for admission to a psychiatric unit may be treated satisfactorily in a well staffed day hospital. The outcome of treatment is similar to that of inpatient care but might possibly reduce readmissions. The hospital costs

  19. Are Dual Eligibles Admitted to Poorer Quality Skilled Nursing Facilities?

    PubMed Central

    Rahman, Momotazur; Grabowski, David C; Gozalo, Pedro L; Thomas, Kali S; Mor, Vincent

    2014-01-01

    Background Dual eligibles, persons who qualify for both Medicare and Medicaid coverage, often receive poorer quality care relative to other Medicare beneficiaries. Objectives To determine whether dual eligibles are discharged to lower quality post-acute skilled nursing facilities (SNFs) compared with Medicare-only beneficiaries. Research Design Following the random utility maximization model, we specified a discharge function using a conditional logit model and tested how this discharge rule varied by dual-eligibility status. Subjects A total of 692,875 Medicare fee-for-service patients (22% duals) who were discharged for Medicare paid SNF care between July 2004 and June 2005. Measures Medicare enrollment and the Medicaid Analytic Extract files were used to determine dual eligibility. The proportion of Medicaid patients and nursing staff characteristics provided measures of SNF quality. Results Duals are more likely to be discharged to SNFs with a higher share of Medicaid patients and fewer nurses. These results are robust to estimation with an alternative subsample of patients based on primary diagnoses, propensity of being dual eligible, and likelihood of remaining in the nursing home. Conclusions Disparities exist in access to quality SNF care for duals. Strategies to improve discharge planning processes are required to redirect patients to higher quality providers, regardless of Medicaid eligibility. PMID:24354695

  20. Factors Influencing Success of Conditionally Admitted Students in Graduate TESOL Programs

    ERIC Educational Resources Information Center

    Micek, Timothy A.; Kim, Soonhyang; Weinstein, Daniel A.

    2012-01-01

    Many graduate TESOL programs grapple with whether to admit applicants who fall short of meeting established admission criteria yet who show promise as future TESOL professionals. This study examined key characteristics affecting the success of candidates admitted conditionally to graduate TESOL programs. Participants were 21 students who had been…

  1. 25 CFR 1000.23 - How is a Tribe/Consortium admitted to the applicant pool?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 2 2011-04-01 2011-04-01 false How is a Tribe/Consortium admitted to the applicant pool... Admission into the Applicant Pool § 1000.23 How is a Tribe/Consortium admitted to the applicant pool? To be considered for admission in the applicant pool, a Tribe/Consortium must submit an application to the...

  2. 25 CFR 1000.23 - How is a Tribe/Consortium admitted to the applicant pool?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 2 2012-04-01 2012-04-01 false How is a Tribe/Consortium admitted to the applicant pool... Admission into the Applicant Pool § 1000.23 How is a Tribe/Consortium admitted to the applicant pool? To be considered for admission in the applicant pool, a Tribe/Consortium must submit an application to the...

  3. 25 CFR 1000.23 - How is a Tribe/Consortium admitted to the applicant pool?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 2 2013-04-01 2013-04-01 false How is a Tribe/Consortium admitted to the applicant pool... Admission into the Applicant Pool § 1000.23 How is a Tribe/Consortium admitted to the applicant pool? To be considered for admission in the applicant pool, a Tribe/Consortium must submit an application to the...

  4. 25 CFR 1000.23 - How is a Tribe/Consortium admitted to the applicant pool?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 2 2014-04-01 2014-04-01 false How is a Tribe/Consortium admitted to the applicant pool... Admission into the Applicant Pool § 1000.23 How is a Tribe/Consortium admitted to the applicant pool? To be considered for admission in the applicant pool, a Tribe/Consortium must submit an application to the...

  5. 41 CFR 102-74.375 - What is the policy on admitting persons to Government property?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... policy on admitting persons to Government property? Federal agencies must— (a) Except as otherwise... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false What is the policy on admitting persons to Government property? 102-74.375 Section 102-74.375 Public Contracts and...

  6. 41 CFR 102-74.375 - What is the policy on admitting persons to Government property?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... policy on admitting persons to Government property? Federal agencies must— (a) Except as otherwise... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What is the policy on admitting persons to Government property? 102-74.375 Section 102-74.375 Public Contracts and...

  7. 41 CFR 102-74.375 - What is the policy on admitting persons to Government property?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... policy on admitting persons to Government property? Federal agencies must— (a) Except as otherwise... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false What is the policy on admitting persons to Government property? 102-74.375 Section 102-74.375 Public Contracts and...

  8. 41 CFR 102-74.375 - What is the policy on admitting persons to Government property?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... policy on admitting persons to Government property? Federal agencies must— (a) Except as otherwise... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What is the policy on admitting persons to Government property? 102-74.375 Section 102-74.375 Public Contracts and...

  9. 41 CFR 102-74.375 - What is the policy on admitting persons to Government property?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... policy on admitting persons to Government property? Federal agencies must— (a) Except as otherwise... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the policy on admitting persons to Government property? 102-74.375 Section 102-74.375 Public Contracts and...

  10. Todays Foundlings: A Survey of Young Children Admitted to the Care of Voluntary Societies in England.

    ERIC Educational Resources Information Center

    London Univ. (England). Inst. of Education.

    This survey was undertaken to provide information about the fate of young children (0-5 years) admitted to the care of voluntary societies. Data, collected from the files of three large voluntary societies, included information about all children admitted in 1962, 1963 and 1964. The movements of the children were followed until December 1968. None…

  11. 25 CFR 1000.23 - How is a Tribe/Consortium admitted to the applicant pool?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false How is a Tribe/Consortium admitted to the applicant pool... Admission into the Applicant Pool § 1000.23 How is a Tribe/Consortium admitted to the applicant pool? To be considered for admission in the applicant pool, a Tribe/Consortium must submit an application to the...

  12. A Semester Late: A Phenomenological Study Examining the Experiences of Spring Admits in Higher Education

    ERIC Educational Resources Information Center

    Roth-Francis, Chrissy

    2013-01-01

    More than 25% of new college students begin their higher education careers outside of the traditional fall start date (National Student Clearinghouse, 2012). This study examines the social, personal, and academic experiences of spring admits at a large, private research institution in the western United States. In this study, a spring admit is…

  13. Differences between Newly Admitted Nursing Home Residents in Rural and Nonrural Areas in a National Sample

    ERIC Educational Resources Information Center

    Bolin, Jane Nelson; Phillips, Charles D.; Hawes, Catherine

    2006-01-01

    Purpose: Previous research in specific locales indicates that individuals admitted to rural nursing homes have lower care needs than individuals admitted to nursing homes in urban areas, and that rural nursing homes differ in their mix of short-stay and chronic-care residents. This research investigates whether differences in acuity are a function…

  14. Substance use and response to psychiatric treatment in methadone-treated outpatients with comorbid psychiatric disorder.

    PubMed

    Kidorf, Michael; King, Van L; Peirce, Jessica; Gandotra, Neeraj; Ghazarian, Sharon; Brooner, Robert K

    2015-04-01

    The psychiatric care of opioid users receiving agonist therapies is often complicated by high rates of illicit drug use (Brooner et al., 2013). The present study evaluates if illicit drug use (i.e., opioids, cocaine, sedatives) detected at the start of psychiatric care affects treatment response. Methadone maintenance patients (n = 125) with at least one current psychiatric disorder completed a 3-month randomized clinical trial evaluating the efficacy of financial incentives on attendance to on-site integrated substance abuse and psychiatric services (Kidorf et al., 2013). The present study re-analyzes the data set by grouping participants into one of two conditions based on the 4-week baseline observation: (1) no illicit drug use (baseline negative; n = 50), or (2) any illicit drug use (baseline positive; n = 75). All participants received a similar schedule of psychiatric services, and had good access to prescribed psychiatric medications. The Global Severity Index (GSI) of the Hopkins Symptom Checklist-Revised was administered monthly to evaluate changes in psychiatric distress. Results showed that while both conditions evidenced similar utilization of on-site psychiatric services, baseline negative participants remained in treatment somewhat longer (80.7 vs. 74.8 days, p = .04) and demonstrated greater reductions in GSI scores than baseline positive participants at month 3 (p = .004). These results have implications for interpreting previous studies that have shown inconsistent efficacy of pharmacotherapy and other psychiatric treatments, and for providing clinical care for patients with co-occurring substance use and psychiatric disorders.

  15. Assessing and Treating the Patient with Acute Psychotic Disorders.

    PubMed

    Jensen, Lisa; Clough, Rebecca

    2016-06-01

    Patients with acute psychosis often present to emergency departments. Management of acute agitation and psychosis can be a challenge for the staff. Medical stabilization, appropriate assessment, and diagnosis are important. Verbal de-escalation and other psychosocial interventions are helpful in creating a safe and therapeutic environment. Psychiatric and emergency room nurses are poised to treat patients presenting with acute psychosis and must be knowledgeable of evidence-based approaches to treat these complex disorders. PMID:27229275

  16. The Checkered History of American Psychiatric Epidemiology

    PubMed Central

    Horwitz, Allan V; Grob, Gerald N

    2011-01-01

    Context American psychiatry has been fascinated with statistics ever since the specialty was created in the early nineteenth century. Initially, psychiatrists hoped that statistics would reveal the benefits of institutional care. Nevertheless, their fascination with statistics was far removed from the growing importance of epidemiology generally. The impetus to create an epidemiology of mental disorders came from the emerging social sciences, whose members were concerned with developing a scientific understanding of individual and social behavior and applying it to a series of pressing social problems. Beginning in the 1920s, the interest of psychiatric epidemiologists shifted to the ways that social environments contributed to the development of mental disorders. This emphasis dramatically changed after 1980 when the policy focus of psychiatric epidemiology became the early identification and prevention of mental illness in individuals. Methods This article reviews the major developments in psychiatric epidemiology over the past century and a half. Findings The lack of an adequate classification system for mental illness has precluded the field of psychiatric epidemiology from providing causal understandings that could contribute to more adequate policies to remediate psychiatric disorders. Because of this gap, the policy influence of psychiatric epidemiology has stemmed more from institutional and ideological concerns than from knowledge about the causes of mental disorders. Conclusion Most of the problems that have bedeviled psychiatric epidemiology since its inception remain unresolved. In particular, until epidemiologists develop adequate methods to measure mental illnesses in community populations, the policy contributions of this field will not be fully realized. PMID:22188350

  17. Mortality and Revascularization following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

    ERIC Educational Resources Information Center

    Abrams, Thad E.; Vaughan-Sarrazin, Mary; Kaboli, Peter J.

    2010-01-01

    Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified…

  18. The psychiatric inpatient physical health assessment sheet (PIPHAS): a useful tool to improve the speed, efficiency, and documentation of physical examination in new psychiatric inpatients.

    PubMed

    Pettipher, Alexander; Ovens, Richard

    2015-01-01

    There is increased morbidity and mortality among patients suffering from mental illness. This is believed to be multi-factorial. Poor access to healthcare, the stigma of mental illness, reduced clinic attendance, lifestyle factors, and side effects of medications are cited as possible contributing factors. It is therefore vital to perform a physical examination to identify previously undiagnosed conditions during the admission of a psychiatric inpatient. The Royal College of Psychiatrists recommends that all patients admitted to a psychiatric hospital should receive a full physical examination on admission, or within twenty-four hours of admission. A snapshot audit was carried out at Prospect Park Hospital in Reading, which highlighted that The Royal College of Psychiatrist's recommendation, along with Trust guidelines regarding physical examination were not being met, with only 78 out of 111 patients (70.3%) undergoing an examination during their admission. In addition to this, examinations were often poorly documented and not covering all examination domains. A psychiatric inpatient physical health assessment sheet (PIPHAS) was designed and introduced, providing a quick and standardised approach to the documentation of a physical examination. After the intervention was put into practice, its impact was assessed by performing a retrospective review of the admission clerking notes of the next 100 admissions to Prospect Park Hospital. Following the introduction of the PIPHAS form there was an increase in the number of patients undergoing physical examination on admission to hospital (75 out of 100 patients, 75%). There was also an increase in the thorough documentation of all examination domains (e.g. respiratory examination) for patients that had a completed PIPHAS form scanned within their medical records. This quality improvement project demonstrates that the PIPHAS form is a useful tool to improve the speed, efficiency, and documentation of a thorough physical

  19. Technological Advances in Psychiatric Nursing: An update.

    PubMed

    Bostrom, Andrea C

    2016-06-01

    Understanding and treating mental illness has improved in many ways as a result of the fast pace of technological advances. The technologies that have the greatest potential impact are those that (1) increase the knowledge of how the brain functions and changes based on interventions, (2) have the potential to personalize interventions based on understanding genetic factors of drug metabolism and pharmacodynamics, and (3) use information technology to provide treatment in the absence of an adequate mental health workforce. Technologies are explored for psychiatric nurses to consider. Psychiatric nurses are encouraged to consider the experiences of psychiatric patients, including poor health, stigmatization, and suffering.

  20. Workroles of staff nurses in psychiatric settings.

    PubMed

    Morrison, E G; Shealy, A H; Kowalski, C; LaMont, J; Range, B A

    1996-01-01

    The purpose of this research was to operationalize Peplau's workroles of the psychiatric staff nurse. Thirty registered nurses audiotaped one-to-one interactions with 62 adult, child, and adolescent psychiatric patients. Content analysis was used to identify role behaviors and to identify roles that were different from those outlined by Peplau. The counselor role was the most frequently occurring primary workrole. Overlap was found between behaviors indicative of autocratic leader versus surrogate and those of resource person versus teacher. The findings supported Peplau's contention that the counselor role is central to the practice of psychiatric nursing. PMID:8710297

  1. Workroles of staff nurses in psychiatric settings.

    PubMed

    Morrison, E G; Shealy, A H; Kowalski, C; LaMont, J; Range, B A

    1996-01-01

    The purpose of this research was to operationalize Peplau's workroles of the psychiatric staff nurse. Thirty registered nurses audiotaped one-to-one interactions with 62 adult, child, and adolescent psychiatric patients. Content analysis was used to identify role behaviors and to identify roles that were different from those outlined by Peplau. The counselor role was the most frequently occurring primary workrole. Overlap was found between behaviors indicative of autocratic leader versus surrogate and those of resource person versus teacher. The findings supported Peplau's contention that the counselor role is central to the practice of psychiatric nursing.

  2. An annotated bibliography of psychiatric medical ethics.

    PubMed

    Anzia, D J; La Puma, J

    1991-03-01

    We offer an annotated bibliography of psychiatric medical ethics that we hope will be useful for psychiatrists and other mental health professionals who are interested in the moral dimensions of psychiatric care. We present the educational and clinical rationale for the bibliography, ways to use the bibliography, and the bibliography itself. Using the American Psychiatric Association's Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry as a principled framework, we selected references based primarily on educational and clinical relevance for physicians. We include both empirical and conceptual analyses of the ethical issues seen daily in the office, clinic, hospital, nursing home, and in society at large.

