Web of Objects Based Ambient Assisted Living Framework for Emergency Psychiatric State Prediction

PubMed Central

Alam, Md Golam Rabiul; Abedin, Sarder Fakhrul; Al Ameen, Moshaddique; Hong, Choong Seon

2016-01-01

Ambient assisted living can facilitate optimum health and wellness by aiding physical, mental and social well-being. In this paper, patients’ psychiatric symptoms are collected through lightweight biosensors and web-based psychiatric screening scales in a smart home environment and then analyzed through machine learning algorithms to provide ambient intelligence in a psychiatric emergency. The psychiatric states are modeled through a Hidden Markov Model (HMM), and the model parameters are estimated using a Viterbi path counting and scalable Stochastic Variational Inference (SVI)-based training algorithm. The most likely psychiatric state sequence of the corresponding observation sequence is determined, and an emergency psychiatric state is predicted through the proposed algorithm. Moreover, to enable personalized psychiatric emergency care, a service a web of objects-based framework is proposed for a smart-home environment. In this framework, the biosensor observations and the psychiatric rating scales are objectified and virtualized in the web space. Then, the web of objects of sensor observations and psychiatric rating scores are used to assess the dweller’s mental health status and to predict an emergency psychiatric state. The proposed psychiatric state prediction algorithm reported 83.03 percent prediction accuracy in an empirical performance study. PMID:27608023

Dopaminergic Neurotransmission in the Human Brain: New Lessons from Perturbation and Imaging

PubMed Central

Ko, Ji Hyun; Strafella, Antonio P.

2012-01-01

Dopamine plays an important role in several brain functions and is involved in the pathogenesis of several psychiatric and neurological disorders. Neuroimaging techniques such as positron emission tomography allow us to quantify dopaminergic activity in the living human brain. Combining these with brain stimulation techniques offers us the unique opportunity to tackle questions regarding region-specific neurochemical activity. Such studies may aid clinicians and scientists to disentangle neural circuitries within the human brain and thereby help them to understand the underlying mechanisms of a given function in relation to brain diseases. Furthermore, it may also aid the development of alternative treatment approaches for various neurological and psychiatric conditions. PMID:21536838

Treating an HIV/AIDS Patient's PTSD and Medication Nonadherence with Cognitive-Behavioral Therapy: A Principle-Based Approach

ERIC Educational Resources Information Center

Chernoff, Robert A.

2007-01-01

HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a…

Evaluating the Effectiveness of Mental Health First Aid Program for Chinese People in Hong Kong

ERIC Educational Resources Information Center

Wong, Daniel F. K.; Lau, Ying; Kwok, Sylvia; Wong, Prudence; Tori, Christopher

2017-01-01

Purpose: Chinese people generally lack knowledge of mental illness. Such phenomenon may lead to a delay in seeking psychiatric treatments. This study evaluated the effectiveness of Mental Health First Aid (MHFA) program in improving mental health knowledge of the general public in Hong Kong. Methods: A quasi-experimental design was adopted whereby…

Psychiatric disorders and treatment among newly homeless young adults with histories of foster care.

PubMed

Thompson, Ronald G; Hasin, Deborah

2012-09-01

Although foster care placement is often preceded by stressful events such as child abuse, foster care itself often exposes children to additional severe stressors. A history of foster care, as well as the childhood abuse that often precedes it, is common among homeless young adults. This study examined whether a history of foster care was associated with psychiatric disorders, prior psychiatric counseling, prescription of psychiatric medications, and prior psychiatric hospitalization among newly homeless young adults. A consecutive sample of 423 adults aged 18 to 21 years who sought emergency shelter for the first time between October 1, 2007, and February 29, 2008, were assessed at intake. Logistic regression analyses determined the associations between foster care and any psychiatric disorder (affective, anxiety, personality, and psychotic) and psychiatric treatment. The analyses adjusted for demographic characteristics, childhood abuse, substance use, prior arrest, unemployment, lack of high school diploma, and histories of psychiatric disorders and drug abuse among biological relatives. Homeless young adults with histories of foster care were 70% more likely than those without such histories to report any psychiatric disorder. They were more than twice as likely to have received mental health counseling for a psychiatric disorder, to have been prescribed psychiatric medication, and to have been hospitalized for psychiatric problems. Histories of foster care among homeless young adults should trigger screening for psychiatric disorders to aid in the provision of treatment (counseling, medication, and hospitalization) tailored to the psychiatric needs of this highly vulnerable population.

A practical approach to the assessment of psychosocial and psychiatric comorbidity in the dermatology patient.

PubMed

Gupta, Madhulika A; Gupta, Aditya K

2013-01-01

It is well recognized that the clinical course of many dermatologic disorders is the result of a complex and sometimes reciprocal interaction between biological, psychiatric/psychological, and social factors that can have a predisposing, precipitating, and/or perpetuating role for the dermatologic disorder. Assessment of psychiatric and psychosocial comorbidity, which can be present in up to 30% of dermatology patients, is an important component of the overall clinical evaluation of the patient. This paper discusses a practical approach to the assessment of psychosocial and psychiatric factors, including suicide risk and parasuicidal behaviors in the dermatology patient. The approach further classifies these factors as predisposing, precipitating, and/or perpetuating, in order to aid the clinician with the possible secondary and tertiary prevention of some dermatologic disorders by management of their psychosocial and psychiatric comorbidity. Copyright © 2013 Elsevier Inc. All rights reserved.

Innovative biomarkers in psychiatric disorders: a major clinical challenge in psychiatry.

PubMed

Lozupone, Madia; Seripa, Davide; Stella, Eleonora; La Montagna, Maddalena; Solfrizzi, Vincenzo; Quaranta, Nicola; Veneziani, Federica; Cester, Alberto; Sardone, Rodolfo; Bonfiglio, Caterina; Giannelli, Gianluigi; Bisceglia, Paola; Bringiotti, Roberto; Daniele, Antonio; Greco, Antonio; Bellomo, Antonello; Logroscino, Giancarlo; Panza, Francesco

2017-09-01

Currently, the diagnosis of psychiatric illnesses is based upon DSM-5 criteria. Although endophenotype-specificity for a particular disorder is discussed, the identification of objective biomarkers is ongoing for aiding diagnosis, prognosis, or clinical response to treatment. We need to improve the understanding of the biological abnormalities in psychiatric illnesses across conventional diagnostic boundaries. The present review investigates the innovative post-genomic knowledge used for psychiatric illness diagnostics and treatment response, with a particular focus on proteomics. Areas covered: This review underlines the contribution that psychiatric innovative biomarkers have reached in relation to diagnosis and theragnosis of psychiatric illnesses. Furthermore, it encompasses a reliable representation of their involvement in disease through proteomics, metabolomics/pharmacometabolomics and lipidomics techniques, including the possible role that gut microbiota and CYP2D6 polimorphisms may play in psychiatric illnesses. Expert opinion: Etiologic heterogeneity, variable expressivity, and epigenetics may impact clinical manifestations, making it difficult for a single measurement to be pathognomonic for multifaceted psychiatric disorders. Academic, industry, or government's partnerships may successfully identify and validate new biomarkers so that unfailing clinical tests can be developed. Proteomics, metabolomics, and lipidomics techniques are considered to be helpful tools beyond neuroimaging and neuropsychology for the phenotypic characterization of brain diseases.

Effectiveness of Dual Focus Mutual Aid for Co-occurring Substance Use and Mental Health Disorders: A Review and Synthesis of the “Double Trouble” in Recovery Evaluation

PubMed Central

Magura, Stephen

2010-01-01

Over five million adults in the U.S. have a co-occurring substance use disorder and serious psychological distress. Mutual aid (“self-help”) can usefully complement treatment, but people with co-occurring substance use and psychiatric disorders often encounter a lack of empathy and acceptance in traditional mutual aid groups. Double Trouble in Recovery (DTR) is a dual focus fellowship whose mission is to bring the benefits of mutual aid to persons recovering from co-occurring disorders. An evaluation of DTR was conducted by interviewing 310 persons attending 24 DTR meetings in New York City in 1998 and following them up for two years, in 1999 and 2000. The evaluation produced 13 articles in 12 peer reviewed journals, the main results of which are summarized here. The sample’s characteristics were: mean age, 40 years; women, 28%; black, 59%; white, 25%; Hispanic, 14%; never married, 63%; live in supported community residence, 53%; high school graduate or GED, 60%; arrested as adult, 63%; diagnoses of: schizophrenia, 39%; major depression, 21%; or bipolar disorder; 20%; currently prescribed psychiatric medication, 92%; primary substance used, current or past: cocaine/crack, 42%; alcohol 34%; or heroin, 11%. Overall, the findings indicate that DTR participation has both direct and indirect effects on several important components of recovery: drug/alcohol abstinence, psychiatric medication adherence, self-efficacy for recovery, and quality of life. The study also identified several “common” therapeutic factors (e.g., internal motivation, social support) and unique mutual aid processes (helper-therapy, reciprocal learning) that mediate the influence of DTR participation on recovery. For clinicians, these results underline the importance of fostering stable affiliation with specialized dual focus 12-step groups for their patients with co-occurring disorders, as part of a comprehensive recovery-oriented treatment approach. PMID:19016171

Effectiveness of dual focus mutual aid for co-occurring substance use and mental health disorders: a review and synthesis of the "Double Trouble" in Recovery evaluation.

PubMed

Magura, Stephen

2008-01-01

Over 5 million adults in the United States have a co-occurring substance use disorder and serious psychological distress. Mutual aid (self-help) can usefully complement treatment, but people with co-occurring substance use and psychiatric disorders often encounter a lack of empathy and acceptance in traditional mutual aid groups. Double Trouble in Recovery (DTR) is a dual focus fellowship whose mission is to bring the benefits of mutual aid to persons recovering from co-occurring disorders. An evaluation of DTR was conducted by interviewing 310 persons attending 24 DTR meetings in New York City (NYC) in 1998 and following them up for 2 years, in 1999 and 2000. The evaluation produced 13 articles in 12 peer-reviewed journals, the main results of which are summarized here. The sample's characteristics were as follows: mean age, 40 years; women, 28%; black, 59%; white, 25%; Hispanic, 14%; never married, 63%; live in supported community residence, 53%; high school graduate or GED, 60%; arrested as adult, 63%; diagnoses of: schizophrenia, 39%; major depression, 21%; or bipolar disorder, 20%; currently prescribed psychiatric medication, 92%; primary substance used, current or past: cocaine/crack, 42%; alcohol 34%; or heroin, 11%. Overall, the findings indicate that DTR participation has both direct and indirect effects on several important components of recovery: drug/alcohol abstinence, psychiatric medication adherence, self-efficacy for recovery, and quality of life. The study also identified several "common" therapeutic factors (e.g., internal motivation and social support) and unique mutual aid processes (helper-therapy and reciprocal learning) that mediate the influence of DTR participation on recovery. For clinicians, these results underline the importance of fostering stable affiliation with specialized dual focus 12-step groups for their patients with co-occurring disorders, as part of a comprehensive recovery-oriented treatment approach.

Improving detection of psychiatric disturbances in Parkinson's disease: the role of informants.

PubMed

Hirsch, Elaina S; Adler, Geri; Amspoker, Amber B; Williams, James R; Marsh, Laura

2013-01-01

Under-recognition of psychiatric disturbances in patients with Parkinson's disease (PD) contributes to greater overall morbidity. Little is known about the value of collateral psychiatric history, obtained using standardized assessments with informants, for increasing recognition of PD-related psychiatric illness. To examine the extent to which informants provide critical information that enabled psychiatrists to establish psychiatric diagnoses in patients with PD. Individuals with PD (n = 223) and an informant were interviewed separately regarding the PD patient's psychiatric history and current status. A six-psychiatrist panel rated the extent to which informant data was required to establish the final consensus best-estimate current psychiatric diagnoses. Informants rated as "Crucial" or "Significantly Informative" comprised a "Critical Informant" (CI) subgroup; remaining informants were classified as the "Non-Critical Informant" (NCI) subgroup. Of the informants, 71 (31.4%) were "critical" for determining a psychiatric diagnosis. Without a CI, 81.3% of those with impulse control disorders and 43.8% of those with anxiety disorders would not have been diagnosed. Male PD patients and those with less severe motor deficits were also more likely to require a CI. Informants aid in the identification of psychiatric diagnoses, especially impulse control and anxiety disorders. This has implications for clinical practice and conduction of clinical trials.

Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature

PubMed Central

Brandt, Charles; Zvolensky, Michael J.; Woods, Steven P.; Gonzalez, Adam; Safren, Steven A.; O’Cleirigh, Conall M.

2016-01-01

There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning. PMID:27939443

Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature.

PubMed

Brandt, Charles; Zvolensky, Michael J; Woods, Steven P; Gonzalez, Adam; Safren, Steven A; O'Cleirigh, Conall M

2017-02-01

There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning. Copyright © 2016 Elsevier Ltd. All rights reserved.

Identifying the 'right patient': nurse and consumer perspectives on verifying patient identity during medication administration.

PubMed

Kelly, Teresa; Roper, Cath; Elsom, Stephen; Gaskin, Cadeyrn

2011-10-01

Accurate verification of patient identity during medication administration is an important component of medication administration practice. In medical and surgical inpatient settings, the use of identification aids, such as wristbands, is common. In many psychiatric inpatient units in Victoria, Australia, however, standardized identification aids are not used. The present paper outlines the findings of a qualitative research project that employed focus groups to examine mental health nurse and mental health consumer perspectives on the identification of patients during routine medication administration in psychiatric inpatient units. The study identified a range of different methods currently employed to verify patient identity, including technical methods, such as wristband and photographs, and interpersonal methods, such as patient recognition. There were marked similarities in the perspectives of mental health nurses and mental health consumers regarding their opinions and preferences. Technical aids were seen as important, but not as a replacement for the therapeutic nurse-patient encounter. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Utilization of psychiatric services integrated with primary care by persons of color with HIV in the inner city.

PubMed

Budin, John; Boslaugh, Sarah; Beckett, Emily; Winiarski, Mark G

2004-08-01

We identify the psychiatric diagnoses and utilization patterns of HIV-positive persons of color who received culturally responsive mental health services integrated into a community medical clinic. Ninety-three patients were referred and 86% (n = 80) appeared for at least one encounter. Hispanics, compared with African-Americans, and HIV patients, compared with AIDS patients, were more likely to receive psychotropic prescriptions. Patients with six or more visits were defined as high utilizers: they comprised 27.5% of the patients but used 67.3% of the services. Development of a broader range of psychiatric interventions that address diagnoses, utilization, and psychotropics will better meet these patients' needs.

Psychological first-aid: a practical aide-memoire.

PubMed

Leach, J

1995-07-01

Despite advances made in recent years in medical first aid, psychiatric intervention, survival training and equipment design, many people still perish quickly during and immediately following a disastrous event. In this study, individuals and groups of survivors of life-threatening events were debriefed and the behavior of those who coped well during such a threat to life were compared with those who did not. The behaviors of those who coped well were distilled into a set of principles for psychological first aid; that is, a series of simple actions for use within a disaster which serves to recover victims to functional behavior as quickly as possible, thus increasing their chance for survival. These principles of psychological first aid have recently been introduced into basic first aid and survival training courses for both military and civilian units.

AIDS-related dementia: a case report of rapid cognitive decline.

PubMed

Morgan, M K; Clark, M E; Hartman, W L

1988-11-01

Little is known psychometrically about the pattern of cognitive decline associated with acquired immunodeficiency syndrome (AIDS)-related dementia. Pre- and posttest results are presented to illustrate a case example of rapid cognitive decline. Increased psychometric assessment is recommended with additional examination of inconsistent results, which may be dismissed mistakenly as related to psychiatric symptoms. Implications for clinical practice and the role of the psychologist are discussed.

AIDS phobia: report of 4 cases.

PubMed

Ross, M W

1988-01-01

Psychological reactions to sexually transmissible disease (STD) infection are common, occurring in up to 85% of some patients with STDs: Hart has suggested that they are among the most common conditions encountered in venereology. Previous psychiatric disturbances in STD patients, however, are relatively uncommon and differ in both etiology and management from such psychological sequelae of STD infection, although both Catalan et al. and Fitzpatrick et al. report that in the United Kingdom, some 40% of STD clinic attenders had General Health Questionnaire scores indicating they were psychiatric cases.

Psychiatric disorders in a cohort of individuals with Prader-Willi syndrome.

PubMed

Shriki-Tal, L; Avrahamy, H; Pollak, Y; Gross-Tsur, V; Genstil, L; Hirsch, H J; Benarroch, F

2017-07-01

Psychiatric manifestations in Prader-Willi Syndrome (PWS) are common and often are the most debilitating problem in these individuals. We present an epidemiological nation-wide survey of psychiatric diagnoses in the PWS population, based on full-range psychiatric interviews. We studied the distribution of psychiatric diagnoses (as opposed to a symptom-based approach) in the Israel national cohort of adolescents and adults with PWS. There was a total of 53 (32 males) ages 12 years and older. All individuals and their caretakers were interviewed using standardized psychiatric questionnaires. Demographic and clinical variables, Clinical Global Impression (CGI) score, IQ, severity of hyperphagia and quality of life (QOL) were also assessed and correlations with NPD (number of psychiatric diagnoses) calculated. An overwhelming majority (89%) of the study participants had at least one psychiatric diagnosis. The most common were disruptive behavior disorders (DBD) (68%), obsessive compulsive disorder (OCD) (45%) and skin picking (35%). Individuals with DBD were at increased risk for OCD and skin picking. Psychotic disorders were found in 11%. NPD had a significant negative influence on QOL. There was no correlation between NPD and BMI, IQ, hyperphagia severity, hormonal profile or genetic subtypes. Psychiatric diagnoses are very frequent in PWS and strongly influence QOL. Furthermore, characterizing the profile of psychiatric comorbidity in PWS is crucial for planning effective interventions. Precise behavioral phenotyping in PWS in combination with a well-defined genetic etiology may aid biological research linking biological correlates to behavior. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Potential biomarkers in psychiatry: focus on the cholesterol system

PubMed Central

Woods, Alisa G; Sokolowska, Izabela; Taurines, Regina; Gerlach, Manfred; Dudley, Edward; Thome, Johannes; Darie, Costel C

2012-01-01

Abstract Measuring biomarkers to identify and assess illness is a strategy growing in popularity and relevance. Although already in clinical use for treating and predicting cancer, no biological measurement is used clinically for any psychiatric disorder. Biomarkers could predict the course of a medical problem, and aid in determining how and when to treat. Several studies have indicated that of candidate psychiatric biomarkers detected using proteomic techniques, cholesterol and associated proteins, specifically apolipoproteins (Apos), may be of interest. Cholesterol is necessary for brain development and its synthesis continues at a lower rate in the adult brain. Apos are the protein component of lipoproteins responsible for lipid transport. There is extensive evidence that the levels of cholesterol and Apos may be disturbed in psychiatric disorders, including autistic spectrum disorders (ASD). Here, we describe putative serum biomarkers for psychiatric disorders, and the role of cholesterol and Apos in central nervous system (CNS) disorders. PMID:22304330

77 FR 57096 - Part C Early Intervention Services Grant Under the Ryan White HIV/AIDS Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-17

... psychiatric and mental health therapy, nurse medical case management focused on treatment adherence, and... therapy, nurse medical case management focused on treatment adherence, and referrals to specialty medical...

Psychiatric Aspects of Artificial Insemination (Donor)

PubMed Central

Watters, W. W.; Sousa-Poza, J.

1966-01-01

Artificial insemination (donor) [A.I.D.] in humans is a medical procedure that has been carried out for roughly 50 years. Its legal status has not yet been established; its moral implications are still hotly contested, and its psychological and psychiatric implications are only now coming under scientific scrutiny. The use of this procedure in couples who are psychologically unsuited for it can have unfortunate consequences. The obstetrician should seek the assistance of a dynamically oriented psychiatrist in screening couples who ask for artificial insemination (donor). Parenthood, in line with psychoanalytic ego psychology, is seen as a phase of ego development. The potential for mothering and fathering children is a later stage in growth than the capacity to conceive and sire them. It is the psychiatrist's role to assess the couple's motivation for A.I.D. in the light of the extent to which they have achieved this degree of ego development. PMID:20328602

HIV Risk Reduction Among Young Adult Chronic Psychiatric Patients

DTIC Science & Technology

1990-08-28

was noted in a cohort of gay men in California. The human immunodeficiency virus (HIV) was discovered as the cause of AIDS and the HI V antibody...sexual practices among homosexual and bisexual men provide a framework for the development of any prevention program designed to reduce the risk of HIV...and the Multicenter Aids Cohort Study and note that many gay men have significantly reduced the frequency of unprotected anal Intercourse. Winkelstein

Prevalence of HIV/AIDS and psychiatric disorders and their related risk factors among adults in Epworth, Zimbabwe.

PubMed

Sebit, M B; Tombe, M; Siziya, S; Balus, S; Nkomo, S D A; Maramba, P

2003-10-01

To examine the prevalence of HIV infection, neuropsychiatric disorders, psychiatric symptoms/signs, alcohol use/misuse, CD4 cell counts and risk factors in adult patients. Cross-sectional study. Epworth, which is about 15 km on the southeastern part of Harare, Zimbabwe. Two hundred subjects were included in the study out of which six were excluded beacause of HIV-1 indeterminate results. A convenience sample of 200 subjects recruited in a cross-sectional study in Epworth, Zimbabwe. Six subjects had indeterminate HIV-1 antibody results and were excluded from the study. The remaining 194 subjects of whom 101 (52.1%) knew about their sero-status and were consecutively recruited, whereas, 93 (47.9%) did not know about their sero-status and were recruited by a systematic random sampling method (1-in-3). They were then interviewed about neuropsychiatric disorders using BPRS, MADRS, AUDIT and MINI Mental State Test, including the risk factors related to HIV infection. After ELISA tests' results, the two groups were combined and then categorised into HIV positive (n=115) and HIV negative (n=79) subjects. Prevalence, neuropsychiatric disorders, increased CD4 cell counts and risk factors associated with HIV infection. The findings were that the overall point prevalence of the HIV infection was 59.3% (115/194). Comparative analyses between seropositive and seronegative HIV/AIDS subjects showed: over two thirds (71.3%) of the HIV positive subjects suffered from psychiatric disorders, more than those with HIV negative 44.3% (OR=3.12, 95% CI=1.64-5.95, P=0.0002), and subjects aged 35 years and less were mostly HIV seronegatives (n=77.2%, OR=2.34, 95% CI=1.18-4.75, P=0.014). The overall prevalence of alcohol use/misuse was 41 (21.1%), with higher prevalence rate among HIV positive subjects, 28 (24.3%) than those who were HIV negative, 13 (16.5%). The commonest psychiatric symptoms/signs (P<0.05) were emotional withdrawal, depressed mood, suspiciousness, apparent sadness, reduced sleep and suicidal thoughts (especially among women). There is very high point prevalence of HIV/AIDS and psychiatric disorders, including a moderate prevalence rate of alcohol use/misuse in this less affluent community that warranted intervention.

Computer-based diagnostic decisionmaking.

PubMed

Miller, R A

1987-12-01

The three decisionmaking aids described by the authors attack the generic problem of "see no evil, hear no evil, speak no evil"--improving the detection, diagnosis, and therapy of psychiatric disorders in the primary care setting. The three systems represent interventions at different steps in the process of providing appropriate care to psychiatric patients. The DSPW system of Robins and Marcus offers the potential of increasing the recognition of psychiatric disease in the physician's office. Politser's IDS program is representative of the sort of sophisticated microcomputer-based decisionmaking support tools that will become available to physicians in the not-too-distant future. Erdman's study of the impact of explanation capabilities on the acceptability of therapy recommending systems points out the need for careful scientific evaluations of features added to diagnostic and therapeutic systems.