  3. Psychiatric nurses' self-rated competence.

    PubMed

    Ewalds-Kvist, Beatrice; Algotsson, Martina; Bergström, Annelie; Lützén, Kim

    2012-07-01

    This study explored the self-rated competence of 52 Swedish psychiatric nurses in three clinical environments: forensic psychiatry, general psychiatric inpatient care, and clinical non-residential psychiatric care. A questionnaire wtih 56 statements from nine areas of expertise was completed. Forensic nurses were more skilled in safety and quality and in dealing with violence and conflicts. Non-specialist nurses appreciated their skills more so than specialist nurses in health promotion and illness prevention and conduct, information, and education. Women were inclined to invite patients' relatives for education and information. Men attended to a patients' spiritual needs; they also coped with violence and managed conflicts. PMID:22757599

  4. AN ECOLOGICAL ANALYSIS OF PSYCHIATRIC HOSPITALIZATIONS.

    PubMed

    Bloom, B L

    1968-10-01

    In order to develop some understanding of community social structure and its association with psychiatric inpatient medical care patterns, first admission rates for psychiatric disorders into both public and private facilities were determined for each of the 33 census tracts of Pueblo, Colorado. At the same time a cluster analysis was made of the structure of these tracts. Four well- defined clusters were identified (socio-economic affluence, young marrieds, social isolation, and social disequilibrium) and strikingly high differential relationships found between the cluster scores and psychiatric inpatient care patterns. Implications of the findings for preventive strategies and for. social etiology hypotheses are presented.

  5. PRN prescribing in psychiatric inpatients: potential for pharmacokinetic drug interactions.

    PubMed

    Davies, Simon J C; Lennard, Martin S; Ghahramani, Parviz; Pratt, Peter; Robertson, Andrea; Potokar, John

    2007-03-01

    Medications are commonly prescribed to psychiatric inpatients on a PRN (pro re nata/as required) basis, allowing drugs to be administered on patient request or at nurses' discretion for psychiatric symptoms, treatment side effects or physical complaints. However, there has been no formal study of the pharmacokinetic implications of PRN prescribing. The objective of the study was to determine the prevalence of PRN drug prescription and administration, and to assess the potential for interactions involving CYP2D6 and CYP3A4 between drugs prescribed and administered to inpatients on psychiatry wards.A cross-sectional survey of prescriptions on general adult and functional elderly psychiatric wards in one city was carried out. Data were recorded from prescription charts of 323 inpatients (236 on general adult and 87 on functional elderly wards). Of 2089 prescriptions, 997 (48%) of prescriptions were on a PRN basis (most commonly benzodiazepines and other hypnotic agents, antipsychotics, analgesics and anticholinergic agents), but only 143 (14%) of these had been administered in the previous 24 hours. One fifth of patients were prescribed drug combinations interacting with CYP2D6 or CYP3A4 of potential clinical importance which included one or more drugs prescribed on a PRN basis.PRN prescribing is common among inpatients in psychiatry, and may lead to cytochrome P450 mediated interactions. Prescribers should be aware of the potential for unpredictability in plasma concentrations, side effects and efficacy which PRN prescribing may cause through these interactions, particularly in old age psychiatry and in treatment of acute psychosis.

  6. Affective responses across psychiatric disorders-A dimensional approach.

    PubMed

    Hägele, Claudia; Friedel, Eva; Schlagenhauf, Florian; Sterzer, Philipp; Beck, Anne; Bermpohl, Felix; Stoy, Meline; Held-Poschardt, Dada; Wittmann, André; Ströhle, Andreas; Heinz, Andreas

    2016-06-01

    Studying psychiatric disorders across nosological boundaries aims at a better understanding of mental disorders by identifying comprehensive signatures of core symptoms. Here, we studied neurobiological correlates of emotion processing in several major psychiatric disorders. We assessed differences between diagnostic groups, and investigated whether there is a psychopathological correlate of emotion processing that transcends disorder categories. 135 patient with psychiatric disorders (alcohol dependence, n=29; schizophrenia, n=37; major depressive disorder (MDD), n=25; acute manic episode of bipolar disorder, n=12; panic disorder, n=12, attention deficit/hyperactivity disorder (ADHD), n=20) and healthy controls (n=40) underwent an functional magnetic resonance imaging (fMRI) experiment with affectively positive, aversive and neutral pictures from the International Affective Picture System (IAPS). Between-group differences were assessed with full-factorial ANOVAs, with age, gender and smoking habits as covariates. Self-ratings of depressed mood and anxiety were correlated with activation clusters showing significant stimulus-evoked fMRI activation. Furthermore, we examined functional connectivity with the amygdala as seed region during the processing of aversive pictures. During the presentation of pleasant stimuli, we observed across all subjects significant activation of the ventromedial prefrontal cortex (vmPFC), bilateral middle temporal gyrus and right precuneus, while a significant activation of the left amygdala and the bilateral middle temporal gyrus was found during the presentation of aversive stimuli. We did neither find any significant interaction with diagnostic group, nor any correlation with depression and anxiety scores at the activated clusters or with amygdala connectivity. Positive and aversive IAPS-stimuli were consistently processed in limbic and prefrontal brain areas, irrespective of diagnostic category. A dimensional correlate of these

  7. Acute Bronchitis

    MedlinePlus

    ... tightness. There are two main types of bronchitis: acute and chronic. Most cases of acute bronchitis get better within several days. But your ... that cause colds and the flu often cause acute bronchitis. These viruses spread through the air when ...

  8. [DRGs in psychiatric hospital financing exemplified by Hungary. A model for Germany?].

    PubMed

    Maylath, E

    2000-12-01

    One of the most important provisions incorporated in the reform of the German health sector has been the introduction of a per case prospective payment system for hospitals with the exception of admissions to psychiatric care. The reasons for the exclusion of psychiatric care are unclear, but it is as a result all the more interesting to look at the experience of Hungary, where in-patient psychiatric care has been financed on the basis of diagnosis-related groups (DRGs) for the past seven years. The article describes how in the early 1990's the funding of the Hungarian health service was reorganized from being a state-financed system with a set budget to a system financed by contributions. Parallel to this development, service-related financing was introduced. In the hospital sector this involved DRGs. At the beginning of 1993 the Hungarian DRGs comprised only 437 categories, but this has since increased to 758. Furthermore, other characteristics are listed which, apart from the number of groups, differentiate the Hungarian DRGs from the AP-DRGs. Among other things, service-related financing includes non-typical areas such as psychiatry. In this case, it covers in-patient psychiatric care in an unusual combination of DRGs in the acute case category (50% of all beds in psychiatric units in Hungary are for acute cases) with daily nursing charges in the chronic case category. An analysis is given in the article of 16 homogeneous diagnostic categories in psychiatric care, followed by experiences gathered in conjunction with the application of this approach in this particular sphere, with special reference to three problem areas. These are as follows: the trend towards diagnoses with a relatively high weighting; the practice of charging for psychiatric DRGs in somatic wards; and, finally, the perpetuation of poor service structures and practices through DRGs. In general, evidently the introduction of psychiatric DRGs may also be recommended in Germany because of the

  9. Complementary and alternative medicine use by psychiatric inpatients.

    PubMed

    Elkins, Gary; Rajab, M Hasan; Marcus, Joel

    2005-02-01

    82 psychiatric inpatients hospitalized for acute care were interviewed about their use of complementary and alternative medicine (CAM) modalities. The clinical diagnoses of respondents included Depressive Disorder (61%), Substance Abuse (26%), Schizophrenia (9%), and Anxiety Disorders (5%). Analysis indicated that 63% used at least one CAM modality within the previous 12 mo. The most frequently used modality was herbal therapies (44%), followed by mind-body therapies such as relaxation or mental imagery, hypnosis, meditation, biofeedback (30%), and spiritual healing by another (30%). Physical modalities such as massage, chiropractic treatment, acupuncture, and yoga were used by 21% of respondents. CAM therapies were used for a variety of reasons ranging from treatment of anxiety and depression to weight loss. However, most respondents indicated they did not discuss such use with their psychiatrist or psychotherapist.

  10. [Psychiatric drugs as risk factor in fatal heat stroke].

    PubMed

    Fijnheer, R; van de Ven, P J; Erkelens, D W

    1995-07-01

    Two men aged 33 and 31 years suffered a fatal heat stroke on a warm summer day. One of them used pimozide and clomipramine, the other zuclopenthixol, dexetimide, droperidol, promethazine and propranolol as psychiatric medication. Both of them had a body temperature > 42.3 degrees C, without perspiring. At first only a comatose situation with practically normal laboratory values existed; this was rapidly followed by massive liver damage, disseminated intravascular coagulation, anaemia, thrombopenia and acute renal failure. In spite of adequate and rapid treatment these complications were fatal. Both patients used medication with an antidopaminergic and anticholinergic (side) effect. The set point of the temperature regulation centre can be elevated by the antidopaminergic activity of antipsychotics. Use of anticholinergic medication can disturb the thermoregulation via inhibition of the parasympathicomimetically mediated sweat secretion. It is recommended to point out the danger of unusually high outdoor temperatures to patients using this medication. PMID:7617062

  11. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a beneficiary under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370...

  12. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a beneficiary under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370...

  13. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a beneficiary under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370...

  14. Concurrent Medical and Psychiatric Disorders among Schizophrenic and Neurotic Outpatients.

    ERIC Educational Resources Information Center

    Lima, Bruno R.; Pai, Shaila

    Although the occurrence of medical illnesses in psychiatric patients is quite high, medical illnesses manifested by psychiatric symptoms are often overlooked. The higher mortality rates among psychiatric patients when compared to the general population may be a reflection of neglect or inadequate treatment of the psychiatric patients' medical…

  15. Race Disparities in Psychiatric Rates in Emergency Departments

    ERIC Educational Resources Information Center

    Kunen, Seth; Niederhauser, Ronda; Smith, Patrick O.; Morris, Jerry A.; Marx, Brian D.

    2005-01-01

    Psychiatric diagnoses based on the International Classification of Diseases--Ninth Revision were examined in the medical discharge records of 33,000 emergency department (ED) patients to determine if (a) psychiatric disorders were underdiagnosed, (b) there were race and gender disparities in psychiatric rates, and (c) psychiatric rates varied as a…

  16. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Medical, psychiatric, and social evaluations. 456..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a recipient under age 21, the medical, psychiatric, and social evaluations required by §§ 456.170, and 456.370...

  17. Training in Psychiatric Genomics during Residency: A New Challenge

    ERIC Educational Resources Information Center

    Winner, Joel G.; Goebert, Deborah; Matsu, Courtenay; Mrazek, David A.

    2010-01-01

    Objective: The authors ascertained the amount of training in psychiatric genomics that is provided in North American psychiatric residency programs. Methods: A sample of 217 chief residents in psychiatric residency programs in the United States and Canada were identified by e-mail and surveyed to assess their training in psychiatric genetics and…

  18. Coping Strategies in Psychiatric Clinical Research.

    ERIC Educational Resources Information Center

    Kraemer, Helena Chmura

    1981-01-01

    A broad range of strategies in sampling, measurement, design, execution, implementation, and analysis are examined. Specific strategies are suggested that tend to be successful in the real world of psychiatric clinical research. (Author)

  19. PSYCHIATRIC ASPECTS OF CHRONIC INTRACTABLE PAIN

    PubMed Central

    Varma, Vijoy K.; Chaturvedi, Santosh K.; Malhotra, Anil; Chari, Promilla

    1983-01-01

    SUMMARY Two hundred patients with chronic intractable pain have been evaluated in order to study the clinical characteristics of pain and associated psychiatric illnesses. The commonest site of pain was reported to be head and face, usually dull in nature. Almost 75% of patients reported continuous pain. A great majority (40%–80%) had some psycho-social problem or other problem resultant from the chronic pain. 72% patients had identifiable psychiatric illness, commonest being neurotic depression and anxiety states. The common symptoms reported on the Present State Examination (PSE) were worrying (77%), depression (40%), hypochondrical pre-occupation (35%), autonomic anxiety (42%) and irritability (40%). There is no specific clinical characteristic associated with any particular psychiatric diagnosis. The relevance of psychiatric symptoms and illness associated with chronic pain has been discussed. PMID:21847282

  20. Prevalence of chronic pain in psychiatric patients.

    PubMed

    Chaturvedi, S K

    1987-05-01

    Five hundred consecutive patients attending a psychiatric clinic were examined in order to ascertain the prevalence of chronic pain in various psychiatric illnesses and demographic categories. Chronic pain was found to be a frequent symptom in anxiety neurosis (60%), neurotic depression (45%) and hysteria (24.3%). Less than 3% of psychotic patients reported chronic pain. Females and those patients who had entered further education beyond secondary level were found to have significantly higher (P less than 0.001) representation as compared to the psychiatric population without pain. The results are in accordance with certain earlier studies carried out almost two decades ago. Chronic pain was found to be a common symptom of psychiatric illness, reported by 18.6% patients, especially those diagnosed as having neurosis. It was also reported more often by females and by those with a higher education. The reasons for these observations require investigation.

  1. Violent psychiatric inpatients in a public hospital.

    PubMed

    Morrison, E F

    1990-01-01

    Violence in inpatient psychiatric settings is a clinically significant and relevant problem requiring attention by the psychiatric community. Despite the prevalence of research on violent behavior, few nursing studies have been conducted that explore the components of nursing care that may influence the amount of violence occurring in inpatient psychiatric settings. The purpose of the study was to identify the characteristics of violent patients and the components of nursing care that are related to violent patient behavior. A qualitative study was conducted using participant observation and grounded theory methodology. Data were collected in a metropolitan public hospital over a 9-month period. Six categories of violent patients were identified during data analysis: (1) the user, (b) the outlaw, (c) the rebel without a cause, (d) the little big man, (e) the child, and (6) the vamp. Implications of the study for clinicians working in inpatient psychiatric settings are discussed.

  2. Chromosomal abnormalities in a psychiatric population

    SciTech Connect

    Lewis, K.E.; Lubetsky, M.J.; Wenger, S.L.; Steele, M.W.

    1995-02-27

    Over a 3.5 year period of time, 345 patients hospitalized for psychiatric problems were evaluated cytogenetically. The patient population included 76% males and 94% children with a mean age of 12 years. The criteria for testing was an undiagnosed etiology for mental retardation and/or autism. Cytogenetic studies identified 11, or 3%, with abnormal karyotypes, including 4 fragile X positive individuals (2 males, 2 females), and 8 with chromosomal aneuploidy, rearrangements, or deletions. While individuals with chromosomal abnormalities do not demonstrate specific behavioral, psychiatric, or developmental problems relative to other psychiatric patients, our results demonstrate the need for an increased awareness to order chromosomal analysis and fragile X testing in those individuals who have combinations of behavioral/psychiatric, learning, communication, or cognitive disturbance. 5 refs., 1 fig., 2 tabs.

  3. [Psychiatric manifestations due to abnormal glucocorticoid levels].

    PubMed

    Lommerse, K M; Dijkstra, F N; Boeke, A J P; Eekhoff, E M W; Jacobs, G E

    2016-01-01

    This clinical case presentation describes the disease trajectory in two patients who presented with psychiatric symptoms as a result of abnormal serum glucocorticoid levels. One case involves a 58-year-old man with hypercortisolism, the other case concerns a 55-year-old woman with hypocortisolism. In both cases there was a considerable diagnostic delay in recognizing the underlying adrenal gland pathology. Abnormal glucocorticoid levels, caused by endocrine disorders, often results in psychiatric symptoms. Delay in diagnosis may have adverse consequences. Hyper- or hypocortisolism should be considered in patients who present with an atypical presentation of psychiatric symptoms. Moreover, the absence of specific physical signs or symptoms at first presentation in such patients does not exclude an underlying endocrinological cause. Therefore, physical and psychiatric reassessment of such patients should be considered at regular intervals. PMID:27507414

  4. Service dogs, psychiatric hospitalization, and the ADA.

    PubMed

    Muramatsu, Russ S; Thomas, Kelly Jones; Leong, Stephanie L; Ragukonis, Frank

    2015-01-01

    A service dog is defined as "any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability." Some psychiatric patients may depend on a service dog for day-to-day functioning. The Americans with Disabilities Act (ADA) established certain rights and responsibilities for individuals with disabilities and health care providers. Psychiatric hospitalization of a patient with a service dog may pose a problem and involves balancing the requirement to provide safe and appropriate psychiatric care with the rights of individuals with disabilities. This Open Forum examines issues that arise in such circumstances, reviews the literature, and provides a foundation for the development of policies and procedures.

  5. Security at a "model" psychiatric center.

    PubMed

    Camacho, H S; Cottrell, P A

    1997-01-01

    The security problems faced by a recently opened psychiatric center located on the campus of a hospital--including staffing, fire safety, access control, patient restraints, and budget cuts--and how they are being dealt with. PMID:10173429

  6. Cultural Competence in Child Psychiatric Practice

    ERIC Educational Resources Information Center

    Jellinek, Michael S.; Henderson, Schuyler W.

    2009-01-01

    The U.S. faces a changing demographic landscape that is increasingly multiracial. The application of a cultural competence model for assessing and treating the psychiatric disorders of minority youths in light of this demographic change is discussed.

  7. Development of the Riverview Psychiatric Inventory.

    PubMed

    Haley, Glenn M T; Iverson, Grant L; Moreau, Margaret

    2002-01-01

    The present study describes the development and initial validation of a behavioral rating scale, the Riverview Psychiatric Inventory (RPI). The RPI is a 36-item scale that is scored into four subscales covering daily routine problems, psychological symptoms, social interaction problems, and aggressive behavior. Interrater reliability using 70 pairs of raters assessing 145 patients resulted in a reliability coefficient of .89. Internal consistency for the total score was high (alpha = .93) and each of the subscales showed alpha coefficients ranging from .76 to .87. Validity was evaluated on a sample of 359 adult psychiatric inpatients. The RPI total score significantly distinguished three groups of patients on hospital units designed to treat differing levels of psychiatric illness. The RPI is superior to other behavioral rating scales employed by mental health clinicians because it does not require lengthy training in administration and scoring. The scale is useful for routine assessments on a busy psychiatric unit. PMID:12143086

  8. Service dogs, psychiatric hospitalization, and the ADA.

    PubMed

    Muramatsu, Russ S; Thomas, Kelly Jones; Leong, Stephanie L; Ragukonis, Frank

    2015-01-01

    A service dog is defined as "any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability." Some psychiatric patients may depend on a service dog for day-to-day functioning. The Americans with Disabilities Act (ADA) established certain rights and responsibilities for individuals with disabilities and health care providers. Psychiatric hospitalization of a patient with a service dog may pose a problem and involves balancing the requirement to provide safe and appropriate psychiatric care with the rights of individuals with disabilities. This Open Forum examines issues that arise in such circumstances, reviews the literature, and provides a foundation for the development of policies and procedures. PMID:25321094

  9. [Psychiatric manifestations of vitamin B12 deficiency: a case report].

    PubMed

    Durand, C; Mary, S; Brazo, P; Dollfus, S

    2003-01-01

    Psychiatric manifestations are frequently associated with pernicious anemia including depression, mania, psychosis, dementia. We report a case of a patient with vitamin B12 deficiency, who has presented severe depression with delusion and Capgras' syndrome, delusion with lability of mood and hypomania successively, during a period of two Months. Case report - Mme V., a 64-Year-old woman, was admitted to the hospital because of confusion. She had no history of psychiatric problems. She had history of diabetes, hypertension and femoral prosthesis. The red blood count revealed a normocytosis with anemia (hemoglobin=11,4 g/dl). At admission she was uncooperative, disoriented in time and presented memory and attention impairment and sleep disorders. She seemed sad and older than her real age. Facial expression and spontaneous movements were reduced, her speech and movements were very slow. She had depressed mood, guilt complex, incurability and devaluation impressions. She had a Capgras' syndrome and delusion of persecution. Her neurologic examination, cerebral scanner and EEG were postponed because of uncooperation. Further investigations confirmed anemia (hemoglobin=11,4 g/dl) and revealed vitamin B12 deficiency (52 pmol/l) and normal folate level. Antibodies to parietal cells were positive in the serum and antibodies to intrinsic factor were negative. An iron deficiency was associated (serum iron=7 micromol/l; serum ferritin concentration=24 mg/l; serum transferrin concentration=3,16 g/l). This association explained normocytocis anemia. Thyroid function, hepatic and renal tests, glycemia, TP, TCA, VS, VDRL-TPHA were normal. Vitamin B12 replacement therapy was started with hydroxycobalamin 1 000 ng/day im for 10 days and iron replacement therapy. Her mental state improved dramatically within a few days. After one week of treatment the only remaining symptoms were lability of mood, delusion of persecution, Capgras' syndrome but disappeared totally 9 days after the

  10. Subjectivity and Severe Psychiatric Disorders

    PubMed Central

    Strauss, John

    2011-01-01

    To have a complete human science in the mental health field it is essential to give adequate attention to both the objective and the subjective data related to people with psychiatric disorders. The tendency in the past has been to ignore or discount one or the other of these data sources. Subjective data are particularly neglected, sometimes considered (only) part of the “art” of medicine since the usual methodologies of the physical sciences in themselves are not adequate to reflect the nature, elusiveness, and complexity of human subjective experience. The complete experience of hallucinated voices, for instance, often includes not only the voices themselves but also terrible anguish and terrifying inability to concentrate. But even such descriptors fall unnecessarily short of reflecting the data of the experience, thus leaving research, theory, and treatment with incomplete information. To represent adequately the subjective data it is essential to recognize that besides the usual discursive knowledge and methods of traditional physical science, a second kind of knowledge and method is required to reflect the depth of human experience. To accomplish this, we must employ approaches to narrative and the arts that are uniquely capable of capturing the nature of these experiences. Only by attending seriously in our research, training, theory, and practice to the unique nature of subjective data is it possible to have a true human science for our field. PMID:20961994

  11. [Current issues in psychiatric ethics].

    PubMed

    Kovács, József

    2015-01-01

    The article analyzes some ethical problems in psychiatry that have been emerging in recent years. It deals with the ongoing intensive debates about the DSM-5 before its publication, and with some of the criticisms of the DSM-5 itself. Then it goes on to analyze the use of placebo. This is followed by the ethical problems of the treatment of ADHD with stimulant drugs, among which one is the question of authenticity, namely whether the pre-treatment or the post-treatment personality is the real, authentic self of the patient. This question has been raised not only in the case of the ADHD, but also in relation with the antidepressant treatment of depression earlier, and in relation with deep brain stimulation and dopamine replacement therapy now, all of which causes changes in the treated patient's personality and motivations. Finally the article describes some ethical problems of informed consent in the case of antidepressant medication, together with the necessity to involve psychiatric nurses and rating scales in the assessment of the patient's decision making capacity.

  12. Add grace to psychiatric practice

    PubMed Central

    Patkar, Shobha V.

    2013-01-01

    Background: The uniqueness of mindset of an individual makes psychiatric practice interesting, sensitive, and at times subjective. The practice in setup of an organization makes the situation more complex in view of administrative regulations, existing work culture, and issues like confidentiality, etc., Dilemmas are often faced while balancing loyalty between an organization and the patients, values of the therapist and the patient, and different dimension of justice coming from different cultural backgrounds of the patients and the treating doctors. A lot of mental work needs to be put in by the practitioner to consistently adhere to medical ethics and professional approach for taking key decisions despite of contradictory external forces from within and without. Aims: I thought of sharing my experiences especially in setup of an organization with my colleagues so that the decision-taking process becomes somewhat easy and balancing for them. Settings and Design: I have to try to interpret my clinical experiences gathered while working with my patients from the Department of Atomic Energy as well as from my private practice. Conclusion: The need of psycho education to self and others from time to time never ceases simply to make the practice more objective, justified, and graceful. PMID:23825861

  13. Psychological aspects of acute low back pain in general practice

    PubMed Central

    Gilchrist, Iain C.

    1983-01-01

    A prospective controlled study of acute low back pain in general practice was carried out. The presence of psychiatric illness was measured by use of the general health questionnaire (GHQ), by clinical assessment, and personality factors by use of the Eysenck personality inventory (EPI). It was found that overall the amount of psychiatric illness did not differ between patients with back pain and their controls at the time of presentation, although there was a higher prevalence of previous psychiatric illness in the back-pain group. The only difference in the personality factors measured was a higher degree of extraversion in the back-pain patients. PMID:6224930

  14. Foreign body mimicking acute coronary syndrome.

    PubMed

    Havrankova, Enikö; Stenová, Emöke; Filkova, Marta

    2014-02-01

    The article presents a case study of a 37-year-old male who was admitted to the Acute Cardiology Unit of our hospital with suspicion of acute coronary syndrome. By invasive imaging examination, acute coronary syndrome was ruled out, but as a secondary finding a foreign body was found in the pericardium - a broken needle that had travelled to the heart after intravenous heroin administration into the right femoral vein, which was also confirmed on a computed tomography scan. Because of a developing pericardial tamponade, surgical intervention and the extraction of the foreign body was indicated. PMID:24640524

  15. Psychiatric hospitalization in Ontario: the revolving door in perspective.

    PubMed Central

    Woogh, C. M.; Meier, H. M.; Eastwood, M. R.

    1977-01-01

    Ontario government statistics have indicated that during the 1960s the proportion of readmissions to psychiatric hospitals doubled to form two thirds of all admissions. Since this pertained to events rather than to individuals, a cohort of patients first admitted in 1969 was followed for 4 years to trace the pattern of readmission and the characteristics of patients at risk of readmission. Routinely returned data were linked and a sample from the greater metropolitan Toronto area was randomly selected. Of the cohort, 31% were readmitted, 8% three or more times. Age and diagnosis distinguished those readmitted. Most with multiple readmissions were under 25 years of age. Although diagnoses were equally distributed on first admission among psychotic, neurotic and other nonpsychotic disorders, with no significant change on readmission or multiple readmission, there was a predictably greater proportion of functional psychoses among the high-risk group and also an equal representation of personality, addictive and the remaining nonpsychotic conditions. The vulnerable few are identifiable early in their intermittent hospital career. It can be concluded that statistics suggesting that two thirds of admissions are readmissions are misleading. PMID:856431

  16. Readiness to change smoking behavior in adolescents with psychiatric disorders.

    PubMed

    Apodaca, Timothy R; Abrantes, Ana M; Strong, David R; Ramsey, Susan E; Brown, Richard A

    2007-06-01

    There has been recent increased interest in utilizing motivational interviewing (MI) to increase adolescent readiness to quit smoking, but attempts to impact quit rates have thus far been discouraging. A better understanding of factors associated with adolescent readiness to quit smoking prior to receiving any intervention may provide guidance when tailoring future MI interventions in order to increase their effectiveness with this population. Adolescent smokers (N=191) who had been admitted to a psychiatric hospital and enrolled in a clinical trial evaluating MI completed questionnaires that assessed smoking behavior and variables thought to be related to smoking. Confidence to quit smoking and negative beliefs about smoking were significant predictors of adolescents' baseline readiness to quit smoking. The failure to demonstrate relationships between health consequences and readiness suggest that caution may be warranted in the use of feedback, a common component of MI-based interventions. Such feedback tends to focus on health consequences, which was unrelated to adolescent baseline readiness to change smoking behavior in the current study. Parallels between current results and the Theory of Planned Behavior are discussed in consideration of developing more effective MI-based interventions for adolescent smokers.

  17. Psychiatric Conditions in Parkinson Disease: A Comparison With Classical Psychiatric Disorders.

    PubMed

    Buoli, Massimiliano; Caldiroli, Alice; Altamura, Alfredo Carlo

    2016-03-01

    Psychiatric conditions often complicate the outcome of patients affected by Parkinson disease (PD), but they differ from classical psychiatric disorders in terms of underlying biological mechanisms, clinical presentation, and treatment response. The purpose of the present review is to illustrate the biological and clinical aspects of psychiatric conditions associated with PD, with particular reference to the differences with respect to classical psychiatric disorders. A careful search of articles on main databases was performed in order to obtain a comprehensive review about the main psychiatric conditions associated with PD. A manual selection of the articles was then performed in order to consider only those articles that concerned with the topic of the review. Psychiatric conditions in patients with PD present substantial differences with respect to classical psychiatric disorders. Their clinical presentation does not align with the symptom profiles represented by Diagnostic and Statistical Manual for Mental Disorders and International Classification of Diseases. Furthermore, psychiatry treatment guidelines are of poor help in managing psychiatric symptoms of patients with PD. Specific diagnostic tools and treatment guidelines are needed to allow early diagnosis and adequate treatment of psychiatric conditions in comorbidity with PD.

  18. A SHOCKING REQUIREMENT IN THE LAW ON NEGLIGENCE LIABILITY FOR PSYCHIATRIC ILLNESS: LIVERPOOL WOMEN'S HOSPITAL NHS FOUNDATION TRUST V RONAYNE [2015] EWCA CIV 588.

    PubMed

    Burrows, Andrew S; Burrows, John H

    2016-01-01

    The Ronayne case concerned a husband who suffered a psychiatric illness, described as an adjustment disorder, in seeing the condition of his wife who was the primary victim of admitted medical negligence. His claim for compensation, as a 'secondary victim', failed because he could not satisfy the legal requirement that there must be a sudden shocking event. This commentary criticises that requirement which appears to make no medical sense. PMID:26856615

  19. Teaching transcendental meditation in a psychiatric setting.

    PubMed

    Candelent, T; Candelent, G

    1975-03-01

    For two and a half years the authors have taught Transcendental Meditation (TM) to psychiatric patients at the Institute of Living in Hartford, Connecticut. They have also presented programs to hospital staff to acquaint them with the technique and practice of TM. In this paper they describe briefly the instruction program given to patients at the institute and point out some of the benefits of regular practice of TM for psychiatric patients.

  20. [Rehabilitation work in a psychiatric service].

    PubMed

    Correa, J O; Ingala, E M; Justo, S N

    1987-06-01

    A description of rehabilitation work at a psychiatric ward with all the benefits specific modalities, and results involved is offered. Focusing from a multidisciplinary angle the authors aim at laying the foundations for the setting up of rehabilitation workteams, in the frame of psychiatric hospitals in our country. At the same time clinical examples are submitted to illustrate situations which had to be met during the work and their linking to setting and transference as well.

  1. Necessity of adapting psychiatric treatment to relevant ethical guidelines.

    PubMed

    Martens, W H

    2001-01-01

    In this article the author investigates to what extent most psychiatric professionals act according to international and national psychiatric ethical guidelines. It seems that many psychiatrists and psychotherapists do not know the international and national ethical guidelines for psychiatric conduct, and as a consequence they frequently do not act according to these ethical codes. The problem is that ignoring of ethical guidelines often does not have legal consequences, because these psychiatric ethical codes are not specifically enshrined in the law. I have discussed how we can improve relevant psychiatric ethical knowledge and related more responsible behavior in psychiatric staff members. Suggestions are made to improve psychiatric treatment in the light of ethical guidelines.