Gender and professional identity in psychiatric nursing practice in Alberta, Canada, 1930-75.

PubMed

Boschma, Geertje; Yonge, Olive; Mychajlunow, Lorraine

2005-12-01

This paper examines gender-specific transformations of nursing practice in institutional mental health-care in Alberta, Canada, based on archival records on two psychiatric hospitals, Alberta Hospital Ponoka and Alberta Hospital Edmonton, and on oral histories with psychiatric mental health nurses in Alberta. The paper explores class and gender as interrelated influences shaping the work and professional identity of psychiatric mental health nurses from the 1930s until the mid-1970s. Training schools for nurses in psychiatric hospitals emerged in Alberta in the 1930s under the influence of the mental hygiene movement, evolving quite differently for female nurses compared to untrained aides and male attendants. The latter group resisted their exclusion from the title 'nurse' and successfully helped to organize a separate association of psychiatric nurses in the 1950s. Post-World War II, reconstruction of health-care and a de-institutionalization policy further transformed nurses' practice in the institutions. Using social history methods of analysis, the paper demonstrates how nurses responded to their circumstances in complex ways, actively participating in the reconstruction of their practice and finding new ways of professional organization that fit the local context. After the Second World War more sophisticated therapeutic roles emerged and nurses engaged in new rehabilitative practices and group therapies, reconstructing their professional identities and transgressing gender boundaries. Nurses' own stories help us to understand the striving toward psychiatric nursing professionalism in the broader context of changing gender identities and work relationships, as well as shifting perspectives on psychiatric care.

Horticultural therapy in a psychiatric in-patient setting.

PubMed

de Seixas, Miguel; Williamson, David; Barker, Gemma; Vickerstaff, Ruth

2017-11-01

In-patient mental health services have a duty to constantly seek to improve patient experience and to assist in the development of new skills that can aid recovery. Horticultural therapy can be implemented in an economic, social and environmentally sustainable way to achieve those goals.

Training South African Mental Health Care Providers to Talk About Sex in the Era of AIDS

PubMed Central

Collins, Pamela Y.; Mestry, Kezziah; Wainberg, Milton L.; Nzama, Thobile; Lindegger, Graham

2009-01-01

Objective Mental health care providers in South Africa often lack the skills to conduct effective prevention activities in psychiatric settings. This article describes the development and evaluation of an HIV education program for mental health care providers at three psychiatric institutions in South Africa. Methods The research team worked with a core group of 16 mental health care providers to assess HIV training needs and to develop a training intervention focused on identified issues. The training intervention was administered to three groups (42 total) during three 1.5-day workshops. Providers completed pre- and postintervention assessments that measured knowledge and attitudes about HIV and AIDS. Results Data analysis revealed a significant increase in reported levels of comfort with HIV care (d=.54), perceived knowledge of HIV (d=1.17), and factual knowledge (d=.74). Conclusions This contextually relevant HIV education curriculum changed providers’ attitudes and knowledge, demonstrated the feasibility of administering the training program, and provided a foundation for further prevention activities. PMID:17085615

A Screening Test for Wilson's Disease and its Application to Psychiatric Patients

PubMed Central

Cox, Diane Wilson

1967-01-01

Varied modes of onset make the early diagnosis of Wilson's disease difficult. A deficiency of serum ceruloplasmin, usually characteristic of the disease, was used as the basis for a screening test. Simple test materials and provision for handling about 50 plasma samples simultaneously made this test feasible for large-scale screening. The screening test was applied to 336 persons hospitalized for psychiatric disorders, to detect patients with Wilson's disease before the classical symptoms appeared. Two patients with ceruloplasmin levels below the normal limits were detected but did not have Wilson's disease. Further application of the screening test to relatives of patients known to have Wilson's disease and to individuals with any symptoms of the disease (hepatic disease, extrapyramidal dysfunction, psychiatric disorders, behaviour problems in children) would aid in early diagnosis and more effective treatment. ImagesFig. 1 PMID:6017170

Emotional and behavioural disorders in HIV seropositive adolescents in urban Uganda.

PubMed

Musisi, S; Kinyanda, E

2009-01-01

To investigate the emotional and behavioral problems of HIV sero-positive adolescents. A cross-sectional descriptive study. A specialised HIV/AIDS Health Care Centre, the Mildmay Centre, in Kampala, Uganda. Eighty two HIV sero-positive adolescents were consecutively enrolled for the study. Over half (55.6%) of the subjects were females. They were mostly (88.9%) under the age of 15 years, orphans (97.6%) and stayed with non-parental relatives (68.3%). Almost two thirds (60.9%) of them were in the HIV/AIDS clinical disease stage III or IV and were not on ARVs drugs. Forty two (51.2%) of the subjects had significant psychological distress (SRQ-25 scores > or = 6) and 14 (17.1%) had attempted suicide within the last 12 months. Their specific psychiatric disorders, made using ICD-10 criteria, were: Anxiety 45.6%, depression 40.8%, somatisation 18.0%, seizures 8.4%, mania 1.2% and HIV-associated progressive encephalopathy 4.8%. HIV/AIDS infection in adolescence was associated with considerable psychological problems and the presence of major psychiatric disorders. With the current increasing availability of effective antiretroviral therapy, many of these children are surviving into adolescence, thus calling for the development of adolescent friendly HIV medical and psychological support and treatment services in developing countries such as Uganda.

Substance Abuse Treatment in Persons with HIV/AIDS: Challenges in Managing Triple Diagnosis

PubMed Central

Durvasula, Ramani; Miller, Theodore R.

2014-01-01

This paper provides a review of the current literature addressing substance abuse treatment in persons living with HIV/AIDS. Clinical management of HIV must account for the “triple diagnosis” of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990's, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention. PMID:24274175

Horticultural therapy in a psychiatric in-patient setting

PubMed Central

Williamson, David; Barker, Gemma; Vickerstaff, Ruth

2017-01-01

In-patient mental health services have a duty to constantly seek to improve patient experience and to assist in the development of new skills that can aid recovery. Horticultural therapy can be implemented in an economic, social and environmentally sustainable way to achieve those goals. PMID:29093958

Antidepressants Increase REM Sleep Muscle Tone in Patients with and without REM Sleep Behavior Disorder.

PubMed

McCarter, Stuart J; St Louis, Erik K; Sandness, David J; Arndt, Katlyn; Erickson, Maia; Tabatabai, Grace; Boeve, Bradley F; Silber, Michael H

2015-06-01

REM sleep behavior disorder (RBD) is associated with antidepressant treatment, especially in younger patients; but quantitative REM sleep without atonia (RSWA) analyses of psychiatric RBD patients remain limited. We analyzed RSWA in adults receiving antidepressants, with and without RBD. We comparatively analyzed visual, manual, and automated RSWA between RBD and control groups. RSWA metrics were compared between groups, and regression was used to explore associations with clinical variables. Tertiary-care sleep center. Participants included traditional RBD without antidepressant treatment (n = 30, 15 Parkinson disease [PD-RBD] and 15 idiopathic); psychiatric RBD receiving antidepressants (n = 30); and adults without RBD, including antidepressant-treated psychiatric (n = 30), untreated psychiatric (n = 15), and OSA (n = 60) controls. N/A. RSWA was highest in traditional and psychiatric RBD, intermediate in treated psychiatric controls, and lowest in untreated psychiatric and OSA controls (P < 0.01). RSWA distribution and type also differed between antidepressant-treated patients having higher values in anterior tibialis, and PD-RBD with higher submentalis and tonic RSWA. Psychiatric RBD had significantly younger age at onset than traditional RBD patients (P < 0.01). Antidepressant treatment was associated with elevated REM sleep without atonia (RSWA) even without REM sleep behavior disorder (RBD), suggesting that antidepressants, not depression, promote RSWA. Differences in RSWA distribution and type were also seen, with higher anterior tibialis RSWA in antidepressant-treated patients and higher tonic RSWA in Parkinson disease-RBD patients, which could aid distinction between RBD subtypes. These findings suggest that antidepressants may mediate different RSWA mechanisms or, alternatively, that RSWA type and distribution evolve during progressive neurodegeneration. Further prospective RSWA analyses are necessary to clarify the relationships between antidepressant treatment, psychiatric disease, and RBD. © 2015 Associated Professional Sleep Societies, LLC.

Psychiatric Discharge Process

PubMed Central

Alghzawi, Hamzah M.

2012-01-01

Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate different levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more effective. Depending on this review, it could be concluded that effective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage. PMID:23762767

Neuropsychology of Timing and Time Perception

ERIC Educational Resources Information Center

Meck, W.H.

2005-01-01

Interval timing in the range of milliseconds to minutes is affected in a variety of neurological and psychiatric populations involving disruption of the frontal cortex, hippocampus, basal ganglia, and cerebellum. Our understanding of these distortions in timing and time perception are aided by the analysis of the sources of variance attributable…

Star Wars in Psychotherapy: Video Games in the Office

ERIC Educational Resources Information Center

Ceranoglu, Tolga Atilla

2010-01-01

Objective: Video games are used in medical practice during psycho-education in chronic disease management, physical therapy, rehabilitation following traumatic brain injury, and as an adjunct in pain management during medical procedures or cancer chemotherapy. In psychiatric practice, video games aid in social skills training of children with…

Dermatitis neglecta: a challenging diagnosis in psychodermatology.

PubMed

Lopes, Sofia; Vide, Júlia; Antunes, Isabel; Azevedo, Filomena

2018-06-01

Dermatitis neglecta is a condition affecting the skin caused by a lack of hygiene. It may be related to psychiatric and neurological disturbances. The appearance of skin lesions results from neglect, which helps distinguish this condition from other similar clinical entities. Resolution of the lesions with adequate cleansing aids a definitive diagnosis.

[A review of thirty years of activity of the Research Program in Psychiatric Epidemiology (PEPSI) of the CONICET].

PubMed

Pavlovsky, Federico

2003-01-01

This article summarizes the activity of the Programa de Investigaciones en Epidemiología Psiquiátrica (PEPSI) (Research Program in Psychiatric Epidemiology) of the CONICET, directed for more than thirty years by Fernando Pages Larraya. After an anthropologic psychiatric experience done in the Gran Chaco Gualamba, by the end of the 60s, Pages Larraya and his team developed the theory of Cultural Isoidias, zones into which the country could be divided for epidemiologic studies. This article summarizes some of the principal lines of investigation of this program which departures from an initial study of the prevalence of mental diseases in Argentina. Other lines of research (such as a study about marginality, about Alzheimer's disease, about alcoholism and about AIDS) are summarized very briefly so as to give the reader an idea about the enormous field of study embraced by the PEPSI.

Psychiatric symptomatology associated with contemporary peacekeeping: an examination of post-mission functioning among peacekeepers in Somalia.

PubMed

Orsillo, S M; Roemer, L; Litz, B T; Ehlich, P; Friedman, M J

1998-10-01

Contemporary peacekeepers frequently confront complex stressors including the need to directly enforce peace between warring factions, to deliver humanitarian aid in the midst of political-social devastation, and to balance shifting rules of engagement. As such, it is proposed that participants may be at increased risk for the development of psychiatric distress. The present study examined the types of stressors encountered by 3,461 peacekeepers in Somalia, their current psychiatric functioning as measured by the Brief Symptom Inventory, and the relationship between exposure to various stressors and adjustment. Over one third of participants met criteria for psychiatric caseness. The most commonly reported symptoms included hostility, psychoticism, depression, and paranoid ideation. The best predictors of current functioning were found to be exposure to traditional war-zone-related stressors and general military pride and cohesion. These findings highlight the mental health consequences that service in a peacekeeping mission may have for United States solidiers. Further research is needed to investigate potential mechanisms that could serve as buffers to the stress associated with peacekeeping service.

Mental health of primary caregivers for children and adolescents with HIV/AIDS in Cuba.