  2. Predictors of Rehospitalization among Elderly Patients admitted to a Rehabilitation Hospital: the Role of Polypharmacy, Functional Status and Length of Stay

    PubMed Central

    Morandi, Alessandro; Bellelli, Giuseppe; Vasilevskis, Eduard. E.; Turco, Renato; Guerini, Fabio; Torpilliesi, Tiziana; Speciale, Salvatore; Emiliani, Valeria; Gentile, Simona; Schnelle, John; Trabucchi, Marco

    2014-01-01

    Objectives Rehospitalizations for elderly patients are an increasing health care burden. Nonetheless, we have limited information on unplanned rehospitalizations and the related risk factors in elderly patients admitted to in-hospital rehabilitation facilities after an acute hospitalization. Setting In-hospital Rehabilitation and Aged Care Unit Design Retrospective cohort study Participants Elderly patients ≥65 years admitted to an in-hospital rehabilitation hospital after an acute hospitalization between January 2004 and June 2011. Measurements The rate of 30-day unplanned rehospitalization to hospitals was recorded. Risk factors for unplanned rehospitalization were evaluated at rehabilitation admission: age, comorbidity, serum albumin, number of drugs, decline in functional status, delirium, Mini Mental State Examination score, length of stay in the acute hospital. A multivariable Cox proportional regression model was used to identify the effect of the above-mentioned risk factors for time to event within the 30-day follow-up. Results Among 2,735 patients, with a median age of 80 years (Interquartile Range 74–85), 98 (4%) were rehospitalized within 30 days. Independent predictors of 30-day unplanned rehospitalization were the use of 7 or more drugs (Hazard Ratio [HR], 3.94; 95% Confidence Interval, 1.62–9.54; P=.002) and a significant decline in functional status (56 points or more at the Barthel Index) compared to the month prior to hospital admission (HR 2.67, 95% CI: 1.35–5.27; P=.005). Additionally, a length of stay in the acute hospital ≥13 days carried a 2 fold higher risk of rehospitalization (HR 2.67, 95% CI: 1.39–5.10); P=.003). Conclusions The rate of unplanned rehospitalization was low in this study. Polypharmacy, a significant worsening of functional status compared to the month prior to acute hospital admission and hospital length of stay are important risk factors. PMID:23664484

  3. Identification of Trauma Exposure and PTSD in Adolescent Psychiatric Inpatients: An Exploratory Study

    PubMed Central

    Havens, Jennifer F.; Gudiño, Omar G.; Biggs, Emily A.; Diamond, Ursula N.; Weis, J. Rebecca; Cloitre, Marylene

    2013-01-01

    Trauma exposure and posttraumatic stress disorder (PTSD), though prevalent among adolescent psychiatric inpatients, are under-identified in standard clinical practice. In a retrospective chart review of 140 adolescents admitted to a psychiatric inpatient unit, we examine associations between probable PTSD identified through the Child PTSD Symptom Scale and adolescents' service use and clinical characteristics. Results suggest a large discrepancy between rates of probable PTSD identified through standardized assessment and during the emergency room psychiatric evaluation (28.6% vs. 2.2%). Adolescents with probable PTSD had greater clinical severity and service utilization, an increased likelihood of being diagnosed with bipolar disorder (27.5% vs. 9.2%) and being prescribed antipsychotic medications (47.5% vs. 27.6%), and were prescribed more psychotropic medications. Upon discharge, those with probable PTSD were more likely to be assigned a diagnosis of PTSD (45% vs. 7.1%), a comorbid diagnoses of major depressive disorder (30% vs. 14.3%), to be prescribed an antidepressant medication (52.5% vs. 33.7%), and they continued to be prescribed more medications. The under-identification of trauma exposure and PTSD have important implications for the care of adolescents given that accurate diagnosis is a prerequisite for providing effective care. Improved methods for identifying trauma-related problems in standard clinical practice are needed. PMID:22522731

  4. Migraine: Clinical pattern and psychiatric comorbidity

    PubMed Central

    Bhatia, Manjeet Singh; Gupta, Ravi

    2012-01-01

    Background: Migraine is a common disorder which has psychiatric sequelae. Objective: The objective of this study was to determine the clinical pattern and psychiatric comorbidity of migraine. Materials and Methods: 100 cases of migraine seen over a period of one year were analysed to know the sociodemographic characteristics, clinical pattern and psychiatric morbidity. Results: Maximum patients were between 31-40 years of age group (40%), females (78.0%), married (76%) and housewives (56.0%). Family history of migraine was present in 12% cases. Average age of onset was 22 years. Unilateral and throbbing type of headache was most common. The commonest frequency was one to two per week. Migraine without aura was commonest sub-type (80%). Generalized anxiety disorder (F41.1) was the most common psychiatric disorder (34%), followed by mixed anxiety and depressive disorder (F41.2) (18%) and depressive episode (F32) (14%). In 22% cases, no psychiatric disorder could be elicited. Conclusion: The present study confirms that majority patients with migraine had psychiatric disorders. This needs timely detection and appropriate intervention to treat and control the migraine effectively. PMID:23766573

  5. Connectomics in psychiatric research: advances and applications.

    PubMed

    Cao, Miao; Wang, Zhijiang; He, Yong

    2015-01-01

    Psychiatric disorders disturb higher cognitive functions and severely compromise human health. However, the pathophysiological mechanisms underlying psychiatric disorders are very complex, and understanding these mechanisms remains a great challenge. Currently, many psychiatric disorders are hypothesized to reflect "faulty wiring" or aberrant connectivity in the brains. Imaging connectomics is arising as a promising methodological framework for describing the structural and functional connectivity patterns of the human brain. Recently, alterations of brain networks in the connectome have been reported in various psychiatric disorders, and these alterations may provide biomarkers for disease diagnosis and prognosis for the evaluation of treatment efficacy. Here, we summarize the current achievements in both the structural and functional connectomes in several major psychiatric disorders (eg, schizophrenia, attention-deficit/hyperactivity disorder, and autism) based on multi-modal neuroimaging data. We highlight the current progress in the identification of these alterations and the hypotheses concerning the aberrant brain networks in individuals with psychiatric disorders and discuss the research questions that might contribute to a further mechanistic understanding of these disorders from a connectomic perspective. PMID:26604764

  6. Predictors of psychiatric disorders in combat veterans

    PubMed Central

    2013-01-01

    Background Most previous research that has examined mental health among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combatants has relied on self-report measures to assess mental health outcomes; few studies have examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders among Marines who deployed to combat in Iraq and Afghanistan. Methods The study sample consisted of 1113 Marines who had deployed to Iraq or Afghanistan. Demographic and psychosocial predictor variables from a survey that all Marines in the sample had completed were studied in relation to subsequent psychiatric diagnoses. Univariate and multivariate logistic regression were used to determine the influence of the predictors on the occurrence of psychiatric disorders. Results In a sample of Marines with no previous psychiatric disorder diagnoses, 18% were diagnosed with a new-onset psychiatric disorder. Adjusting for other variables, the strongest predictors of overall psychiatric disorders were female gender, mild traumatic brain injury symptoms, and satisfaction with leadership. Service members who expressed greater satisfaction with leadership were about half as likely to develop a mental disorder as those who were not satisfied. Unique predictors of specific types of mental disorders were also identified. Conclusions Overall, the study’s most relevant result was that two potentially modifiable factors, low satisfaction with leadership and low organizational commitment, predicted mental disorder diagnoses in a military sample. Additional research should aim to clarify the nature and impact of these factors on combatant mental health. PMID:23651663

  7. A review of reception order in the management of mentally ill persons in a psychiatric institute

    PubMed Central

    Subramanian, Nakkeerar; Ramanathan, Rajkumar; Kumar, Venkatesh Madhan; Chellappan, Dhanabalan Kalingarayan Palayam; Ramasamy, Jeyaprakash

    2016-01-01

    Background: Mentally ill prisoners, when requiring admission in a psychiatric facility, have to be admitted only by a reception order of a judicial magistrate and convicts by warrants issued by the Government to jail superintendents and the superintendent of the hospital. Both can be only under Section 27 of The Mental Health Act, 1987. Materials and Methods: A study of the contents of reception order and warrants regarding the acts and section under which they were issued over 1 year period for the admission of the patients in the criminal ward of the Institute of Mental Health was carried out. Results: Only three reception orders quoted Section 27 out of 54 patients admitted under a reception order. Nineteen patients were admitted by the jail superintendents. Discussion: Various issues that were found in the reception order and their consequences are discussed, and a possible response to these issues is mooted. Conclusion: Almost none of the reception orders were found to be proper. This deficit needs to be rectified by sensitizing the various authorities. PMID:27385850

  8. Norms, Reliability, and Item Analysis of the Hopelessness Scale in General Psychiatric, Forensic Psychiatric, and College Populations.

    ERIC Educational Resources Information Center

    Durham, Thomas W.

    1982-01-01

    Administered the Hopelessness Scale to criminal psychiatric inpatients, general psychiatric inpatients, and college students. Both psychiatric groups endorsed significantly more items in the hopeless direction. Found the scale more reliable with the psychiatric patients. Item analysis of the Hopelessness Scale suggests that three items were not…

  9. Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur.

    PubMed

    Lee, W S; Ooi, T L

    1999-09-01

    The risk factors and modes of death following acute diarrhoeal illness in children admitted to University Hospital, Kuala Lumpur between 1982 and 1997 were studied retrospectively. Among 4,689 cases of acute gastroenteritis admitted, ten deaths were noted. The case mortality rate was 2.1/1000 admissions. All deaths were infants below one year, with eight females and two males. Acute renal failure and acute pulmonary oedema were common preceding events. Female sex, infants less than twelve months, the presence of hyper or hyponatraemia and moderate to severe dehydration on admission were risk factors for deaths.

  10. [Acute intermittent porphyria and inappropriate ADH syndrome].

    PubMed

    Tébar, M T; Aguilera, L

    2010-05-01

    A 44-year-old woman complained of abdominal pain of 4 days' duration accompanied by vomiting and painful urination. The admitting physician noted neurologic signs consistent with axonal polyneuropathy and hyponatremia. In the absence of other explanations for the syndrome, SIADH was diagnosed. Because of the nonspecific nature of the observations, the patient was assessed by various specialists and admitted to the anesthetic recovery unit due to worsening of neurologic signs and suspicion of acute intermittent porphyria. The diagnosis was confirmed by laboratory findings of elevated d-aminolevulinic acid and porphobilinogen levels and normal stool porphyrins. The patient improved with intravenous hematin infused over 4 days.

  11. Steroid-induced acute psychosis in a child with asthma: report of one case.

    PubMed

    Lee, K M; Lin, Y Z; Huang, F Y

    2001-01-01

    A 5-year-old girl was admitted due to severe asthmatic attack. She was treated with methylprednisolone (40 mg i.v. q6h), aminophylline (loading with 5 mg/kg and maintained with 0.6 mg/kg/hr i.v. drip), nebulized terbutaline sulphate (5 mg q6h), oral procaterol 12.5 micrograms bid, along with oxygen therapy. Acute psychotic reaction with visual hallucination, delusion, panic reaction and myoclonic movement of hands developed on day 3 of admission. The patient had no previous history of psychiatric problems. The theophylline level was 9.89 micrograms/ml at the moment of psychotic reaction. After the dose of methylprednisolone was reduced from 40 mg to 20 mg i.v. q6h and shifted to other anti-asthma treatment by procaterol metered dose inhaler via spacer, the psychotic reaction disappeared a few hours later. The psychotic reaction was thought to be due to steroid therapy since no other causes could explain the psychotic reaction. PMID:11431864

  12. Engram formation in psychiatric disorders

    PubMed Central

    Gebicke-Haerter, Peter J.

    2014-01-01

    Environmental factors substantially influence beginning and progression of mental illness, reinforcing or reducing the consequences of genetic vulnerability. Often initiated by early traumatic events, “engrams” or memories are formed that may give rise to a slow and subtle progression of psychiatric disorders. The large delay between beginning and time of onset (diagnosis) may be explained by efficient compensatory mechanisms observed in brain metabolism that use optional pathways in highly redundant molecular interactions. To this end, research has to deal with mechanisms of learning and long-term memory formation, which involves (a) epigenetic changes, (b) altered neuronal activities, and (c) changes in neuron-glia communication. On the epigenetic level, apparently DNA-methylations are more stable than histone modifications, although both closely interact. Neuronal activities basically deliver digital information, which clearly can serve as basis for memory formation (LTP). However, research in this respect has long time neglected the importance of glia. They are more actively involved in the control of neuronal activities than thought before. They can both reinforce and inhibit neuronal activities by transducing neuronal information from frequency-encoded to amplitude and frequency-modulated calcium wave patterns spreading in the glial syncytium by use of gap junctions. In this way, they serve integrative functions. In conclusion, we are dealing with two concepts of encoding information that mutually control each other and synergize: a digital (neuronal) and a wave-like (glial) computing, forming neuron-glia functional units with inbuilt feedback loops to maintain balance of excitation and inhibition. To better understand mental illness, we have to gain more insight into the dynamics of adverse environmental impact on those cellular and molecular systems. This report summarizes existing knowledge and draws some outline about further research in molecular

  13. [Evaluation of the oropharyngeal tularemia cases admitted to our hospital from the provinces of Central Anatolia].

    PubMed

    Uyar, Melek; Cengiz, Buğra; Unlü, Murat; Celebi, Bekir; Kılıç, Selçuk; Eryılmaz, Adil

    2011-01-01

    Tularemia caused by the bacterium Francisella tularensis is a zoonotic infection which has re-emerged in Turkey in recent years as water-borne endemics. Oropharyngeal form is the most frequently reported form of the disease from Turkey. The aim of this study was to evaluate the clinical and laboratory findings of oropharyngeal tularemia patients admitted to ear, nose & throat outpatient clinic between January-March 2010. A total of 10 patients (age range: 16-80 years, mean age: 43.9 years; nine were male) inhabiting in the provinces in Central Anatolia, Turkey, were admitted to our hospital with the complaints of fever, sore throat and painful cervical lump. They have been previously diagnosed as tonsillo-pharyngitis at different medical centers and empirical antibiotic therapy has initiated, however, their complaints have not recovered. Endoscopic laryngoscopic examination revealed that oropharynx, larynx and hypopharynx were normal. Physical examination of the neck yielded localized fixed masses with diameters between 2-7 cm. The lesions were localized at right submandibular (n= 4), upper jugular (n=3) and one of each at left posterior cervical, left submandibular and left jugulodigastric regions. The patients were hospitalized with the pre-diagnosis of "neck mass with unknown origin" for further investigation and treatment. The mean white blood cell count of the cases was 9730 (7500-15.100) cells/µl; the mean erythrocyte sedimantation rate was 68.7 (46-85) mm3/hours and the mean C-reactive protein level was 4.3 (1.5-7.4) µg/dl. Salmonella, Brucella, Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex virus, Epstein-Barr virus and viral hepatitis serology did not indicate acute infections. Serum and tissue samples were sent to Refik Saydam National Public Health Agency in order to test for tularemia, namely culture, microagglutination test (MAT), direct fluorescence antibody (DFA) test and in-house polymerase chain reaction (PCR). All of the patients

  14. [The onset of psychiatric disorders and Wilson's disease].

    PubMed

    Benhamla, T; Tirouche, Y D; Abaoub-Germain, A; Theodore, F

    2007-12-01

    Wilson's disease is an infrequent, autosomic recessive pathology, resulting from a loss of function of an adenosine triphosphatase (ATP7B or WDNP), secondarily to a change (more than 60 are described currently), insertion or deletion of the ATP7B gene located on the chromosome 13q14.3-q21.1, which involves a reduction or an absence of the transport of copper in the bile and its accumulation in the body, notably the brain. Wilson's disease is transmitted by an autosomic recessive gene located on the long arm of chromosome 13. The prevalence of the heterozygote is evaluated at 1/90 and the homozygote at 1/30,000. Consanguinity, frequent in the socially geographically isolated populations, increases the prevalence of the disease. The toxic quantities of copper, which accumulate in the liver since early childhood and perhaps before, remain concentrated in the body for years. Hence, cytological and histological modifications can be detected in the biopsies, before the appearance of clinical or biological symptoms of hepatic damage. The accumulation of copper in the liver is due to a defect in the biliary excretion of metal and is accompanied invariably by a deficit in ceruloplasmin; protein synthesized from a transferred ATP7B gene, which causes retention of the copper ions in the liver. The detectable cellular anomalies are of two types: hepatic lesions resulting in acute hepatic insufficiency, acute hepatitis and finally advanced cirrhosis and lesions of the central nervous system responsible for the neurological and psychiatric disorders. In approximately 40-50% of the patients, the first manifestation of Wilson's disease affects the central nervous system. Although copper diffuses in the liver towards the blood and then towards other tissues, it has disastrous consequences only in the brain. It can therefore cause either a progressive neurological disease, or psychiatric disorders. Wilson's disease begins in the form of a hepatic, neurological, or psychiatric

  15. Prevalence of pressure ulcers by race and ethnicity for older adults admitted to nursing homes.

    PubMed

    Harms, Susan; Bliss, Donna Z; Garrard, Judith; Cunanan, Kristen; Savik, Kay; Gurvich, Olga; Mueller, Christine; Wyman, Jean F; Eberly, Lynn; Virnig, Beth

    2014-03-01

    Little is known about the prevalence of pressure ulcers (PUs) among racial and ethnic groups of older individuals admitted to nursing homes (NHs). NHs admitting higher percentages of minority individuals may face resource challenges for groups with more PUs or ones of greater severity. This study examined the prevalence of PUs (Stages 2 to 4) among older adults admitted to NHs by race and ethnicity at the individual, NH, and regional levels. Results show that the prevalence of PUs in Black older adults admitted to NHs was greater than that in Hispanic older adults, which were both greater than in White older adults. The PU rate among admissions of Black individuals was 1.7 times higher than White individuals. A higher prevalence of PUs was observed among NHs with a lower percentage of admissions of White individuals. [Journal of Gerontological Nursing, 40(3), 20-26.]. PMID:24219072

  16. The Effect of Depression on Social Engagement in Newly Admitted Dutch Nursing Home Residents.

    ERIC Educational Resources Information Center

    Achterberg, Wilco; Pot, Anne Margriet; Kerkstra, Ada; Ooms, Marcel; Muller, Martien; Ribbe, Miel

    2003-01-01

    Studies the effect of depression on social engagement among newly admitted nursing home residents. Results reveal that residents with depression were significantly more often found to have low social engagement. (Contains 26 references and 3 tables.) (GCP)

  17. A 5-year retrospective study of demographic, anamnestic, and clinical factors related to psychiatric hospitalizations of adolescent patients

    PubMed Central

    Di Lorenzo, Rosaria; Cimino, Nina; Di Pietro, Elena; Pollutri, Gabriella; Neviani, Vittoria; Ferri, Paola

    2016-01-01

    Background Psychiatric emergencies of children and adolescents have greatly increased during the last years, but this phenomenon has not been studied in detail. The aim of this study was to analyze the correlation between acute psychiatric hospitalizations of adolescents and selected variables to highlight risk factors for psychiatric emergencies. Methods This retrospective research was conducted in the acute psychiatric public ward, Service of Psychiatric Diagnosis and Treatment (SPDT), and in the residential facility for adolescents, “The Medlar”, located in Modena. The sample was constituted by all adolescent patients (n=101, age range 14–18) who had acute hospitalizations (n=140) in SPDT and had been successively transferred to “The Medlar” (n=83), from February 2, 2010 to January 31, 2015. From clinical charts, we extracted demographic and anamnestic characteristics of patients and clinical variables related to hospitalizations. Data were statistically analyzed. Results Sixty-one percent of our patients lived with one divorced parent, with adoptive or immigrant family, or in institutions; 51% had experienced stressful events during childhood; 81% had a normal intellective level, but only 6% presented regular school performance. Parental psychiatric illness was negatively related, in a statistically significantly way, with onset age of adolescent mental disorders (coefficient −2.28, 95% confidence interval [CI]: −3.53 to 1.01, P<0.001, single linear regression; odds ratio: 4.39, 95% CI: 1.43–13.47, P<0.010, single logistic regression). The most frequent reasons for admission were aggressive behavior in males and suicide risk in females (P=0.002). The most frequent psychiatric diagnosis at SPDT discharge was “conduct disorder”, more frequent in males, followed by “adjustment disorder”, more frequent in females (P=0.001). In SPDT, the adolescent hospitalizations progressively increased fivefold at the end of the observation period

  18. Management of Chronic Obstructive Pulmonary Disease in Patients Admitted to a Tertiary Care Centre for Exacerbation of Their Disease

    PubMed Central

    Dault, Roxanne; Dubé, Anne-Isabelle; Blais, Lucie; Boileau, Robert; Larrivée, Pierre; Dumas, Mario-Eddy; Beauchesne, Marie-France

    2012-01-01

    Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with an accelerated decline in lung function and a significant decrease in health status. Maintenance therapy with respiratory medications can reduce the risk of such exacerbations. Objective: To determine whether respiratory maintenance medications were being prescribed in accordance with the 2007 COPD guidelines of the Canadian Thoracic Society for patients admitted to hospital for acute exacerbation of COPD. Methods: A chart review was conducted for admissions to the Centre hospitalier universitaire de Sherbrooke, in Sherbrooke, Quebec, for acute exacerbation of COPD (according to diagnostic codes in the International Statistical Classification of Diseases and Related Health Problems, 10th revision) between January 1, 2008, and January 31, 2011. Data were extracted from patients’ medical charts concerning respiratory medications prescribed before the admission, during the hospital stay, and at discharge. Results: A total of 846 hospital admissions involving 561 patients were reviewed. In almost 70% of admissions for which data were available on respiratory medications prescribed before the admission, during the hospital stay, and at discharge (238/341 [69.8%]), a combination of 3 medications was prescribed at discharge: tiotropium, a long-acting ß2 agonist, and an inhaled corticosteroid. For more than 80% of the admissions, a prescription for at least one inhaled long-acting bronchodilator was documented both on admission and at discharge. Few patients had a prescription for inhaled corticosteroid without long-acting ß2 agonist, but the number of admissions with a prescription for regular use of systemic corticosteroids increased at discharge. Conclusions: Respiratory medications were generally prescribed in accordance with Canadian COPD guidelines, but improvements could be made regarding use of the combination of tiotropium, long-acting ß2agonist, and inhaled

  19. Psychiatric Service Use and Psychiatric Disorders in Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    Bhaumik, S.; Tyrer, F. C.; McGrother, C.; Ganghadaran, S. K.

    2008-01-01

    Background: UK policies aim to facilitate access to general psychiatric services for adults with intellectual disability (ID). If this is to be achieved, it is important to have a clear idea of the characteristics and proportion of people with ID who currently access specialist psychiatric services and the nature and extent of psychiatric…

  20. Psychiatric genetics in China: achievements and challenges

    PubMed Central

    Schulze, Thomas G.; Burmeister, Margit; Sham, Pak Chung; Yao, Yong-gang; Kuo, Po-Hsiu; Chen, Chao; An, Yu; Dai, Jiapei; Yue, Weihua; Li, Miao Xin; Xue, Hong; Su, Bing; Chen, Li; Shi, Yongyong; Qiao, Mingqi; Liu, Tiebang; Xia, Kun; Chan, Raymond C.K.

    2016-01-01

    To coordinate research efforts in psychiatric genetics in China, a group of Chinese and foreign investigators have established an annual “Summit on Chinese Psychiatric Genetics” to present their latest research and discuss the current state and future directions of this field. To date, two Summits have been held, the first in Changsha in April, 2014, and the second in Kunming in April, 2015. The consensus of roundtable discussions held at these meetings is that psychiatric genetics in China is in need of new policies to promote collaborations aimed at creating a framework for genetic research appropriate for the Chinese population: relying solely on Caucasian population-based studies may result in missed opportunities to diagnose and treat psychiatric disorders. In addition, participants agree on the importance of promoting collaborations and data sharing in areas where China has especially strong resources, such as advanced facilities for non-human primate studies and traditional Chinese medicine: areas that may also provide overseas investigators with unique research opportunities. In this paper, we present an overview of the current state of psychiatric genetics research in China, with emphasis on genome-level studies, and describe challenges and opportunities for future advances, particularly at the dawn of “precision medicine.” Together, we call on administrative bodies, funding agencies, the research community, and the public at large for increased support for research on the genetic basis of psychiatric disorders in the Chinese population. In our opinion, increased public awareness and effective collaborative research hold the keys to the future of psychiatric genetics in China. PMID:26481319

  1. The effect of admitted patients in the emergency department on rates of hospital admissions

    PubMed Central

    Fogarty, Eoin M; Cummins, Fergal

    2013-01-01

    Emergency Department overcrowding with admitted inpatients is a common international occurrence. We undertook a retrospective review to compare patient admission rates from patients presenting to our Emergency Department with the level of overcrowding with admitted inpatients on that particular day in the Emergency Department. Over the 2-year study period there was no change in the rate or absolute number of admissions per day compared with the level of inpatient overcrowding. PMID:23073760

  2. The effect of admitted patients in the emergency department on rates of hospital admissions.

    PubMed

    Fogarty, Eoin M; Cummins, Fergal

    2013-09-01

    Emergency Department overcrowding with admitted inpatients is a common international occurrence. We undertook a retrospective review to compare patient admission rates from patients presenting to our Emergency Department with the level of overcrowding with admitted inpatients on that particular day in the Emergency Department. Over the 2-year study period there was no change in the rate or absolute number of admissions per day compared with the level of inpatient overcrowding. PMID:23073760

  3. Morbidity and mortality of bald eagles (Haliaeetus leucocephalus) and peregrine falcons (Falco peregrinus) admitted to the Wildlife Center of Virginia, 1993-2003.

    PubMed

    Harris, M Camille; Sleeman, Jonathan M

    2007-03-01

    Medical records from 111 threatened bald eagles (86%, Haliaeetus leucocephalus) and peregrine falcons (14%, Falco peregrinus) admitted to the Wildlife Center of Virginia from 1993 to 2003 were reviewed to identify submitters, causes of morbidity and mortality, and final disposition. Half of all patients admitted were submitted by the Virginia Department of Game and Inland Fisheries personnel. Trauma was the most common reason for presentation in bald eagles (70%) and peregrine falcons (81%). Additional causes of morbidity and mortality in bald eagles included toxicoses (10%), infectious diseases (8%), and orphaned young (1%). Neoplasia was confirmed in two trauma cases, suggesting underlying disease might have increased susceptibility to acute traumatic injuries. Peregrine falcons were also admitted for infectious disease (19%). The most frequent infectious disease for both species was West Nile virus. Thirty-nine percent of patients were released back into the wild, 28% were euthanized, 20% died, and 13% were placed in captivity. Postrelease monitoring that would determine whether rehabilitated animals survived to contribute to threatened populations was not performed in this study.

  4. The Risk of Repetition of Attempted Suicide Among Iranian Women with Psychiatric Disorders as Quantified by the Suicide Behaviors Questionnaire

    PubMed Central

    Shakeri, Jalal; Farnia, Vahid; Abdoli, Nasrin; Akrami, Mohammad R.; Arman, Farid; Shakeri, Hania

    2015-01-01

    Objectives: The factors associated with repetition of attempted suicide are poorly categorized in the Iranian population. In this study, the prevalence of different psychiatric disorders among women who attempted suicide and the risk of repetition were assessed.  Methods: Participants were women admitted to the Poisoning Emergency Hospital, Kermanshah University of Medical Sciences following failed suicide attempts. Psychiatric disorders were diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom checklist. Risk of repetition was evaluated using the Suicide Behaviors Questionnaire-Revised (SBQ-R).  Results: About 72% of individuals had a SBQ-R score >8 and were considered to be at high risk for repeated attempted suicide. Adjustment disorders were the most common psychiatric disorders (40.8%). However, the type of psychiatric disorder was not associated with the risk of repetition (p=0.320). Marital status, educational level, employment, substance use, history of suicide among family members, and motivation were not determinant factors for repetition of suicide attempt (p=0.220, 0.880, 0.220, 0.290, 0.350 and 0.270, respectively). Younger women were associated with violent methods of attempted suicide, such as self-cutting, whereas older individuals preferred consumption of poison (p<0.001). Drug overdose was more common among single and married women whereas widows or divorcees preferred self-burning (p=0.004).  Conclusion: About 72% of patients with failed suicide attempts were at high risk for repeated attempts. Age, marital status, and type of psychiatric disorder were the only determinants of suicide method. Adjustment disorders were the most common psychiatric disorders among Iranian women. However, this did not predict the risk of further attempts. PMID:26171123

  5. Does HIV status influence the outcome of patients admitted to a surgical intensive care unit? A prospective double blind study.

    PubMed Central

    Bhagwanjee, S.; Muckart, D. J.; Jeena, P. M.; Moodley, P.

    1997-01-01

    OBJECTIVES: (a) To assess the impact of HIV status (HIV negative, HIV positive, AIDS) on the outcome of patients admitted to intensive care units for diseases unrelated to HIV; (b) to decide whether a positive test result for HIV should be a criterion for excluding patients from intensive care for diseases unrelated to HIV. DESIGN: A prospective double blind study of all admissions over six months. HIV status was determined in all patients by enzyme linked immunosorbent assay (ELISA), immunofluorescence assay, western blotting, and flow cytometry. The ethics committee considered the clinical implications of the study important enough to waive patients' right to informed consent. Staff and patients were blinded to HIV results. On discharge patients could be advised of their HIV status if they wished. SETTING: A 16 bed surgical intensive care unit. SUBJECTS: All 267 men and 135 women admitted to the unit during the study period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: APACHE II score (acute physiological, age, and chronic health evaluation), organ failure, septic shock, durations of intensive care unit and hospital stay, and intensive care unit and hospital mortality. RESULTS: No patient had AIDS. 52 patients were tested positive for HIV and 350 patients were tested negative. The two groups were similar in sex distribution but differed significantly in age, incidence of organ failure (37 (71%) v 171 (49%) patients), and incidence of septic shock (20 (38%) v 54 (15%)). After adjustment for age there were no differences in intensive care unit or hospital mortality or in the durations of stay in the intensive care unit or hospital. CONCLUSIONS: Morbidity was higher in HIV positive patients but there was no difference in mortality. In this patient population a positive HIV test result should not be a criterion for excluding a patient from intensive care. PMID:9133887

  6. Psychiatric comorbidity in patients with conversion disorder and prevalence of dissociative symptoms.

    PubMed

    Yayla, Sinan; Bakım, Bahadır; Tankaya, Onur; Ozer, Omer Akil; Karamustafalioglu, Oguz; Ertekin, Hulya; Tekin, Atilla

    2015-01-01

    The 1st objective of the current study was to investigate the frequency and types of dissociative symptoms in patients with conversion disorder (CD). The 2nd objective of the current study was to determine psychiatric comorbidity in patients with and without dissociative symptoms. A total of 54 consecutive consenting patients primarily diagnosed with CD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria who were admitted to the psychiatric emergency outpatient clinic of Sisli Etfal Research and Teaching Hospital (Istanbul, Turkey) were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, Structured Interview for DSM-IV Dissociative Disorders, and Dissociative Experiences Scale were administered. Study groups consisted of 20 patients with a dissociative disorder and 34 patients without a diagnosis of any dissociative disorder. A total of 37% of patients with CD had any dissociative diagnosis. The prevalence of dissociative disorders was as follows: 18.5% dissociative disorder not otherwise specified, 14.8% dissociative amnesia, and 3.7% depersonalization disorder. Significant differences were found between the study groups with respect to comorbidity of bipolar disorder, past hypomania, and current and past posttraumatic stress disorder (ps = .001, .028, .015, and .028, respectively). Overall comorbidity of bipolar disorder was 27.8%. Psychiatric comorbidity was higher and age at onset was earlier among dissociative patients compared to patients without dissociative symptoms. The increased psychiatric comorbidity and early onset of conversion disorder found in patients with dissociative symptoms suggest that these patients may have had a more severe form of conversion disorder.