PubMed

Santiesteban, Yasel; Castro, Marta; Calvo, Marina

2012-04-01

An HIV diagnosis, like that of any another chronic illness, alters family dynamics. Although the whole family is affected, usually only one member is the primary caregiver of the sick person. Children and adolescents with HIV/AIDS need care according to their physical, psychological and social needs, requiring responsible caregivers who maintain adequate physical and mental health. To describe general mental health characteristics of primary caregivers of Cuban children and adolescents from across the country diagnosed with HIV/AIDS at the Pedro Kourí Tropical Medicine Institute. A descriptive study was carried out from November 2009 through March 2010. Twenty-six caregivers met inclusion criteria and 13 participated. A psychological assessment was made of each caregiver's mental health, including both externally evaluated and self reported factors associated with physical or psychological problems. Clinical interview and observation, psychiatric examination and various psychological tests were used. A simple descriptive analysis of caregiver characteristics, qualitative information and test results was made. Most caregivers were women, infected with HIV/AIDS themselves, unemployed and without a partner. They presented symptoms of anxiety but no clinical psychiatric diagnoses. The study group reported dissatisfaction with family functioning and partner relationships, as well as problems related to HIV and poor employment prospects. Caregivers studied described complex intra- and interpersonal life dynamics influenced by their HIV infection. Their mental health status, evaluated through a combination of objective and subjective factors reveals a complex reality, indicating the need for a more comprehensive and efficient approach to caregivers' health care, integrating attention to both physical and mental health.

Who cares? Pathways to psychiatric care for young people experiencing a first episode of psychosis.

PubMed

Lincoln, C V; McGorry, P

1995-11-01

The authors reviewed the literature to better understand pathways to psychiatric care among young persons experiencing a first episode of psychosis. Because no discrete body of literature exists about how young people with psychotic illness gain access to psychiatric services, the authors examined three related areas: illness recognition, help-seeking, and referral pathways. Automated and manual searches of primarily medical and psychological sources from 1977 to 1995 were conducted. The review found evidence of delay in obtaining early treatment among young people with an emerging psychosis, although comparisons between studies are difficult. Early psychiatric intervention is believed to significantly aid recovery and is an increasingly important clinical issue. Recognizing psychiatric illness is problematic for professionals and nonprofessionals. Understanding of help seeking by patients experiencing a first psychotic episode and of their referral pathways is limited. Taken together, studies suggest factors affecting access to treatment but provide neither sufficient empirical information nor an adequate conceptual framework to better target secondary prevention strategies. Formulation of a pathways-to-care model appears to offer a useful way of understanding mental health care use. Exploration of consumer experiences would enrich the model. Strategies to reduce treatment delay could then be developed and evaluated. Increased consumer involvement might help ensure that services are better tailored to patients' needs.

Sociodemographic and clinical features of patients with depressive disorder in Khartoum, Sudan.

PubMed

Najim, Hellme; Omer, Abdelaziz Ahmed

2015-09-01

It's known worldwide that depression is becoming a major health problem and its prevalence is increasing. The main objective of this study is to find out the prevalence of depression among patients attending a general psychiatric clinic, and study their sociodemographic and clinical features. Files of patients attending a private psychiatric clinic in Khartoum in the period June 2005-June 2010 were reviewed. Only those with a diagnosis of depression were chosen, sociodemographic date and clinical features were documented and results were shown below. Total numbers of patients with depression were 137 (11.4%). Females were more than males (56.2%), the majority are between ages 41-60 (40.9%), married (65%), (14.9%) had family history of psychiatric disorders and (52%) had a previous history of psychiatric treatment. Depressed mood is the commonest symptom (98.5%), loss of interest (91.9%), reduced energy (57%), guilt feelings (17.9%) and (35.8%) of our samples expressed suicidal ideations. The commonest type of somatic symptom is generalized aches and pain (30.7%), (18%) were psychotic. The present study is a retrospective descriptive study, based on a private psychiatric clinic sample. It provided a useful baseline for more comprehensive field based studies, to try to aid planning and development of services to meet the needs of the population.

The association of psychiatric disorders and HIV infection in the correctional setting.

PubMed

Baillargeon, Jacques; Ducate, Suzanne; Pulvino, John; Bradshaw, Patrick; Murray, Owen; Olvera, Rene

2003-10-01

Psychiatric disorders, such as bipolar disorder, schizophrenia, and depression, have been associated with both HIV-associated risk behaviors and HIV infection. While the US prison population is reported to exhibit elevated rates of HIV/AIDS and most psychiatric disorders, scarce information currently exists on the association of these conditions in the prison setting. The present study examined the association of six major psychiatric disorders with HIV infection in one of the nation's largest prison populations. The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system. Inmates diagnosed with HIV infection exhibited elevated rates of major depression, dysthymia, bipolar disorder, schizophrenia, schizoaffective disorder, and non-schizophrenic psychotic disorder. These rates persisted in stratified analyses and in a multivariate analysis that statistically adjusted for gender, race, and age category. The present cross-sectional study's finding of a positive association between HIV infection and psychiatric diagnoses among inmates holds both clinical and public health relevance. It will be important for future investigations to prospectively assess the underlying mechanisms of these associations in the correctional setting.

Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis.

PubMed

Durvasula, Ramani; Miller, Theodore R

2014-01-01

Clinical management of HIV must account for the "triple diagnosis" of HIV, psychiatric diagnosis, and substance use disorders and requires integrated treatment services that focus beyond just mitigation of substance use and psychiatric and medical symptoms but also address other health behaviors. Because clinical management of HIV/AIDS has shifted significantly with the advent of highly active antiretroviral therapies (HAART) in the mid 1990s, a literature review focusing on literature published since 2000, and using relevant key words was conducted using a wide range of literature search databases. This literature review was complemented by studies to expand on specific treatment modalities for which there was a dearth of literature addressing HIV infected cohorts and to provide discussion of issues around substance abuse treatment as an HIV prevention tool. Existing models of substance abuse treatment including cognitive behavioral therapy and motivational interviewing have proven to be useful for enhancing adherence and reducing substance use in outpatient populations, while methadone maintenance and directly observed treatment have been useful with specific subgroups of users. Contextualization of services heightens the likelihood of successful outcomes and relapse prevention.

Report of the Northern California Conference for Guidelines on Aid-in-Dying: definitions, differences, convergences, conclusions.

PubMed Central

Young, E W; Marcus, F S; Drought, T; Mendiola, M; Ciesielski-Carlucci, C; Alpers, A; Eaton, M; Koenig, B A; Loewy, E; Raffin, T A; Ross, C

1997-01-01

In September 1996, the Stanford University Center for Biomedical Ethics convened a conference entitled "Comprehensive Care of the Terminally Ill: The Northern California Consensus Development Conference for Guidelines on Aid-in-Dying." The regionally based, multidisciplinary conference gathered people from a variety of disciplines and diverse perspectives on physician aid-in-dying. This report documents important points of convergence, disagreement, and uncertainty that emerged from the conference and provides commentary on crucial issues: the definition of terminal illness, ensuring adequate palliative care, psychiatric challenges, coping with family pressures, the doctor-patient relationship, the managed care context, the role of ethics committees, and institutional challenges. Should physician aid-in-dying become a legal practice in California, the report will provide guidance to health care organizations, health professionals, and public policy officials engaged in local or state guideline or policy development. PMID:9217449

Worker was harassed due to homosexuality, not AIDS.

PubMed

1999-07-23

An HIV-negative gay man, [name removed], who suffered anti-gay bigotry on the job, lost his suit claiming his employer, General Motors, violated the Americans with Disabilities Act by subjecting him to a hostile work environment. According to [name removed] he was repeatedly harassed and subjected to abuse on the job, including being called "an AIDS case." He went on medical leave twice for psychiatric care, as a result of the harassment. [Name removed] did not allege that supervisors or managers ever perceived him as having AIDS, but he argued that his co-worker's actions substantially limited his ability to perform a major life activity, working. The judge disagreed, pointing out that his employer never regarded him as having AIDS. The judge also found the harassment suffered was sporadic and merely offensive. Evidence also showed that [name removed] was offered a reassignment to another position which he declined.

Services provided by volunteer psychiatrists after 9/11 at the New York City family assistance center: September 12-November 20, 2001.

PubMed

Pandya, Anand; Katz, Craig L; Smith, Rebecca; Ng, Anthony T; Tafoya, Michael; Holmes, Anastasia; North, Carol S

2010-05-01

To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future research should focus on the short- and long-term effects of psychiatric interventions, such as providing acute psychotropic medication services and assessing the effectiveness of traditional acute post-disaster interventions including crisis counseling and psychological first aid.

[Effect of sociodemographic factors, cancer, psychiatric disorder on suicide: gender and age-specific patterns].

PubMed

Park, Jae Young; Moon, Ki Tae; Chae, Yoo Mi; Jung, Sang Hyuk

2008-01-01

We examined the effect of sociodemographic factors, cancer, and psychiatric disorders on suicide by gender and age-specific patterns in South Korea. The study is a case-control study. Claim data was obtained from the national health insurance database and national death registration database. The number of people who committed suicide was 11,523, which was matched with a control group consisting of ten times as many people at 115,230 selected from the national health insurance and medical aids beneficiaries. The medical utilization of the case group was one year before death and that of the control group was from July 1,2003 to June 30, 2004. Four variables-address, economic status, presence of a psychiatric disease, and cancer-were used in multiple logistic regression analyses. Living in cities or in rural areas showed a greater risk for suicide than living in a metropolitan city. Low economic status, the presence of a psychiatric disorder, and cancer were also statistically meaningful risk factors for suicide. The three major psychiatric diseases, schizophrenia, alcohol abuse, and bipolar disorder, were meaningful in all age groups, but the scale of the odds ratio differed by the age group. Only the psychiatric disorder variable was meaningful in the adolescent group, whereas a psychiatric disorder and economic status were meaningful for the young adult group, and all variables were meaningful for the middle-aged group. A psychiatric disorder and cancer were meaningful in the elderly group, economic status was meaningful for male subjects, and address was meaningful for female subjects. Factors such as living in city or rural areas, low economic status, the presence of a psychiatric disorder, and cancer were statistically meaningful risk factors in suicide. These factors also differed by age group. Therefore, policymakers should establish policies for suicide prevention that are relevant for each age group.

Training in Good Psychiatric Management for Borderline Personality Disorder in Residency: An Aide to Learning Supportive Psychotherapy for Challenging-to-Treat Patients.

PubMed

Bernanke, Joel; McCommon, Benjamin

2018-01-01

Given many competing demands, psychotherapy training to competency is difficult during psychiatric residency. Good Psychiatric Management for borderline personality disorder (GPM) offers an evidence-based, simplified, psychodynamically informed framework for the outpatient management of patients with borderline personality disorder, one of the most challenging disorders psychiatric residents must learn to treat. In this article, we provide an overview of GPM, and show that training in GPM meets a requirement for training in supportive psychotherapy; builds on psychodynamic psychotherapy training; and applies to other severe personality disorders, especially narcissistic personality disorder. We describe the interpersonal hypersensitivity model used in GPM as a straightforward way for clinicians to collaborate with patients in organizing approaches to psychoeducation, treatment goals, case management, use of multiple treatment modalities, and safety. A modification of the interpersonal hypersensitivity model that includes intra-personal hypersensitivity can be used to address narcissistic problems often present in borderline personality disorder. We argue that these features make GPM ideally suited for psychiatry residents in treating their most challenging patients, provide clinical examples to illustrate these points, and report the key lessons learned by a psychiatry resident after a year of GPM supervision.