  7. Nicotine dependence and psychiatric disorders.

    PubMed

    Salín-Pascual, Rafael J; Alcocer-Castillejos, Natasha V; Alejo-Galarza, Gabriel

    2003-01-01

    Nicotine addiction is the single largest preventable cause of morbidity and mortality in the Western World. Smoking is not any more just a bad habit, but a substance addiction problem. The pharmacological aspects of nicotine show that this substance has a broad distribution in the different body compartnents, due mainly to its lipophilic characteristic. There are nicotinic receptors as members of cholinergic receptors' family. They are located in neuromuscular junction and in the central nervous system (CNS). Although they are similar, pentameric structure with an ionic channel to sodium, there are some differences in the protein chains characteristics. Repeated administration of nicotine in rats, results in the sensitization phenomenon, which produces increase in the behavioral locomotor activity response. It has been found that most psychostimulants-induced behavioral sensitization through a nicotine receptor activation. Nicotine receptors in CNS are located mainly in presynaptic membrane and in that way they regulated the release of several neurotransmitters, among them acetylcholine, dopamine, serotonin, and norepinephrine. In some activities like sleep-wake cycle, nicotine receptors have a functional significance. Nicotine receptor stimulation promotes wake time, reduces both, total sleep time and rapid eye movement sleep (REMS). About nicotine dependence, this substance full fills all the criteria for dependence and withdrawal syndrome. There are some people that have more vulnerability for to become nicotine dependent, those are psychiatric patients. Among them schizophrenia, major depression, anxiety disorders and attention deficit disorder, represent the best example in this area. Nicotine may have some beneficial effects, among them are some neuroprotective effects in disorders like Parkinson's disease, and Gilles de la Tourette' syndrome. Also there are several evidences that support the role of nicotine in cognitive improvement functions like attention

  8. Legal issues in psychiatric treatment.

    PubMed

    Mills, M J

    1984-09-01

    This paper has presented a discussion of the three overlapping phases in the regulation of psychiatric treatment: consent, patients' rights, and physicians' duties. The concepts of consent are relatively well defined. Still, the courts sometimes utilize the rubric of consent to decide difficult cases (e.g., Clites). One can predict that litigation attempting to further define the specific aspects of consent for high-risk therapies will continue. Because of the court's decision in Youngberg, one can also predict that there will be more litigation as to the constituents of constitutionally-adequate treatment. Given the court's dicta in that case, about deferring to professional judgment, it is impossible to know how these cases will fare if and when they are reviewed by the Supreme Court. Given the court's decisions in Mills and Rennie, it is unlikely that the Supreme Court will be ruling on a broad constitutionally-based right to refuse treatment for some time. The most active interface of psychiatry and law is that detailing physicians' duties. In terms of dangerousness, the majority of cases require that psychiatrists attempt to protect victims, or classes of victims, when they believe that dangerous conduct is apt to occur. Still unclear is the extent to which the courts will inquire specifically into the clinical decision-making process to determine whether the physician "reasonably should have known" that the patient was dangerous. Also unclear is the extent to which the courts will find that physicians owe a duty to an ill-defined class. Still, a reasonable guess would be that other courts will find Lipari persuasive. Finally, with regard to specific treatment modalities, it is evident that physicians are being required to practice with an extra measure of care and caution when prescribing neuroleptics, ECT, or psychosurgery. One final note: Too often, physicians have been leery of the political process. Since many decisions with great impact on patients and

  9. [Decision trees in psychiatric therapy].

    PubMed

    Dantchev, N

    1996-01-01

    The main objective of decision analysis is to offer a theoretical representation of choices made in an environment of uncertainty. This technique is currently under development in a great variety of fields, particularly in medicine, where aid in decision making is the topic of much research. Psychiatry, in turn, is very much concerned by these new developments which could be of particular interest to therapeutics-an area where the large number of studies and date are in great contrast with the lack of consensus concerning the various solutions proposed to patients. Decision analysis utilizes different techniques among which are decision trees. The technique of decision trees goes far beyond a simple graphic representation of reasoning in the form of a chart. Its basic principles is to measure the uncertainty associated with decision making in the hopes of better understanding the rationale of decisions while optimizing the gain versus cost ratio. The goal is to calculate, within a series of decisions, the weight of their importance expressed in terms of usefulness or unpleasantness. In psychiatric therapeutics, only three studies have been published which incorporate the technique of decision trees. Two of these deal with treating depression (Schulberg et al., 1989; Koenig et al., 1993) while the third deals with schizophrenia (Hatcher, 1995). The limits of these techniques are, on one hand, due to their feasibility in that their complexity renders them inapplicable when a great number of variables have to be taken into account or when the amount of necessary data is still insufficient. Moreover, the use of these techniques remains relatively restricted as their expansion depends upon their acceptance by clinical physicians. Also, their use raises questions as to what extent it is possible to rationalize decisions in psychiatry. From a larger perspective, one must consider that these techniques may eventually furnish certain elements which could be integrated to

  10. A 12-month, open-label, comparative study of quetiapine and risperidone in the acute and long-term treatment of schizophrenia.

    PubMed

    Perez, Victor; Cañas, Fernando; Tafalla, Monica

    2008-05-01

    This multicentre, observational, prospective, nonrandomized study compared the effectiveness and tolerability of quetiapine and risperidone in the acute and long-term treatment of schizophrenia in a clinical setting. Patients admitted to an acute unit with schizophrenia, schizophreniform or schizoaffective disorder (DSM-IV), who were prescribed quetiapine or risperidone (3 : 1 ratio) within the first week of treatment, according to the physician's usual practice, were recruited. In total, 492 patients (quetiapine: 367; risperidone: 125) were followed up at weeks 1 and 2, discharge and 6 and 12 months thereafter. Mean doses at 12 months were: quetiapine 718.5 mg/day and risperidone 7.0 mg/day. Efficacy measures (Brief Psychiatric Rating Scale, Clinical Global Impression Severity of Illness and Improvement) indicated similar results for both agents. No difference was found in rehospitalization rate with either drug. In terms of tolerability, orthostatic hypotension was more frequent with quetiapine, but extrapyramidal symptoms and male sexual dysfunction were more frequent with risperidone. In conclusion, quetiapine and risperidone had comparable effectiveness, but there were differences between treatments in their side effect profile.

  11. [Circadian rhythm sleep disorders in psychiatric diseases].

    PubMed

    Bromundt, Vivien

    2014-11-01

    Circadian rhythm sleep disorders are prevalent among psychiatric patients. This is most probable due to a close relationship between functional disturbances of the internal clock, sleep regulation and mental health. Mechanisms on molecular level of the circadian clock and neurotransmitter signalling are involved in the development of both disorders. Moreover, circadian disorders and psychiatric diseases favour each other by accessory symptoms such as stress or social isolation. Actimetry to objectively quantify the rest-activity cycle and salivary melatonin profiles as marker for the circadian phase help to diagnose circadian rhythm sleep disorders in psychiatric patients. Chronotherapeutics such as bright light therapy, dark therapy, melatonin administration, and wake therapy are used to synchronise and consolidate circadian rhythms and help in the treatment of depression and other psychiatric disorders, but are still neglected in medicine. More molecular to behavioural research is needed for the understanding of the development of circadian disorders and their relationship to psychiatric illnesses. This will help to boost the awareness and treatment of circadian rhythm sleep disorders in psychiatry.

  12. Understanding psychiatric institutionalization: a conceptual review

    PubMed Central

    2013-01-01

    Background Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day. Method A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings. Results Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care. Conclusions The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry. PMID:23773398

  13. Comorbidity between neurological illness and psychiatric disorders.

    PubMed

    Hesdorffer, Dale C

    2016-06-01

    Psychiatric disorders are common in many neurological disorders, including epilepsy, migraine, Alzheimer's disease, Parkinson's disease, essential tremor, and stroke. These comorbidities increase disease burden and may complicate the treatment of the combined disorders. Initial studies of the comorbidity of psychiatric and neurological disorders were cross-sectional, and time order of the associations was impossible to elucidate. More recent work has clarified time associations between psychiatric disorders and neurological disorders, particularly in epilepsy and stroke where epidemiological evidence suggests that there is a bidirectional relationship. This article takes an epidemiological approach to understanding these relationships and focuses mostly on epilepsy. Although, these relationships are understood in many neurological disorders, routine screening for psychiatric disorders in neurological disorders is infrequent, mostly due to the lack of partnerships between psychiatrists and neurologists and the paucity of neuropsychiatrists. Much more needs to be done to improve the detection and treatment of patients affected by neurological and psychiatric disorders. Understanding the scope of this overlap may inspire collaborations to improve the lives of people affected by both disorders. PMID:26898322

  14. Parental psychiatric disorders and autism spectrum disorders

    PubMed Central

    Jokiranta, Elina; Brown, Alan S.; Heinimaa, Markus; Cheslack-Postava, Keely; Partanen, Auli; Sourander, Andre

    2013-01-01

    The present population-based, case-control study examines associations between specific parental psychiatric disorders and autism spectrum disorders (ASD) including childhood autism, Asperger’s syndrome and pervasive developmental disorder (PDD-NOS). The cohort includes 4713 children born between 1987 and 2005 with diagnoses of childhood autism, Asperger’s syndrome or PDD-NOS. Cases were ascertained from the Finnish Hospital Discharge Register, and each was matched to four controls by gender, date of birth, place of birth, and residence in Finland. Controls were selected from the Finnish Medical Birth Register. Parents were identified through the Finnish Medical Birth Register and Finnish Central Population Register. Parental psychiatric diagnoses from inpatient care were collected from the Finnish Hospital Discharge Register. Conditional logistic regression models were used to assess whether parents’ psychiatric disorders predicted ASD after controlling for parents’ age, smoking during pregnancy and weight for gestational age. In summary, parental schizophrenia spectrum disorders and affective disorders were associated with the risk of ASD regardless of the subgroup. PDD-NOS was associated with all parental psychiatric disorders investigated. Further studies are needed to replicate these findings. These results may facilitate the investigation of shared genetic and familial factors between ASD and other psychiatric disorders. PMID:23391634

  15. [Psychiatric anamnesis, psychiatric findings and their relevance for legal questions in psychiatric assessment before the social court].

    PubMed

    Zeit, T; Wiester, W

    1995-03-01

    Psychiatric expertise in court implies specific requirements with regard to the formal aspects. On the one hand, they are determined by psychiatry as a branch of medical research and on the other by the fact that the expert testimony serves as a piece of evidence in court. Up to now psychiatrists have focused on the legal consequences of different kinds of diseases rather than on the formal aspects of expertise testimony. In this paper, we try to reconcile the specific requirements of psychiatric exploration with the requirements that have to be fulfilled in order to convince the court.

  16. Sleep-disordered breathing and psychiatric disorders.

    PubMed

    Naqvi, Haider A; Wang, David; Glozier, Nicholas; Grunstein, Ronald R

    2014-12-01

    Sleep-disordered breathing, the commonest form of which is obstructive sleep apnoea (OSA) is increasingly recognised as a treatable cause of morbidity. It shares many risk factors with psychiatric disorders including behaviours such as smoking and physical comorbidity. Many symptoms of the two overlap, leaving OSA often undetected and undertreated. In the few studies that assess the two, OSA is commonly comorbid with depression (17-45%) and schizophrenia (up to 55%) and possibly bipolar. There is some limited evidence that treating OSA can ameliorate psychiatric symptoms. Some psychotropics, such as narcotics, cause sleep-disordered breathing (SDB), whilst weight-inducing neuroleptics may exacerbate it. An extreme form of SDB, sudden infant death syndrome (SIDS), is a risk in mothers with substance abuse. Being aware of these common comorbidities may help improve psychiatric patient's treatment and quality of life. PMID:25308389

  17. Deep Brain Stimulation for Psychiatric Disorders

    PubMed Central

    Holtzheimer, Paul E.; Mayberg, Helen S.

    2015-01-01

    Medications, psychotherapy, and other treatments are effective for many patients with psychiatric disorders. However, with currently available interventions, a substantial number of patients experience incomplete resolution of symptoms, and relapse rates are high. In the search for better treatments, increasing interest has focused on focal neuromodulation. This focus has been driven by improved neuroanatomical models of mood, thought, and behavior regulation, as well as by more advanced strategies for directly and focally altering neural activity. Deep brain stimulation (DBS) is one of the most invasive focal neuromodulation techniques available; data have supported its safety and efficacy in a number of movement disorders. Investigators have produced preliminary data on the safety and efficacy of DBS for several psychiatric disorders, as well. In this review, we describe the development and justification for testing DBS for various psychiatric disorders, carefully consider the available clinical data, and briefly discuss potential mechanisms of action. PMID:21692660

  18. Psychiatric considerations in military aerospace medicine.

    PubMed

    Jones, D R; Marsh, R W

    2001-02-01

    Military aerospace medicine requires a psychiatric selection and certification process that determines not only the absence of significant mental disorders, but also the presence of positive qualities in the realms of motivation, ability and stability: not all normal people are fit to fly. Other issues of aerospace psychiatry involve maintenance of mental resilience and hardiness during a flying career, aeromedical decisions about when to remove from flight duties and when to return, criteria for waivers for psychiatric conditions, use of medications for treatment of psychiatric symptoms, questions of substance abuse, and research in such areas as genetics. This report reviews the basis for military aerospace psychiatry, primarily as practiced in the United States Air Force (USAF), and presents some of its underlying principles as they apply to clinical situations.

  19. Negative Rumor: Contagion of a Psychiatric Department

    PubMed Central

    McEwan, Stephanie; Bota, Robert G.

    2014-01-01

    Over the past few decades, a sizable body of literature on the effects of rumors and gossip has emerged. Addressing rumors in the workplace is an important subject, as rumors have a direct impact on the quality of the work environment and also on the productivity and creativity of the employees. To date, little has been written on the effect of rumors and gossip in psychiatric hospitals. This article presents case vignettes of rumors spread in psychiatric hospitals and the impact on team cohesion and morale among the staff implicated in these, too often, neglected occurrences. Dynamic aspects with particular focus on rumors in psychiatric units and suggestions for remedy and treatment are presented. PMID:25133051

  20. Narcissism and relational representations among psychiatric outpatients.

    PubMed

    Kealy, David; Ogrodniczuk, John S; Joyce, Anthony S; Steinberg, Paul I; Piper, William E

    2015-06-01

    Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety. A semistructured interview was used to assess quality of object relations. Multiple regression analysis was conducted, controlling for general psychiatric distress. Pathological narcissism was associated with anxious attachment, but not with avoidant attachment. Narcissism was also associated with lower levels of quality of object relations. The implications of these results are discussed in terms of internal representations of self-other relations.

  1. Childhood Maltreatment, Emotional Dysregulation, and Psychiatric Comorbidities

    PubMed Central

    Dvir, Yael; Ford, Julian D.; Hill, Michael; Frazier, Jean A.

    2014-01-01

    Affect dysregulation, defined as the impaired ability to regulate and/or tolerate negative emotional states, and has been associated with interpersonal trauma and post-traumatic stress. Affect regulation difficulties also play a role in many other psychiatric conditions, including anxiety disorders and mood disorders, specifically major depression in youth and bipolar disorder throughout the life span. Exposure to traumatic events and interpersonal trauma in childhood is associated with a wide range of psychosocial, developmental, and medical impairments in children, adolescents and adults, with emotional dysregulation being a core feature that may help to account for this heightened risk. In order to understand how the developmental effects of childhood maltreatment contribute to emotional dysregulation and psychiatric sequelae, we review emotional regulation and its developmental neurobiology, and examine the research evidence of associations between childhood traumatization, emotional dysregulation, and psychiatric co-morbidities in children, adolescents and adults. PMID:24704784

  2. Defining the psychiatric role in spastic dysphonia.

    PubMed

    Ginsberg, B I; Wallack, J J; Srain, J J; Biller, H F

    1988-03-01

    The authors evaluated 11 surgically-treated patients with spastic dysphonia, a phonation disorder of unclear etiology. The results indicate that the illness does not appear to be a somatoform disorder, but that stress may play a role in its expression, and that there may be secondary depression and anxiety. The experience of spastic dysphonics suggests that psychiatric treatments may be inappropriately applied to an illness without clear organic etiology, whereas, conversely, a proper psychiatric role may be rejected when effective medical or surgical treatment is available. The authors recommend that psychiatrists evaluating patients with illnesses of unclear etiology should be cautious in making a primary psychiatric diagnosis unless DSM-III criteria are met.

  3. Indian – American contributions to psychiatric research

    PubMed Central

    Pandurangi, Anand K.

    2010-01-01

    The Indian Diaspora, especially in North America, is a visible force in the field of psychiatric medicine. An estimated 5000 persons of Indian origin practice psychiatry in the USA and Canada, and an estimated 10% of these are in academic psychiatry. Wide ranging contributions, from molecular biology of psychiatric disorders to community and cultural psychiatry, are being made by this vibrant group of researchers. This article is a brief summary and work-in-progress report of the contributions by Indian – American psychiatric researchers. Although not exhaustive in coverage, it is meant to give the reader an overview of the contributions made by three waves of researchers over a span of 50 years. PMID:21836715

  4. Psychiatric thoughts in the Tamil culture.

    PubMed

    Somasundaram, O

    2002-04-01

    THE SIGNIFICANCE OF PSYCHIATRIC THOUGHTS IN TAMIL CULTURE IS BROUGHT FORTH WITH RELEVANT HISTORICAL AND LITERARY EVIDENCES: psycho-physiological aspects of emotions, descriptions of severely disturbed individuals, attitude of the society towards the mentally ill and epigraphic material describing hospital care of psychiatric patients in the first millennium are alluded. These references unravel the advanced psychiatric medical knowledge in the Ancient Tamil system of Medicine namely the Siddha system. The mythical origin of Siddha Medicine, attributes of the Siddhars (knowledgeable persons) and short biographical notes of eminent siddhars like Agathiyar, Bogar, Therayar and Thirumoolar are cited. Ancient theories of etiopathogenesis, namely the Panchaboothas and Tridoshas are detailed. Agathiyar's deschptions, classification and treatment of mental illnesses and Yogi Siddhar's contribution to psychiatry require significant mentioning. Siddha system has proved its potential effect by displaying promising results in treating HIV and Hepatitis-B. Likewise the author encourages similar discoveries in Siddha Medicine with relevance to psychiatry.

  5. Ethical Challenges in Psychiatric Administration and Leadership.

    PubMed

    Moffic, H Steven; Saeed, Sy Atezaz; Silver, Stuart; Koh, Steve

    2015-09-01

    As with all professional ethical principles, those in psychiatry have to evolve over time and societal changes. The current ethical challenges for psychiatric administration and leadership, especially regarding for-profit managed care, need updated solutions. One solution resides in the development by the American Association of Psychiatric Administrators (AAPA) of the first set of ethical principles designed specifically for psychiatric administrators. These principles build on prior Psychological Theories of leadership, such as those of Freud, Kernberg, and Kohut. Supplementing these theories are the actual real life models of psychiatrist leadership as depicted in the memoirs of various psychiatrists. Appreciating these principles, theories, and models may help emerging leaders to better recognize the importance of ethical challenges. A conclusion is that psychiatrists should have the potential to assume more successful leadership positions once again. In such positions, making the skills and well-being of all in the organization seems now to be the foremost ethical priority.

  6. Psychiatric aspects of brain tumors: A review

    PubMed Central

    Madhusoodanan, Subramoniam; Ting, Mark Bryan; Farah, Tara; Ugur, Umran

    2015-01-01

    Infrequently, psychiatric symptoms may be the only manifestation of brain tumors. They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety, or anorexia. Symptoms may be misleading, complicating the clinical picture. A comprehensive review of the literature was conducted regarding reports of brain tumors and psychiatric symptoms from 1956-2014. Search engines used include PubMed, Ovid, Psych Info, MEDLINE, and MedScape. Search terms included psychiatric manifestations/symptoms, brain tumors/neoplasms. Our literature search yielded case reports, case studies, and case series. There are no double blind studies except for post-diagnosis/-surgery studies. Early diagnosis is critical for improved quality of life. Symptoms that suggest work-up with neuroimaging include: new-onset psychosis, mood/memory symptoms, occurrence of new or atypical symptoms, personality changes, and anorexia without body dysmorphic symptoms. This article reviews the existing literature regarding the diagnosis and management of this clinically complex condition. PMID:26425442

  7. Clinical profile of patients admitted to the coronary care unit with possible myocardial infarction without diagnostic ECG and/or enzyme changes.

    PubMed

    Abdul-Mohsen, M F; al-Quorain, A; al-Hamdan, A A; Husain, A; Qutub, H; Ladipo, G O

    1993-12-01

    Concern has been expressed about the cost-effectiveness of the Coronary Care Unit (CCU) and solution options offered on account of the large number of patients admitted to the CCU who turn out not to have acute myocardial infarction. In a prospective study over four years, we studied a group of patients admitted to the CCU with suspected myocardial infarction but who did not have diagnostic ECG and/or enzyme changes for the causes of their chest pain. We compared the clinical profile of these patients (Group A) with that of a random sample of patients with confirmed myocardial infarction (Group B). Gastrointestinal disorders, musculoskeletal chest pain, panic and anxiety disorders were the major causes of chest pain in Group A patients. A normal ECG and a normal creatine phosphokinase (CPK) within the first 24 hours, a normal initial random blood sugar, a younger age and absence of coronary risk factors effectively separated Group A patients as low risk from Group B patients as high risk for acute myocardial infarction. These simple parameters will assist physicians providing CCU care in most hospitals in early decision making and in the judicious use of the CCU. PMID:8026351

  8. Psychobiotics: An emerging probiotic in psychiatric practice.

    PubMed

    Kali, Arunava

    2016-06-01

    Intestinal microbial flora plays critical role in maintenance of health. Probiotic organisms have been recognized as an essential therapeutic component in the treatment of intestinal dysbiosis. Current research suggests their health benefits extends beyond intestinal disorders. The neuroactive molecules produced by the gut microbiota has been found to modulate neural signals which affect neurological and psychiatric parameters like sleep, appetite, mood and cognition. Use of these novel probiotics opens up the possibility of restructuring of intestinal microbiota for effective management of various psychiatric disorders. PMID:27621125

  9. Genetics and genomics of psychiatric disease.

    PubMed

    Geschwind, Daniel H; Flint, Jonathan

    2015-09-25

    Large-scale genomic investigations have just begun to illuminate the molecular genetic contributions to major psychiatric illnesses, ranging from small-effect-size common variants to larger-effect-size rare mutations. The findings provide causal anchors from which to understand their neurobiological basis. Although these studies represent enormous success, they highlight major challenges reflected in the heterogeneity and polygenicity of all of these conditions and the difficulty of connecting multiple levels of molecular, cellular, and circuit functions to complex human behavior. Nevertheless, these advances place us on the threshold of a new frontier in the pathophysiological understanding, diagnosis, and treatment of psychiatric disease. PMID:26404826

  10. Mind and brain in psychiatric treatment.

    PubMed

    Gabbard, G O

    1994-01-01

    Psychological and biological components of psychiatric illness must be integrated to avoid the perils of reductionism in diagnosis and treatment. With the decline of dualism, a number of creative thinkers have conceptualized the mind-body problem in a manner that values perspectives derived from psychoanalytic thinking as well as from the neurosciences. Similarly, modern studies of the etiology and pathogenesis of major psychiatric disorders suggest that only through a sophisticated synthesis of psychosocial and genetic/biochemical points of view can causation be comprehensively understood. In light of this accumulating knowledge, the author concludes that treatment must be informed by psychotherapeutic approaches as well as by pharmacotherapy.

  11. Genetics and genomics of psychiatric disease.

    PubMed

    Geschwind, Daniel H; Flint, Jonathan

    2015-09-25

    Large-scale genomic investigations have just begun to illuminate the molecular genetic contributions to major psychiatric illnesses, ranging from small-effect-size common variants to larger-effect-size rare mutations. The findings provide causal anchors from which to understand their neurobiological basis. Although these studies represent enormous success, they highlight major challenges reflected in the heterogeneity and polygenicity of all of these conditions and the difficulty of connecting multiple levels of molecular, cellular, and circuit functions to complex human behavior. Nevertheless, these advances place us on the threshold of a new frontier in the pathophysiological understanding, diagnosis, and treatment of psychiatric disease.

  12. Genetics and genomics of psychiatric disease

    PubMed Central

    Geschwind, Daniel H.; Flint, Jonathan

    2015-01-01

    Large-scale genomic investigations have just begun to illuminate the molecular genetic contributions to major psychiatric illnesses, ranging from small-effect-size common variants to larger-effect-size rare mutations. The findings provide causal anchors from which to understand their neurobiological basis. Although these studies represent enormous success, they highlight major challenges reflected in the heterogeneity and polygenicity of all of these conditions and the difficulty of connecting multiple levels of molecular, cellular, and circuit functions to complex human behavior. Nevertheless, these advances place us on the threshold of a new frontier in the pathophysiological understanding, diagnosis, and treatment of psychiatric disease. PMID:26404826

  13. Effects of a complete smoking ban on inpatients at an intermediate to long-term psychiatric facility.

    PubMed

    Smith, Philip H; Homish, Gregory G; Kozlowski, Lynn T; Spacone, Celia; Trigoboff, Eileen; Joffe, Susan

    2013-04-01

    The majority of research on reactions to smoking bans in psychiatric facilities focuses on staff feedback in acute inpatient settings. The purpose of this pilot study was to assess inpatient attitudes about a complete smoking ban in an intermediate to long-term psychiatric facility. One hundred inpatients were surveyed via questionnaire. Inpatients reported changes in smoking and improvements in health as a result of the ban, despite evidence of non-compliant smoking at the facility. There was evidence that inpatients perceived others' attitudes about the ban to be worse than reality. The findings from this pilot study suggest that consequences of smoking bans in psychiatric facilities are not as negative as some perceive. Smoking bans in intermediate to long-term settings may result in improvements in health among both smoking and non-smoking patients.

  14. The Centre for Psychiatric Nursing Research and practice: promoting excellence in psychiatric nursing.

    PubMed

    Happell, Brenda

    2006-09-01

    The Centre for Psychiatric Nursing Research and Practice (CPNRP), is funded by the Department of Human Services Victoria, as an initiative to support psychiatric nurses throughout the State of Victoria. At the time of the CPNRPs inception in 1999, psychiatric nursing had been affected by widespread changes in the delivery of mental health services and nursing education in Victoria. The aim of this paper is to provide an overview of the development of the CPNRP and how this development reflected the significant issues of the time. The CPNRP introduced a number of programs and other initiatives in response to six primary issues: recruitment, retention, leadership, professional development, research: practice gap and communication.

  15. Drug-Related Hyponatremic Encephalopathy: Rapid Clinical Response Averts Life-Threatening Acute Cerebral Edema

    PubMed Central

    Siegel, Arthur J.; Forte, Sophie S.; Bhatti, Nasir A.; Gelda, Steven E.

    2016-01-01

    Patient: Female, 63 Final Diagnosis: Drug-induced hyponatremic encephalopathy Symptoms: Seizures • coma Medication: Hypertonic 3% saline infusion Clinical Procedure: — Specialty: Internal Medicine Objective: Unusual clinical course Background: Drug-induced hyponatremia characteristically presents with subtle psychomotor symptoms due to its slow onset, which permits compensatory volume adjustment to hypo-osmolality in the central nervous system. Due mainly to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), this condition readily resolves following discontinuation of the responsible pharmacological agent. Here, we present an unusual case of life-threatening encephalopathy due to adverse drug-related effects, in which a rapid clinical response facilitated emergent treatment to avert life-threatening acute cerebral edema. Case Report: A 63-year-old woman with refractory depression was admitted for inpatient psychiatric care with a normal physical examination and laboratory values, including a serum sodium [Na+] of 144 mEq/L. She had a grand mal seizure and became unresponsive on the fourth day of treatment with the dual serotonin and norepinephrine reuptake inhibitor [SNRI] duloxetine while being continued on a thiazide-containing diuretic for a hypertensive disorder. Emergent infusion of intravenous hypertonic (3%) saline was initiated after determination of a serum sodium [Na+] of 103 mEq/L with a urine osmolality of 314 mOsm/kg H20 and urine [Na+] of 12 mEq/L. Correction of hyposmolality in accordance with current guidelines resulted in progressive improvement over several days, and she returned to her baseline mental status. Conclusions: Seizures with life-threatening hyponatremic encephalopathy in this case likely resulted from co-occurring SIADH and sodium depletion due to duloxetine and hydrochlorothiazide, respectively. A rapid clinical response expedited diagnosis and emergent treatment to reverse life-threatening acute cerebral edema

  16. Psychiatric home care: a new tool for crisis intervention.

    PubMed

    Spiro, A H

    1994-03-01

    The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care.

  17. 3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. PSYCHIATRIC WARD IN 24' X 60' QUONSET HUT, VIEW OF SOUTH FACE - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

  18. 4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. FIRE BREAK BETWEEN PSYCHIATRIC WARD AND NEXT WARD TO THE SOUTH - Fort Randall, Neuro-Psychiatric Ward, Northeast of intersection of California Boulevard & Nurse Drive, Cold Bay, Aleutian Islands, AK

  19. Psychiatric home care: a new tool for crisis intervention.

    PubMed

    Spiro, A H

    1994-03-01

    The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care. PMID:10132548

  20. Psychiatric services in China: or, Mao versus Freud.

    PubMed

    Allodi, F; Dukszta, J

    1978-10-01

    Reportedly, the People's Republic of China has made great progress in health care services, particularly at preventive, primary and community levels. Information on their psychiatric services is still scarce. A group of 12 health professionals visited the country for three weeks in July 1977. This paper provides a description and an analysis of the network of mental health services using a sample of one mental hospital, six general hospitals and a number of health units in cities, factories and communes. The basic principles of policy and administration are those of a collective socialism with strong central guidelines and considerable local administrative initiative. Admissions to the mental hospital in Shanghai reveal that 83% are young acute schizophrenic cases and very few are neurotic or non-psychotic. This distribution stands in great contrast with admissions to mental hospitals in the West, as is the case in Canada, where schizophrenics represent only 12% of all first admissions to mental hospitals and non-psychotic or minor conditions amount to two-thirds. An impressionistic survey of Chinese traditional medicine rooms in general hospitals revealed that a good proportion of their cases (60-70%) are diagnosed as suffering from minor organic or vague organic conditions without evidence of organic pathology and which in the West would be considered as neurotic or psychosomatic conditions. Outside the institutions, in the communes of the rural and urban areas behavioural, interpersonal and family problems are not defined specifically as mental health problems, but handled within the moral and political ideology prevalent in the country. None of the general hospitals visited had a psychiatric unit, but every patient in every hospital or health unit in the cities and countryside received a combination of traditional Chinese medicine (herbal preparations, acupuncture and moxibustion) besides the Western or modern type of treatment. Officially mental illness is not

  1. The legal basis of forensic psychiatry: statutorily mandated psychiatric diagnoses.

    PubMed

    Bloom, J D; Rogers, J L

    1987-07-01

    Using the Oregon statutory scheme as an example, the authors review certain areas of the law where psychiatric expertise is mandated by statute. This review points out the diversity of determinations where forensic psychiatric expertise is required by law. The authors' thesis is that forensic psychiatry draws its vitality from the law. Legal requirements, however, should not dictate psychiatric response, which should be guided by psychiatric knowledge and ethical concerns.