RAADS-14 Screen: validity of a screening tool for autism spectrum disorder in an adult psychiatric population

PubMed Central

2013-01-01

Background Autism spectrum disorder (ASD) can be difficult to distinguish from other psychiatric disorders. The clinical assessment of ASD is lengthy, and has to be performed by a specialized clinician. Therefore, a screening instrument to aid in the identification of patients who may have undiagnosed ASD should be useful. The purpose of this study was to develop such a screening instrument. Methods Based on the 80 item Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-R), we developed a 14 item self-evaluation questionnaire, the RAADS-14 Screen. In total, 135 adults with ASD and 508 psychiatric controls completed the abridged version of the RAADS-R. Results The RAADS-14 Screen score was significantly higher in the ASD group than in the control samples, with a median score of 32 for ASD, 15 for attention deficit hyperactivity disorder, and 11 for other psychiatric disorders (P < 0.001). A cut-off score of 14 or above reached a sensitivity of 97% and a specificity of 46 to 64%. A factor analysis identified three factors consistent with mentalizing deficits, social anxiety, and sensory reactivity relevant for the diagnosis of ASD. The psychometric properties of RAADS-14 Screen were shown to be satisfactory. Conclusions The results of this study indicate that RAADS-14 Screen is a promising measure in screening for ASD in adult psychiatric outpatients. PMID:24321513

The Role of Parenting Styles in the Relation Between Functions of Aggression and Internalizing Symptoms in a Child Psychiatric Inpatient Population.

PubMed

Pederson, Casey A; Rathert, Jamie L; Fite, Paula J; Stoppelbein, Laura; Greening, Leilani

2016-10-01

Psychiatric inpatient hospitalization is a costly intervention for youth. With rates of hospitalization rising, efforts to refine prevention and intervention are necessary. Aggression often precedes severe internalizing behaviors, and proactive and reactive functions of aggression are differentially associated with internalizing symptomatology. Thus, further understanding of the links between functions of aggression and internalizing symptomatology could aid in the improvement of interventions for hospitalized youth. The current study examined parenting styles, gender, and age as potential moderators of the relations between proactive and reactive aggression and internalizing symptoms. Participants included 392 children, 6-12 years of age admitted consecutively to a psychiatric inpatient unit. Reactive aggression was uniquely associated with anxiety symptoms. However, proactive aggression was associated with internalizing problems only when specific parenting styles and demographic factors were present. Although both proactive and reactive subtypes of aggression were associated with internalizing symptoms, differential associations were evident. Implications of findings are discussed.

Individual variation in functional brain connectivity: implications for personalized approaches to psychiatric disease.

PubMed

Finn, Emily S; Todd Constable, R

2016-09-01

Functional brain connectivity measured with functional magnetic resonance imaging (fMRI) is a popular technique for investigating neural organization in both healthy subjects and patients with mental illness. Despite a rapidly growing body of literature, however, functional connectivity research has yet to deliver biomarkers that can aid psychiatric diagnosis or prognosis at the single-subject level. One impediment to developing such practical tools has been uncertainty regarding the ratio of intra- to interindividual variability in functional connectivity; in other words, how much variance is state- versus trait-related. Here, we review recent evidence that functional connectivity profiles are both reliable within subjects and unique across subjects, and that features of these profiles relate to behavioral phenotypes. Together, these results suggest the potential to discover reliable correlates of present and future illness and/or response to treatment in the strength of an individual's functional brain connections. Ultimately, this work could help develop personalized approaches to psychiatric illness.

Continue, adjust, or stop antipsychotic medication: developing and user testing an encounter decision aid for people with first-episode and long-term psychosis.

PubMed

Zisman-Ilani, Yaara; Shern, David; Deegan, Patricia; Kreyenbuhl, Julie; Dixon, Lisa; Drake, Robert; Torrey, William; Mishra, Manish; Gorbenko, Ksenia; Elwyn, Glyn

2018-05-22

People with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics. A diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation. The EDA was tested using 24 semistructured interviews with participants representing six stakeholder groups: patients with first-episode psychosis, patients with long-term psychosis, family members, psychiatrists, mental health counselors, and administrators. We used inductive and deductive coding of interview transcripts to identify points to revise within three domains: general impression and purpose of the EDA; suggested changes to the content, wording, and appearance; and usability and potential contribution to the psychiatric consultation. An EDA was developed in an iterative process that yielded evidence-based answers to five frequently asked questions about antipsychotic medications. Patients with long-term psychosis and mental health counselors suggested more changes and revisions than patients with first-episode psychosis and psychiatrists. Family members suggested more revisions to the answers about potential risks of stopping or adjusting antipsychotics than other respondents. The EDA was perceived as potentially useful and feasible in psychiatric routine care, especially if presented during the consultation.

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

PubMed Central

Collins, Pamela Y.

2009-01-01

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers’ perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support. PMID:16647793

Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit.

PubMed

Salzmann-Erikson, Martin

2018-06-22

Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness. © 2018 Australian College of Mental Health Nurses Inc.

From CBCL to DSM: A Comparison of Two Methods to Screen for DSM-IV Diagnoses Using CBCL Data

ERIC Educational Resources Information Center

Krol, Nicole P. C. M.; De Bruyn, Eric E. J.; Coolen, Jolanda C.; van Aarle, Edward J. M.

2006-01-01

The screening efficiency of 2 methods to convert Child Behavior Checklist (CBCL) assessment data into Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnoses was compared. The Machine-Aided Diagnosis (MAD) method converts CBCL input data directly into DSM-IV symptom criteria. The…

Gender, Aids, and Bereavement: A Comparison of Women and Men Living with HIV

ERIC Educational Resources Information Center

Summers, Jacquelyn; Zisook, Sidney; Sciolla, Andres D.; Patterson, Thomas; Atkinson, J. Hampton

2004-01-01

The purpose of this study was to examine the bereavement experience, psychiatric morbidity, and suicidality in bereaved men and women living with HIV. HIV+ women (n =31) who reported a loss in the recent 12 months were case matched to bereaved HIV+ men (n =62) on the basis of lifetime histories of major depression. Study participants were…

Cognitive and noncognitive neurological features of young-onset dementia.

PubMed

Kelley, Brendan J; Boeve, Bradley F; Josephs, Keith A

2009-01-01

The rarity of young-onset dementia (YOD), the broad differential diagnosis and unusual clinical presentations present unique challenges to correctly recognize the condition and establish an accurate diagnosis. Limited data exist regarding clinical features associated with dementia prior to the age of 45. We retrospectively assessed cognitive and noncognitive neurological characteristics of 235 patients who presented for evaluation of YOD to investigate the clinical characteristics of YOD compared to later-onset dementias and to identify clinical features associated with specific etiologies that may aid in the evaluation of YOD. Multiple cognitive domains were affected in most patients, and no significant differences in affected domains existed between groups. Early psychiatric and behavioral features occurred at very high frequencies. Nearly 80% of this YOD cohort had additional noncognitive symptoms or signs as a feature of their disease. Chorea was strongly associated with Huntington disease. Parkinsonism was not seen in patients having an autoimmune/inflammatory etiology. The rarity of YOD and the high frequency of early psychiatric features led to frequent misdiagnosis early in the clinical course. The high frequency of noncognitive symptoms and signs may aid clinicians in distinguishing patients requiring a more extensive evaluation for YOD.

Depressive Symptoms and Associated Factors among People Living with HIV/AIDS.

PubMed

Dal-Bó, Márcio José; Manoel, André Luciano; Filho, Arthur Onofre Beltram; Silva, Bibiana Quatrin Tiellet da; Cardoso, Yuri Souza; Cortez, Josué; Tramujas, Lucas; Silva, Rosemeri Maurici da

2015-01-01

The purpose of this study was to evaluate the prevalence of depressive symptoms and associated variables among people living with HIV/AIDS (PLWHA) in a specialized treatment center in a city located in southern Brazil. A cross-sectional study was conducted using the Beck Depression Inventory to assess the presence of depressive symptoms. The prevalence of depressive symptoms was 53.5% among the surveyed population, which supports the idea that depressive symptoms are more common among PLWHA, mainly if compared with the general population. It was observed that 57.7% of the study participants were with depressive symptoms and did not take any psychiatric medication and 100% did not undergo psychotherapy, which indicates undertreatment. There was no statistically significant difference in the mean CD4 count between patients with depressive symptoms (484.1  ±  353) and patients without depressive symptoms (528.4  ±  263). Further actions should be taken to improve the care for PLWHA. The interface between psychology, psychiatry, and internal medicine is of utmost importance to provide a more humanized care, in which the psychosocial, psychological, and psychiatric aspects are not neglected. © The Author(s) 2013.

Semantic Web Ontology and Data Integration: a Case Study in Aiding Psychiatric Drug Repurposing.

PubMed

Liang, Chen; Sun, Jingchun; Tao, Cui

2015-01-01

There remain significant difficulties selecting probable candidate drugs from existing databases. We describe an ontology-oriented approach to represent the nexus between genes, drugs, phenotypes, symptoms, and diseases from multiple information sources. We also report a case study in which we attempted to explore candidate drugs effective for bipolar disorder and epilepsy. We constructed an ontology incorporating knowledge between the two diseases and performed semantic reasoning tasks with the ontology. The results suggested 48 candidate drugs that hold promise for further breakthrough. The evaluation demonstrated the validity our approach. Our approach prioritizes the candidate drugs that have potential associations among genes, phenotypes and symptoms, and thus facilitates the data integration and drug repurposing in psychiatric disorders.

[Guidelines for the facilitation of wholeness in patients with AIDS: the experience of patients with AIDS: I].

PubMed

Torrente, A C; Greeff, M

1996-03-01

AIDS will be remembered as the illness that was discovered in the 1980s of which the effects of this epidemic were only realised in the 1990s. Statistics show that the number of patients with AIDS increase annually because of the number of patients now diagnosed as HIV infected. Statistics indicate that AIDS has a much wider impact on the community than only homosexuals and drug-dependent people. Much attention is paid currently to the prevention of AIDS, but the problem is vested in the third phase of the HIV infection, namely AIDS. Nurses will be more and more exposed to the patient with AIDS and she can make a valuable contribution to facilitating the quest to wholeness of the patient with AIDS. This research was aimed at exploring and describing the experiences of the patient with AIDS and to lay down guidelines for the nurse and the psychiatric nurse specialist as consultant to facilitate the quest for wholeness of the patient with AIDS. A exploratory, descriptive contextual study was done with the aim of achieving insight into the experiences of the patient with AIDS, by way of a specific convenience test sample, five patients who complied with the set criteria were included in the research. The application possibilities of this research are generally set out as regards practice, research and teaching, and also as specific guidelines for the nurse treating the patient with AIDS. By following the guidelines set out in this research, the nurse can facilitate the patient's quest for wholeness.

[Shared decision-making in acute psychiatric medicine : Contraindication or a challenge?

PubMed

Heres, S; Hamann, J

2017-09-01

The concept of shared decision-making (SDM) has existed since the 1990s in multiple fields of somatic medicine but has only been poorly applied in psychiatric clinical routine despite broad acceptance and promising outcomes in clinical studies on its positive effects. The concept itself and its practicability in mental health are carefully assessed and strategies for its future implementation in psychiatric medicine are presented in this article. Ongoing clinical studies probing some of those strategies are further outlined. On top of the ubiquitous shortage of time in clinical routine, psychiatrists report their concern about patients' limited abilities in sharing decisions and their own fear of potentially harmful decisions resulting from a shared process. Misinterpretation of shared decision-making restricting the health care professional to rather an informed choice scenario and their own adhesion to the traditional paternalistic decision-making approach further add to SDM's underutilization. Those hurdles could be overcome by communication skill workshops for all mental health care professionals, including nursing personnels, psychologists, social workers and physicians, as well as the use of decision aids and training courses for patients to motivate and empower them in sharing decisions with the medical staff. By this, the patient-centered treatment approach demanded by guidelines, carers and users could be further facilitated in psychiatric clinical routine.

An overview of the socio-cultural and psychiatric aspects of women's reproductive health in West Africa.

PubMed

Aina, O F

2007-09-01

The challenges associated with women reproductive health in West African sub region have over the years become a source of concern to relevant world bodies such as WHO, UNFPA, World Bank etc. Some of these challenges include Infertility, Family Planning and Female Genital Mutilation (FGM). However, of greater concern is the scourge of Sexually Transmitted Diseases (STDs) most especially HIV/ AIDS and the unacceptably high maternal mortality in the sub region where Nigeria alone accounts for the highest percentage (10%) of the global 60,000 maternal deaths annually. Significant psychiatric complications such as anxiety and depression are associated with menstruation and menopause. However, the postpartum period is the most vulnerable with significant proportion of women developing such psychopathologies as Puerperal (maternity) blues, Postpartum Depression (PPD) and Acute Organic Brain Syndrome. Sociocultural factors, the dearth of psychiatrists in West Africa coupled with the poor or non-recognition of the psychiatric complications by the obstetric staff have not allowed enough clinical attention to be paid to these problems. It is thus advocated that improvement in the maternal and child health care component of the primary health care (PHC) services will go a long way to attenuate the psychiatric complications associated with childbirth.

The successful treatment of mania due to acquired immunodeficiency syndrome using ziprasidone: a case series.

PubMed

Spiegel, David R; Weller, Amanda L; Pennell, Kirsten; Turner, Krista

2010-01-01

Secondary causes of mania need to be considered when atypical features of mania are manifested. These would include those patients with a later onset and without a prior psychiatric history. This case series investigates the use of ziprasidone for the treatment of mania due to HIV, a complication that could develop in those patients with advanced stages of AIDS.

Acute mutism: a useful lesson.

PubMed

Maguire, Melissa; Seidi, Osheik; Baker, Mark; Gupta, Arun; Muwanga, Cyrus

2011-01-01

Broca's aphasia may manifest as mutism in some patients. Mutism may be misinterpreted as part of a depressive illness in patients with a psychiatric history. We report on a patient presenting with acute mutism who had a history of amphetamine and cannabis abuse and was later found to have sustained an infarct of the dorsolateral frontal cortex. Recognition of this mode of presentation will aid early diagnosis and treatment.

Attitudes and beliefs regarding depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females

PubMed Central

Brawner, Bridgette M.

2012-01-01

Individuals’ attitudes and beliefs toward behaviors are key indicators of behavioral performance. The purpose of this study was to elucidate attitudes and beliefs about depression, HIV/AIDS and HIV risk-related sexual behaviors among clinically depressed African American adolescent females and to develop an understanding of their context for HIV risk. For this descriptive qualitative inquiry, semi-structured interviews and surveys were employed (N = 24). The narratives reveal that behavioral sequelae of depression (i.e. loneliness) can produce risk for HIV. These findings may guide psychiatric nurse educators, scientists, and practitioners to modify HIV risk among clinically depressed African American adolescent females. PMID:23164403

Religious competence as cultural competence

PubMed Central

2012-01-01

Definitions of cultural competence often refer to the need to be aware and attentive to the religious and spiritual needs and orientations of patients. However, the institution of psychiatry maintains an ambivalent attitude to the incorporation of religion and spirituality into psychiatric practice. This is despite the fact that many patients, especially those from underserved and underprivileged minority backgrounds, are devotedly religious and find much solace and support in their religiosity. I use the case of mental health of African Americans as an extended example to support the argument that psychiatric services must become more closely attuned to religious matters. I suggest ways in which this can be achieved. Attention to religion can aid in the development of culturally competent and accessible services, which in turn, may increase engagement and service satisfaction among religious populations. PMID:22421686

Medical management of epileptic seizures: challenges and solutions.

PubMed

Sarma, Anand K; Khandker, Nabil; Kurczewski, Lisa; Brophy, Gretchen M

2016-01-01

Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical-psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and "pseudoseizure" patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.

Lifetime sexual behavior of psychiatric inpatients.

PubMed

Gonzalez-Torres, Miguel Angel; Salazar, Miguel Angel; Inchausti, Lucía; Ibañez, Berta; Pastor, Javier; Gonzalez, Gixane; Carvajal, María Josefa; Fernandez-Rivas, Aranzazu; Madrazo, Aranzazu; Ruiz, Eduardo; Basterreche, Edurne

2010-09-01

Sexual life of psychiatric patients, including risk behaviors related to sexually transmitted diseases, remains a poorly studied area, especially in those with severe mental illnesses. To assess some aspects of lifetime sexual behavior of psychiatric inpatients. Patients consecutively admitted to a psychiatric unit in a general hospital were interviewed about partner-related lifetime sexual behavior. A semi-structured interview developed by the authors was used to collect information concerning their general sexual experience throughout life, homosexual and heterosexual relations, and relations with partners who were intravenous drug users (IVDU), HIV carriers or suffering from AIDS, and with sex workers. In each of these areas, time elapsed since last sexual contact; number of partners in previous year, frequency of these relations and condom use were investigated. Five hundred forty-six patients (306 men and 240 women) were assessed, and 87.7% of them reported sexual relations at some point during their life. Of these, 90% reported heterosexual and 10% homosexual or bisexual sexual contacts. Further, 11.06% had had at least one partner who was an IVDU; 8.1% an HIV-positive partner, and 32.4% (50% of the men) had paid for sex. Overall 49.79% of the total sample reported never using condoms in their sexual relations, with similar percentages for those with HIV-positive (46%) and IVDU (47%) partners. Of those who paid for sex, 29% never used condoms. Psychiatric patients admitted to a general hospital psychiatric unit have sexual experience close to the general population, with a higher percentage of homosexual contacts and lower rates of condom use, even in higher risk situations, such as men having sex with men, and partners who are HIV-positive or IVDUs. This information obliges clinicians to systematically explore the sexual behavior of psychiatric patients, evaluate risk behaviors, and adopt measures to promote safe sex practices in this population. © 2010 International Society for Sexual Medicine.

Co-financing for viral load monitoring during the course of antiretroviral therapy among patients with HIV/AIDS in Vietnam: A contingent valuation survey.

PubMed

Nguyen, Quyen Le Thi; Nguyen, Long Hoang; Tran, Bach Xuan; Phan, Huong Thi Thu; Le, Huong Thi; Nguyen, Hinh Duc; Tran, Tho Dinh; Do, Cuong Duy; Nguyen, Cuong Manh; Thuc, Vu Thi Minh; Latkin, Carl; Zhang, Melvyn W B; Ho, Roger C M

2017-01-01

Viral load testing is considered the gold standard for monitoring HIV treatment; however, given its high cost, some patients cannot afford viral load testing if this testing is not subsidized. Since foreign aid for HIV/AIDS in Vietnam is rapidly decreasing, we sought to assess willingness to pay (WTP) for viral load and CD4 cell count tests among HIV-positive patients, and identified factors that might inform future co-payment schemes. A multi-site cross-sectional survey was conducted with 1133 HIV-positive patients on antiretroviral therapy (ART) in Hanoi and Nam Dinh. Patients' health insurance coverage, quality of life, and history of illicit drug use were assessed. A contingent valuation approach was employed to measure patients' WTP for CD4 cell count and viral load testing. HIV-positive patients receiving ART at provincial sites reported more difficulty obtaining health insurance (HI) and had the overall the poorest quality of life. Most patients (90.9%) were willing to pay for CD4 cell count testing; here, the mean WTP was valued at US$8.2 (95%CI = 7.6-8.8 US$) per test. Most patients (87.3%) were also willing to pay for viral load testing; here, mean WTP was valued at US$18.6 (95%CI = 16.3-20.9 US$) per test. High income, high education level, and hospitalization were positively associated with WTP, while co-morbidity with psychiatric symptoms and trouble paying for health insurance were both negatively related to WTP. These findings raise concerns that HIV-positive patients in Vietnam might have low WTP for CD4 cell count and viral load testing. This means that without foreign financial subsidies, many of these patients would likely go without these important tests. Treating psychiatric co-morbidities, promoting healthcare services utilization, and removing barriers to accessing health insurance may increase WTP for monitoring of HIV/AIDS treatment among HIV+-positive Vietnamese patients.

Psychiatric symptoms and disorders in HIV infected mine workers in South Africa. A retrospective descriptive study of acute first admissions.

PubMed

Säll, L; Salamon, E; Allgulander, C; Owe-Larsson, B

2009-08-01

The social and living conditions of mine workers in South Africa contribute to a rapid transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections. HIV-associated dementia is a serious condition during HIV disease. Several other psychiatric symptoms and disorders, such as psychosis, secondary mania and depression, have also been associated with clinical HIV infection. We describe the onset of psychiatric symptoms and signs in a group of untreated, HIV infected male mine workers first admitted for psychiatric treatment at the Rand Mutual Hospital in Johannesburg. Between 1987 and 1997, 38 consecutive cases were admitted, and their files were retrieved for study in 2006. The subjects were 38 black male mine workers admitted acutely for psychiatric care due to psychiatric symptoms, and subsequently diagnosed with HIV infection. The presenting psychiatric symptoms on admission and diagnoses at discharge were compiled for all patients, not to infer causality but to establish the range of symptoms that the clinician has to deal with. The 38 patients presented with a wide range of psychiatric symptoms. The dominating symptoms were those of cognitive deficits, and different psychotic manifestations. 12 of the patients, almost one third of the individuals, were diagnosed with dementia. The patients with dementia exhibited cognitive deficits, and in addition often abnormal behaviour and psychotic symptoms, and several also had symptoms of secondary mania. 5 of the patients presented with delirium. Psychosis, without concurrent dementia, was diagnosed in 5 patients. Bipolar disorder with mania, without concurrent dementia, and major depression was present in 2 patients, respectively. Screening for substance abuse showed that 9 of the patients had ongoing cannabis abuse and 10 had alcohol abuse. Cannabis-induced psychotic disorder was present in 5 patients. The findings confirm that patients with a new diagnosis of HIV may present with disorders of thought and/or cognition as well as gross behavioural disturbance, and that psychotic symptoms and secondary mania could be manifestations of the clinical onset of HIV/acquired immune deficiency syndrome (AIDS) infection.

Two-year prospective study of major depressive disorder in HIV-infected men.

PubMed

Atkinson, J Hampton; Heaton, Robert K; Patterson, Thomas L; Wolfson, Tanya; Deutsch, Reena; Brown, Stephen J; Summers, J; Sciolla, A; Gutierrez, R; Ellis, Ronald J; Abramson, Ian; Hesselink, John R; McCutchan, J Allen; Grant, Igor

2008-06-01

The risks and factors contributing to major depressive episodes in HIV infection remain unclear. This 2-year prospective study compared cumulative rates and predictors of a major depressive episode in HIV-infected (HIV+) men (N=297) and uninfected (HIV-) risk-group controls (N=90). By design participants at entry were without current major depression, substance dependence or major anxiety disorder. Standardized neuromedical, neuropsychological, neuroimaging, life events, and psychiatric assessments (Structured Clinical Interview for DSM III-R) were conducted semi-annually for those with AIDS, and annually for all others. Lifetime prevalence of major depression or other psychiatric disorder did not differ at baseline between HIV+ men and controls. On a two-year follow-up those with symptomatic HIV disease were significantly more likely to experience a major depressive episode than were asymptomatic HIV+ individuals and HIV-controls (p<0.05). Episodes were as likely to be first onset as recurrent depression. After baseline disease stage and medical variables associated with HIV infection were controlled, a lifetime history of major depression, or of lifetime psychiatric comorbidity (two or more psychiatric disorders), predicted subsequent major depressive episode (p<0.05). Neither HIV disease progression during follow-up, nor the baseline presence of neurocognitive impairment, clinical brain imaging abnormality, or marked life adversity predicted a later major depressive episode. Research cohort of men examined before era of widespread use of advanced anti-HIV therapies. Symptomatic HIV disease, but not HIV infection itself, increases intermediate-term risk of major depression. Prior psychiatric history most strongly predicted future vulnerability.

Psychiatric Disorders in Smokers Seeking Treatment for Tobacco Dependence: Relations with Tobacco Dependence and Cessation

PubMed Central

Piper, Megan E.; Smith, Stevens S.; Schlam, Tanya R.; Fleming, Michael F.; Bittrich, Amy A.; Brown, Jennifer L.; Leitzke, Cathlyn J.; Zehner, Mark E.; Fiore, Michael C.; Baker, Timothy B.