  2. Use of animal-assisted therapy with psychiatric patients.

    PubMed

    Rossetti, Jeanette; King, Camille

    2010-11-01

    The use of animal-assisted therapy (AAT) as an adjunct treatment approach in psychiatric settings has received much attention in the literature. This article explores the use of AAT with psychiatric patients. The authors performed a literature review and found that AAT can have a significant effect on the improvement of psychiatric patients' socialization and provides a variety of psychological benefits. Nurses can benefit from learning about the potential benefits of AAT for psychiatric patients.

  3. Prader-Willi syndrome: new insights in the behavioural and psychiatric spectrum.

    PubMed

    Descheemaeker, M J; Vogels, A; Govers, V; Borghgraef, M; Willekens, D; Swillen, A; Verhoeven, W; Fryns, J P

    2002-01-01

    Prader-Willi syndrome (PWS) is a genetic disorder caused by the loss of the paternal contribution of the proximal part (15q11-q13) of the long arm of chromosome 15 (i.e. deletion, disomy and imprinting mutation). The syndrome is associated with distinct physical dysmorphism, as well as with specific behavioural and psychopathological characteristics. Psychiatric symptoms in adolescence and adulthood have been described, including acute cycloid psychosis, and obsessive compulsive, bipolar and pervasive developmental disorders. At the Centre for Human Genetics in Leuven, Belgium, 53 individuals (31 children and adolescents, and 22 adults) have been followed up for 15 years by a special multidisciplinary team. Attention was given to their medical, cognitive, behavioural and emotional development, and the evolution of psychiatric disorders in adolescence and adulthood. This study describes the psychiatric problems in four patients diagnosed with acute cycloid psychosis and traces their development from infancy to adolescence. Four other individuals needed psychiatric evaluation and treatment, and could be diagnosed as having unspecified bipolar disorder, also termed unstable mood disorder. Both groups were compared, and significant differences in early development and later evolution into adulthood were noted. The individuals with PWS who later developed psychotic episodes were described as active and extrovert toddlers, and showed autistic behaviour during their primary school education. Their intellectual functioning was in the moderate to severely retarded range. The individuals with PWS who later developed an unstable mood disorder were described as rather passive and introvert toddlers, and they presented less disturbed behaviour during their primary school education. The intellectual functioning of these subjects was in the normal to borderline range. PMID:11851855

  4. Involvement of a Surgical Service Improves Patient Satisfaction in Patients Admitted with Small Bowel Obstruction

    PubMed Central

    Schmocker, Ryan K.; Vang, Xia; Cherney Stafford, Linda M.; Leverson, Glen E.; Winslow, Emily R.

    2015-01-01

    Background For patients with small bowel obstruction (SBO), surgical care has been associated with improved outcomes; however it remains unknown how it impacts satisfaction. Methods Patients admitted for SBO who completed the hospital satisfaction survey were eligible. Only those with adhesions or hernias were included. Chart review extracted structural characteristics and outcomes. Results 47 patients were included; 74% (n=35) were admitted to a surgical service. 26% (n=12) were admitted to medicine, and 50% of those (n=6) had surgical consultation. Patients with surgical involvement as the consulting or primary service (SURG) had higher satisfaction with the hospital than those cared for by the medical service (80% SURG; 33% MED, p=0.015). SURG patients also had higher satisfaction with physicians (74% SURG; 44% MED; p=0.015). Conclusions Surgical involvement during SBO admissions is associated with increased patient satisfaction, and adds further weight to the recommendation that these patients be cared for by surgeons. PMID:25886702

  5. Sexual Attitude Reassessment for Psychiatric Patients.

    ERIC Educational Resources Information Center

    Dincin, Jerry; Wise, Shirley

    1979-01-01

    Sexuality programs are one part of the program at Thresholds, a rehabilitation center for psychiatric patients (17 to 50 years old). A 16 week sexuality group includes seven phases: initial interview; beginning group development (health care, contraception, reproduction, sexuality); masturbation; intercourse; homosexuality; coed group discussion;…

  6. Consent in psychiatric biobanks for pharmacogenetic research.

    PubMed

    van der Baan, Frederieke H; Bernabe, Rose D C; Bredenoord, Annelien L; Gregoor, Jochem G; Meynen, Gerben; Knol, Mirjam J; van Thiel, Ghislaine J M W

    2013-04-01

    In psychiatric practice, pharmacogenetics has the potential to identify patients with an increased risk of unsatisfactory drug responses. Genotype-guided treatment adjustments may increase benefits and reduce harm in these patients; however, pharmacogenetic testing is not (yet) common practice and more pharmacogenetic research in psychiatric patients is warranted. An important precondition for this type of research is the establishment of biobanks. In this paper, we argue that, for the storage of samples in psychiatric biobanks, waiving of consent is not ethically justifiable since the risks cannot be considered minimal and the argument of impracticability does not apply. An opt-out consent procedure is also not justifiable, since it presumes competence while the decisional competence of psychiatric patients needs to be carefully evaluated. We state that an enhanced opt-in consent procedure is ethically necessary, i.e. a procedure that supports the patients' decision-making at the time when the patient is most competent. Nevertheless, such a procedure is not the traditional exhaustive informed consent procedure, since this is not feasible in the case of biobanking. PMID:22607776

  7. Profiling psychiatric inpatient suicide attempts in Japan.

    PubMed

    Ikeshita, Katsumi; Shimoda, Shigero; Norimoto, Kazunobu; Arita, Keisuke; Shimamoto, Takuya; Murata, Kiyoshi; Makinodan, Manabu; Kishimoto, Toshifumi

    2014-01-01

    Suicide is an adverse event that can occur even when patient are hospitalized in psychiatric facilities. This study delineates the demographic characteristics of suicide attempts in mental hospitals and psychiatric wards of general hospitals in Japan, a country where the suicide rate is remarkably high. Analyses of incident reports on serious suicide attempts in psychiatric inpatients were performed using prefectural incident records between April 1, 2001, and December 31, 2012. Suicide reports were included for 35 incidents that occurred over 11 years, and demonstrated that 83% of patients (n = 29) committed suicide and 17% (n = 6) survived their attempt with serious aftereffects, such as cognitive impairment or persistent vegetative state. The male/female ratio of inpatient suicide was 1.5:1. The mean age of the attempters was 50.5 years (SD = 18.2). The most common psychiatric diagnoses for those with suicide incident reports were schizophrenia spectrum disorders (51.4%) and affective disorders (40%). Hanging (60%) was the most common method of suicide attempt, followed by jumping in front of moving objects (14.3%) and jumping from height (11.4%). Fifty-four percent of suicides (n = 19) occurred within hospital sites and the remainder (46%; n = 16) occurred outside hospital sites (e.g., on medical leave or elopement) while they were still inpatients. PMID:25345233

  8. Psychiatric Comorbidity in Gender Dysphoric Adolescents

    ERIC Educational Resources Information Center

    de Vries, Annelou L. C.; Doreleijers, Theo A. H.; Steensma, Thomas D.; Cohen-Kettenis, Peggy T.

    2011-01-01

    Background: This study examined psychiatric comorbidity in adolescents with a gender identity disorder (GID). We focused on its relation to gender, type of GID diagnosis and eligibility for medical interventions (puberty suppression and cross-sex hormones). Methods: To ascertain DSM-IV diagnoses, the Diagnostic Interview Schedule for Children…

  9. [Physical activities, psychiatric care and mental health].

    PubMed

    Davanture, Olivier

    2014-02-01

    At Ville-Evrard psychiatric hospital, sports activities are used as one of several therapeutic tools. The day-long multi-sport sessions, led notably by a nurse, form part of the care programme. Sport not only enables the patients to exert themselves, it is above all a form of therapeutic mediation which encourages verbal and non-verbal communication.

  10. Tobacco Smoking in Adolescent Psychiatric Outpatients

    ERIC Educational Resources Information Center

    Ditchburn, K. Marie; Sellman, J. Douglas

    2013-01-01

    Three main aims of this study were to ascertain the prevalence rate of smoking among adolescent psychiatric outpatients; estimate smokers' degree of nicotine dependence; and investigate the relationship between smoking and common mental health disorders. Face-to-face interviews were conducted on 93 patients ages 13-18 presenting to an adolescent…

  11. Novel Therapeutic GPCRs for Psychiatric Disorders

    PubMed Central

    Komatsu, Hidetoshi

    2015-01-01

    G protein-coupled receptors (GPCRs) are the most common targets of the neuropharmacological drugs in the central nervous system (CNS). GPCRs are activated by manifold neurotransmitters, and their activation in turn evokes slow synaptic transmission. They are deeply involved in multiple neurological and psychiatric disorders such as Parkinson’s disease and schizophrenia. In the brain, the striatum is strongly innervated by the ventral tegmental area (VTA) and plays a central role in manifestation of psychiatric disorders. Recently, anatomical and comprehensive transcriptome analysis of the non-odorant GPCR superfamily revealed that the orphan GPCRs GPR88, GPR6, and GPR52, as well as dopamine D1 and D2 receptors and the adenosine A2a receptor, are the most highly enriched in the rodent striatum. Genetically engineered animal models and molecular biological studies have suggested that these striatally enriched GPCRs have a potential to be therapeutic psychiatric receptors. This review summarizes the current understanding of the therapeutic GPCR candidates for psychiatric disorders. PMID:26101869

  12. Educational Needs in the Psychiatric Setting.

    ERIC Educational Resources Information Center

    Sluckin, Andy; Hanna, Bob

    1991-01-01

    Case studies in Norwich, England, identified issues in the provision of adult education in psychiatric settings: differing definitions of the role of adult education; role conflict between adult educators and health professionals; and opposing beliefs about outsiders entering an institution. The cases also affirmed the therapeutic value of…

  13. Asperger Syndrome: Associated Psychiatric and Medical Conditions.

    ERIC Educational Resources Information Center

    Ghaziuddin, Mohammad

    2002-01-01

    This article explores the association of medical and psychiatric conditions with Asperger syndrome, based mainly on publications from the last two decades. It examines comorbidity of Asperger syndrome with mood disorders, schizophrenia, obsessive-compulsive disorder, attention deficit/hyperactivity disorder, tic disorders, violence and aggression,…

  14. Prevalence of Psychiatric Disorders in Preschoolers

    ERIC Educational Resources Information Center

    Wichstrom, Lars; Berg-Nielsen, Turid Suzanne; Angold, Adrian; Egger, Helen Link; Solheim, Elisabet; Sveen, Trude Hamre

    2012-01-01

    Background: Many disorders in childhood and adolescence were already present in the preschool years. However, there is little empirical research on the prevalence of psychiatric disorders in young children. A true community study using structured diagnostic tools has yet to be published. Methods: All children born in 2003 or 2004 in the city of…

  15. Psychiatric Symptoms in Alpha-Mannosidosis

    ERIC Educational Resources Information Center

    Malm, D.; Pantel, J.; Linaker, O. M.

    2005-01-01

    Alpha-mannosidosis is characterized by mild to moderate intellectual disability (ID), moderate to severe neurosensory hearing loss, frequent infections, psychomotor disturbances and skeletal dysmorphism. For the first time, a panel of nine alpha-mannosidosis patients with psychiatric symptoms is presented. The clinical picture has several…

  16. Psychiatric Patients Face Longer Waits in ER

    MedlinePlus

    ... MedlinePlus Site Map FAQs Contact Us Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Latest Health News → Article URL of this page: https://medlineplus.gov/news/fullstory_160934.html Psychiatric Patients Face Longer Waits in ER And they're ...

  17. Prosecuting Assaultive Forensic and Psychiatric Inpatients

    ERIC Educational Resources Information Center

    Angus, Kerri C.; Reddon, John R.; Chudleigh, Michele D.

    2008-01-01

    Inpatient assault of forensic and psychiatric staff is a complex and multifaceted issue. Hence, the consequences reported in the literature regarding prosecuting assaultive inpatients are quite variable. In this article, issues pertaining to the prosecution of violent inpatients are reviewed. Illustrative cases, challenges of prosecution,…

  18. Sexual Health Education: A Psychiatric Resident's Perspective

    ERIC Educational Resources Information Center

    Waineo, Eva; Arfken, Cynthia L.; Morreale, Mary K.

    2010-01-01

    Objective: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. Methods: An anonymous, web-based survey was sent to residents in one general psychiatry program (N = 33). The response rate was 69.7%. Results: Residents reported inadequate experience in multiple…

  19. Psychiatric Symptoms in Children with Primary Headache

    ERIC Educational Resources Information Center

    Anttila, Pirjo; Sourander, Andre; Metsahonkala, Liisa; Aromaa, Minna; Helenius, Hans; Sillanpaa, Matti

    2004-01-01

    Objective: To examine the association of psychiatric symptoms with migraine and tension-type headache in children. Method: A questionnaire completed by 1,135 Finnish children in the sixth grade identified 154 children with migraine, 138 with tension-type headache, and 407 children who were headache-free. Seventy children were randomly selected…

  20. Cholinergic connectivity: it's implications for psychiatric disorders

    PubMed Central

    Scarr, Elizabeth; Gibbons, Andrew S.; Neo, Jaclyn; Udawela, Madhara; Dean, Brian

    2013-01-01

    Acetylcholine has been implicated in both the pathophysiology and treatment of a number of psychiatric disorders, with most of the data related to its role and therapeutic potential focusing on schizophrenia. However, there is little thought given to the consequences of the documented changes in the cholinergic system and how they may affect the functioning of the brain. This review looks at the cholinergic system and its interactions with the intrinsic neurotransmitters glutamate and gamma-amino butyric acid as well as those with the projection neurotransmitters most implicated in the pathophysiologies of psychiatric disorders; dopamine and serotonin. In addition, with the recent focus on the role of factors normally associated with inflammation in the pathophysiologies of psychiatric disorders, links between the cholinergic system and these factors will also be examined. These interfaces are put into context, primarily for schizophrenia, by looking at the changes in each of these systems in the disorder and exploring, theoretically, whether the changes are interconnected with those seen in the cholinergic system. Thus, this review will provide a comprehensive overview of the connectivity between the cholinergic system and some of the major areas of research into the pathophysiologies of psychiatric disorders, resulting in a critical appraisal of the potential outcomes of a dysregulated central cholinergic system. PMID:23653591