2009-01-01

Objective The present research examined the relation of psychiatric disorders to tobacco dependence and cessation outcomes. Method Data were collected from 1504 smokers (58.2% women, 83.9% white, 44.67 [SD = 11.08] years old) making an aided smoking cessation attempt as part of a clinical trial. Psychiatric diagnoses were determined using the Composite International Diagnostic Interview (CIDI) structured clinical interview. Tobacco dependence was assessed using the Fagerstrom Test of Nicotine Dependence (FTND) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Results Diagnostic groups included those who were never diagnosed, ever diagnosed (at any time, including in the past year), and those with past-year diagnoses (with or without prior diagnosis). Some diagnostic groups had lower follow-up abstinence rates than did the never diagnosed group (p’s < .05). At 8 weeks post-quit, strong associations were found between cessation outcome and both past-year mood disorder and ever-diagnosed anxiety disorder. At 6 months post-quit those ever diagnosed with an anxiety disorder (OR = .72, p = .02) and those ever diagnosed with more than one psychiatric diagnosis (OR = .74, p = .03) had lower abstinence rates. The diagnostic categories did not differ in smoking heaviness or the FTND, but they did differ in dependence motives assessed with the WISDM. Conclusion Information on recent or lifetime psychiatric disorders may help clinicians gauge relapse risk and may suggest dependence motives that are particularly relevant to affected patients. These findings also illustrate the importance of using multidimensional tobacco dependence assessments. PMID:20099946

[Acute psychiatric pathology disclosing subcortical lesion in neuro-AIDS].

PubMed

Donnet, A; Harlé, J R; Cherif, A A; Gastaut, J A; Weiller, P J

1991-01-01

Maccario et al. described, in 1987, the case of an HIV-positive patient whose psychotic symptomatology was the expression of right centrum semi-ovale lesion. We report the case of a patient who suffered a sudden delirium, expression of a probable right lenticular cerebral toxoplasmosis. This 35-year-old male homosexual, who had no psychiatric history, suddenly developed in November 1988 the following psychiatric signs: he started to walk back and forth incessantly, he had the impression that he was the subject of the conversations of the passers-by, that all the posters and notices refer to him, and that he was God. He was admitted in a psychiatric department where the symptoms were progressively curbed by neuroleptics (cyamemazine 75 mg, and haloperidol 15 mg). The episode was not questioned by the patient, but attributed to bad eating habits. HIV-positivity had been discovered a year later (during systematic screening). A computerized tomographic (CT) scan performed subsequently to this delirium was interpreted as normal. Four weeks later the patient was referred to us. The psychiatric condition was stabilized in spite of a certain aggressiveness and the probable persistence of an underlying delirium state. Laboratory examinations showed the following: blood count revealed leukopenia (2.2 G/l) and thrombocytopenia (135 G/l; OKT4/OKT8 ratio was 0.08; CSF: normal; sputum culture evidenced the presence of pneumocystis carinii; EEG were normal. Neuropsychological symptoms concerned in particular a lack of concentration during the different tests with a definitive wavering of attention. Lexical retrieval was poor whatever the topic proposed.(ABSTRACT TRUNCATED AT 250 WORDS)

mHealth and memory aids: levels of smartphone ownership in patients.

PubMed

Migo, Ellen M; Haynes, Becky I; Harris, Lara; Friedner, Kim; Humphreys, Kate; Kopelman, Michael D

2015-01-01

The use of mobile devices to deliver healthcare has not yet been exploited in neuropsychological rehabilitation. Smartphones have the potential to serve as multi-functional memory aids. To investigate whether patients attending a clinic for mixed memory problems own smartphones, to determine whether this could be a widely applicable medium to use as a memory aids device. A questionnaire on smartphone ownership was given to an opportunity sample of consecutive patients attending a neuropsychiatry and memory disorders outpatient clinic. Data were collected in 2012 and repeated 12 months later in 2013 to assess changes over time. Ownership of mobile phones was stable between 2012 (81%) and 2013 (85%), but ownership of smartphones showed a significant increase (from 26% to 40%). Age negatively predicted smartphone ownership. Despite cognitive or psychiatric problems, our patient group are as likely to own a mobile phone as a member of the general population. Ownership levels are at 40% and likely to increase in the future. Exploring how smartphones and their apps could function as memory aids is likely to be useful for a large enough number of patients to be clinically worthwhile.

Report of the Defense Science Board Task Force on Department of Defense Biological Safety and Security Program

DTIC Science & Technology

2009-05-01

Three (NAMRU-3) - Lima, Peru : Naval Medical Research Center Detachment (NMRCD) *These labs are co-located. To provide some measure of the scope and...Aceh, Indonesia and the more recent earthquakes in central Java and Peru . Edgewood Chemical Biological Center (ECBC) ECBC’s science and technology... diabetes , obesity, cancer, psychiatric disorders, problems of pregnancy, AIDS, hepatitis, malaria, parasitic infections, and a host of other

The mental health impact of AIDS-related mortality in South Africa: a national study

PubMed Central

Myer, L; Seedat, S; Stein, D J; Moomal, H; Williams, D R

2011-01-01

Background Few data exist on how the HIV/AIDS epidemic may influence population mental health. The associations were examined between knowing someone who died of HIV/AIDS and common mental disorders among South African adults. Methods Between 2002 and 2004, a nationally representative sample of 4351 adults were interviewed about personally knowing someone who died of HIV/AIDS, and the World Health Organization Composite International Diagnostic Interview was used to generate psychiatric diagnoses for depression, anxiety and substance abuse disorders during the preceding 12 months based on the Diagnostic and Statistical Manual, 4th edition (DSM-IV). Results Overall, 42.2% of the sample knew someone who died of HIV/AIDS, and 16.5% met the criteria for at least one DSM-IV diagnosis. Individuals who knew someone who died of HIV/AIDS were significantly more likely to have any DSM-IV defined disorder, including any depressive, anxiety or substance-related disorder (p<0.001 for all associations). In multivariate models adjusted for participant demographic characteristics, life events and socioeconomic status, individual disorders significantly associated with knowing someone who died of HIV/AIDS included generalised anxiety disorder, social phobia and alcohol/drug dependence or abuse. Based on these results, it is estimated that up to 15% of 12-month DSM-IV disorders in the South African adult population may be related to knowing someone who died of HIV/AIDS. Conclusion These novel data suggest that AIDS-related mortality may contribute substantially to the burden of mental disorders in settings of high HIV prevalence. While this finding requires further investigation, these data suggest the need to strengthen mental health services in communities where HIV/AIDS is prevalent. PMID:19074926

Recall and dating of psychiatric symptoms. Test-retest reliability of time-related symptom questions in a standardized psychiatric interview.

PubMed

Wittchen, H U; Burke, J D; Semler, G; Pfister, H; Von Cranach, M; Zaudig, M

1989-05-01

The advent of more explicit diagnostic criteria and the growing interest in "lifetime" rates of mental disorders has made imperative an accurate determination of time-related diagnostic criteria. We used data from two independent test-retest studies of the Diagnostic Interview Schedule (DIS) and the Composite International Diagnostic Interview (CIDI) to study the reliability of different time-related questions in these fully standardized diagnostic interviews. With two exceptions (anxiety disorders and alcohol-related questions), the test-retest reliability of most time-related questions in both interviews was judged to be satisfactorily high. Furthermore, the validity of time-related questions in the DIS (age at symptom onset, duration and frequency of illness episodes) was examined by comparing them with detailed "consensus" ratings done independently by different clinicians for 207 former psychiatric inpatients. A surprisingly high concordance was found for former psychotic patients except for those still severely disturbed at the follow-up investigation. Some severe restrictions were also found for nonpsychotic disorders with regard to judgment of the age at onset of phobias, panic attacks, and depression. For a more valid assessment of time-related symptom information, the use of specific memory aids is suggested.

[Feeling of Liberty and Internalized Stigma: Comparison of Inpatient and Outpatient Cases Receiving Psychiatric Treatment].

PubMed

Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat

2016-01-01

In this study, we investigated whether liberty-restricting and other factors can predict internalized stigma among psychiatric inpatients and outpatients. The study sample comprised of 129 inpatients, admitted at least once to psychiatry ward, and 100 outpatients who have never been hospitalized, receiving psychiatric treatment. In addition to demographic and clinical features, patients were evaluated for perceived deprivation of liberty and internalized stigma levels. Patients stated that their liberty was restrained mostly due to involuntary treatment, communication problems, side effects of medical treatment and inability to choose their treatment team. Regression analysis showed that internalized stigma was predicted by perceived deprivation of liberty, marital status and number of admissions to ward. Stigma was related to marital status and admissions to the psychiatry ward. Perceived deprivation of liberty predicts stigma regardless of the disease severity CONCLUSION: Perception of stigma leads to self-isolation, behavioral avoidance and refusal of aid-seeking. Our study indicated that perceived deprivation of liberty is one of the most important factors that lead to increased stigma. Based on our findings, we can say that as patients experience less perceived deprivation of liberty, they would have less stigma and thus, their compliance would increase.

Health status and suicide in the second half of life

PubMed Central

Conwell, Yeates; Duberstein, Paul R.; Hirsch, Jameson K.; Conner, Kenneth R.; Eberly, Shirley; Caine, Eric D.

2010-01-01

Objective To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services. Method A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence. Results Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical, or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk. Conclusions Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions. PMID:19582758

Differences in nocturnal and daytime sleep between primary and psychiatric hypersomnia: diagnostic and treatment implications.

PubMed

Vgontzas, A N; Bixler, E O; Kales, A; Criley, C; Vela-Bueno, A

2000-01-01

The differential diagnosis of primary (idiopathic) vs. psychiatric hypersomnia is challenging because of the lack of specific clinical or laboratory criteria differentiating these two disorders and the frequent comorbidity of mental disorders in patients with primary hypersomnia. The aim of this study was to assess whether polysomnography aids in the differential diagnosis of these two disorders. After excluding patients taking medication and those with an additional diagnosis of sleep-disordered breathing, we compared the nocturnal and daytime sleep of 82 consecutive patients with a diagnosis of either primary hypersomnia (N = 59) or psychiatric hypersomnia (N = 23) and normal control subjects (N = 50). During nocturnal sleep, patients with psychiatric hypersomnia showed significantly higher sleep latency, wake time after sleep onset, and total wake time and a significantly lower percentage of sleep time than patients with primary hypersomnia and control subjects (p < .05). In addition, the daytime sleep of patients with psychiatric hypersomnia was significantly higher in terms of sleep latency, total wake time, and percentage of light (stage 1) sleep and lower in terms of percentage of sleep time and stage 2 sleep than in patients with primary hypersomnia and control subjects (p < .05). The daytime sleep of patients with primary hypersomnia as compared with that of control subjects was characterized by lower sleep latency and total wake time and a higher percentage of sleep time (p < .05). Finally, a sleep latency of less than 10 minutes or a sleep time percentage greater than 70% in either of the two daytime naps was associated with a sensitivity of 78.0% and a specificity of 95.7%. Our findings indicate that psychiatric hypersomnia is a disorder of hyperarousal, whereas primary hypersomnia is a disorder of hypoarousal. Polysomnographic measures may provide useful information in the differential diagnosis and treatment of these two disorders.

[Public music concerts in a psychiatric hospital: effects on public opinion and as therapy for patients].

PubMed

Takasaka, Y; Yokota, O; Tanioka, T; Nagata, K; Yasuoka, K; Toda, H

2001-01-01

We investigate the effects of music therapy concerts, which were held 60 times over a four year period, 1992 to 1996, in Geiyo Psychiatric Hospital, Kochi Prefecture and found that; 1) Musicians who performed at the concerts were not only from Kochi prefecture but also from other prefectures (10 times) and from four foreign countries (7 times). 2) Live concerts in a small hall had a positive influence on patients and drew the patient's attention and interest away from their hallucinations and delusions to the real world. Moreover, the concerts provided the patients with chances to acquire social graces such as being well-groomed. 3) Explanations by the musicians, interviews with the musicians and the seasonal choruses accompanied by the musicians were helpful to give the patients motives for recovering communication skills and to interact with society. 4) Inquiries to the patients about the concerts indicated discrepancies between the poor observed estimations during the concerts (83.3%) and the good subjective impressions expressed by the patients (82.0%), suggesting that the patients were not good at expressing their internal emotions through facial expressions or attitudes. 5) Many citizens including children came to the concerts and/or gave aid to the hospital because the concerts were open to the public and we suggest that this contributed to improving the general publics' image of psychiatric hospitals. Questionnaires revealed that 90% of people in a control group had a bad image of psychiatric hospitals in Japan, but only 32% of the members of the general public who attended our concerts had a bad image of psychiatric hospitals. In addition, the revolving ratio of the hospital beds rose from 0.4 to 1.2 over the four years, which also suggests a beneficial effect on the patients.

Multi-informant perspective on psychological distress among Ghanaian orphans and vulnerable children within the context of HIV/AIDS.

PubMed

Doku, P N; Minnis, H

2016-08-01

There is little knowledge about the psychosocial distress of children affected by human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) in Ghana, to aid the planning of services. This study investigated mental health problems among children affected by HIV/AIDS, compared with control groups of children orphaned by other causes, and non-orphans. The study employed a cross-sectional survey that interviewed 291 children and their caregivers. Both children and caregivers completed the Strengths and Difficulties Questionnaire that measured children's psychosocial wellbeing. Verbal autopsy was used to identify whether children lost one or both parents from AIDS. The results indicated that controlling for relevant sociodemographic factors, both children's self-reports and caregivers' reports indicate that both children living with HIV/AIDS-infected caregivers and children orphaned by AIDS were at heightened risk for mental health problems than both children orphaned by other causes and non-orphans. The findings further indicated that a significant proportion of orphaned and vulnerable children exhibited symptoms for depression and other psychiatric disorders (approximately 63%) compared with 7% among the non-orphaned group. Caregivers gave higher ratings for children on externalizing problems and lower on internalizing problems, and vice versa when the children's self-reports were analysed. The findings suggest that both children and their informants have diverse yet complementary perspectives on psychological outcomes. The study discusses the theoretical and practical implications of these findings and urgently calls for necessary intervention programmes that target all children affected by HIV/AIDS to effectively alleviate psychological distress and enhance the mental health of these children.

A Cost-Benefit Analysis Applied to Example Proposals for Army Training and Education Research

DTIC Science & Technology

2007-10-01

communication are major areas of concern for children with autism (Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric...aids, and the picture exchange communication sys- tem (PECS), can increase the communicative interactions of children with A-34 autism and enable them...integrate R&D propos- als with an analysis methodology to determine their value to the Army. With that in mind , TRADOC may wish to alter the cost or

The Great Smoky Mountains Study: developmental epidemiology in the southeastern United States.

PubMed

Costello, E Jane; Copeland, William; Angold, Adrian

2016-05-01

To describe the Great Smoky Mountains Study (GSMS). GSMS is a longitudinal study of child psychiatric disorders that began in 1992 to look at need for mental health services in a rural area of the USA. Over 20 years it has expanded its range to include developmental epidemiology more generally, not only the development of psychiatric and substance abuse problems but also their correlates and predictors: family and environmental risk, physical development including puberty, stress and stress-related hormones, trauma, the impact of poverty, genetic markers, and epigenetics. Now that participants are in their 30s the focus has shifted to adult outcomes of childhood psychopathology and risk, and early physical, cognitive, and psychological markers of aging. This paper describes the results from over 11,000 interviews, examples of the study's contributions to science and policy, and plans for the future. Longitudinal studies can provide insights that aid in policy planning.

The course of post-traumatic stress disorder after the Oklahoma City bombing.

PubMed

North, C S

2001-12-01

Oklahoma City bombing survivors (N = 182) were studied 6 months post-bombing and reassessed approximately 1 year later (N = 141) to determine the longitudinal course of post-traumatic stress disorder (PTSD) and other psychiatric disorders. The Diagnostic Interview Schedule assessed lifetime, current, predisaster, and post-bombing psychiatric diagnoses at both assessment points. One-third of the Oklahoma City bombing survivors had PTSD at index, and similar rates were diagnosed at follow-up. More recovery from depression was apparent than from PTSD. No delayed onset PTSD was observed, and all PTSD was chronic. Avoidance and numbing symptoms were dominant in defining the development of PTSD. Early onset and chronicity of PTSD indicate need for prompt and long-term intervention after disasters. Focus on avoidance and numbing symptoms may aid in identification of individuals needing intervention and monitoring the course of PTSD.

Computational Psychiatry

PubMed Central

Wang, Xiao-Jing; Krystal, John H.

2014-01-01

Psychiatric disorders such as autism and schizophrenia arise from abnormalities in brain systems that underlie cognitive, emotional and social functions. The brain is enormously complex and its abundant feedback loops on multiple scales preclude intuitive explication of circuit functions. In close interplay with experiments, theory and computational modeling are essential for understanding how, precisely, neural circuits generate flexible behaviors and their impairments give rise to psychiatric symptoms. This Perspective highlights recent progress in applying computational neuroscience to the study of mental disorders. We outline basic approaches, including identification of core deficits that cut across disease categories, biologically-realistic modeling bridging cellular and synaptic mechanisms with behavior, model-aided diagnosis. The need for new research strategies in psychiatry is urgent. Computational psychiatry potentially provides powerful tools for elucidating pathophysiology that may inform both diagnosis and treatment. To achieve this promise will require investment in cross-disciplinary training and research in this nascent field. PMID:25442941

[Standard operating procedures (SOPs) for palliative care : Presence and relevance of palliative SOPs within the network of German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid].

PubMed

Stachura, P; Berendt, J; Stiel, S; Schuler, U S; Ostgathe, C

2017-02-01

Standard operating procedures (SOPs) can contribute to the improvement of patient care. Survey the presence and relevance of SOPs for palliative care (PC) within the network of German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid. In a descriptive survey, palliative care services within 15 CCCs funded by the German Cancer Aid were asked to rate availability and thematic relevance of (1) symptom-related, (2) clinical pathways and (3) measures- and processes-oriented SOPs using a structured questionnaire. Pain management SOPs were the most common (n =11; 73 %). The most thematic relevance showed SOPs dedicated to pain management, care in the last days of life and delirium and other neuro-psychiatric diseases (each n =13; 87 %), followed by bowel obstruction, dyspnoea, nausea and palliative sedation (each n =12; 80 %). There is a wide gap between availability and perceived relevance of palliative care SOPs within the network of German CCCs funded by the German Cancer Aid. It is obvious that there is a need for further development of relevant SOPs in palliative care.

Co-financing for viral load monitoring during the course of antiretroviral therapy among patients with HIV/AIDS in Vietnam: A contingent valuation survey

PubMed Central

Tran, Bach Xuan; Phan, Huong Thi Thu; Le, Huong Thi; Nguyen, Hinh Duc; Tran, Tho Dinh; Do, Cuong Duy; Nguyen, Cuong Manh; Thuc, Vu Thi Minh; Latkin, Carl; Zhang, Melvyn W. B.; Ho, Roger C. M.

2017-01-01

Background Viral load testing is considered the gold standard for monitoring HIV treatment; however, given its high cost, some patients cannot afford viral load testing if this testing is not subsidized. Since foreign aid for HIV/AIDS in Vietnam is rapidly decreasing, we sought to assess willingness to pay (WTP) for viral load and CD4 cell count tests among HIV-positive patients, and identified factors that might inform future co-payment schemes. Methods A multi-site cross-sectional survey was conducted with 1133 HIV-positive patients on antiretroviral therapy (ART) in Hanoi and Nam Dinh. Patients’ health insurance coverage, quality of life, and history of illicit drug use were assessed. A contingent valuation approach was employed to measure patients’ WTP for CD4 cell count and viral load testing. Results HIV-positive patients receiving ART at provincial sites reported more difficulty obtaining health insurance (HI) and had the overall the poorest quality of life. Most patients (90.9%) were willing to pay for CD4 cell count testing; here, the mean WTP was valued at US$8.2 (95%CI = 7.6–8.8 US$) per test. Most patients (87.3%) were also willing to pay for viral load testing; here, mean WTP was valued at US$18.6 (95%CI = 16.3–20.9 US$) per test. High income, high education level, and hospitalization were positively associated with WTP, while co-morbidity with psychiatric symptoms and trouble paying for health insurance were both negatively related to WTP. Conclusions These findings raise concerns that HIV-positive patients in Vietnam might have low WTP for CD4 cell count and viral load testing. This means that without foreign financial subsidies, many of these patients would likely go without these important tests. Treating psychiatric co-morbidities, promoting healthcare services utilization, and removing barriers to accessing health insurance may increase WTP for monitoring of HIV/AIDS treatment among HIV+-positive Vietnamese patients. PMID:28199405

Interprofessional practice and decision support: an organizational framework applied to a mental health setting.

PubMed

Campbell, Susan; Stowe, Karen; Ozanne, Elissa M

2011-11-01

Decision support as a means to assist people in making healthcare decisions has been discussed extensively in the medical literature. However, the potential for use of decision support and decision aids with people with psychiatric disabilities in order to promote recovery has only begun to be researched and discussed in the mental health literature. Organizational factors that foster interprofessional practice within a decision support environment focused on mental health issues are examined in this paper.

Nature of depression in patients with HIV/AIDS.

PubMed

Judd, Fiona; Komiti, Angela; Chua, Phyllis; Mijch, Anne; Hoy, Jennifer; Grech, Paul; Street, Alan; Lloyd, John; Williams, Ben

2005-09-01

Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an 'organic' or secondary depression has major implications in the treatment of HIV/AIDS. The aim of the current study was to further investigate the nature and underlying aetiology of depression in people living with HIV/AIDS. One hundred and twenty-nine people living with HIV/AIDS recruited for the study from outpatients clinics and primary care settings completed a range of self-report symptom measures including the Beck Depression Inventory (BDI), SF-36, SPHERE and a personality measure, the NEO Personality Inventory (NEO-PI). They also completed a battery of neuropsychological tests (CANTAB) and a structured clinical interview (SCID-DSM-IV). Medical and sociodemographic data were also recorded. Approximately one-third scored > or = 14 on the BDI and 27% met criteria for a current 'mood disorder' on the SCID. Depressive symptoms were strongly related to personality style, having a past psychiatric history and current stressful psychosocial situation. There was no association between depression and HIV disease status. There was no evidence in this study cohort of a distinct subtype of 'organic' or secondary depression. These results suggest that at least for 'well' people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for other non-HIV groups. Further longitudinal studies will be required to dissect out the multiple factors underlying depression in HIV/AIDS.

Abuse Characteristics and Psychiatric Consequences Associated with Online Sexual Abuse.

PubMed

Say, Gökçe Nur; Babadağı, Zehra; Karabekiroğlu, Koray; Yüce, Murat; Akbaş, Seher

2015-06-01

The current study examined the rate and psychiatric correlates of sexual abuse involving the use of digital technologies by the offender in a wide sample of juvenile victims. Sociodemographic, abuse, and psychiatric characteristics of 662 sexually abused children and adolescents were evaluated. Of these, 93 reported that digital devices were used by the offender in several ways to facilitate the sexual abuse. The offender-victim relationship was initiated through the Internet in 39 victims. Involvement of digital technologies in sexual abuse was significantly associated with penetrative and recurrent form of sexual abuse commited by multiple offenders with coexisting violence. Additionally, victims of sexual abuse with a digital component were 4.21 times more likely to develop any psychopathology, 3.77 times more likely to have depression, and 2.14 times more likely to have post-traumatic stress disorder as a result of sexual abuse. These results indicated that the offender's use of digital technology may aid the initiation and facilitation of the sexual abuse of youths and may relate to more severe outcomes. This study revealed the importance of raising the awareness of professionals and the community about the potential risks associated with digital technologies and sexual abuse. Mental health professionals should consider this additional form of victimization, especially when dealing with sexual abuse victims.

Actigraphy and motion analysis: new tools for psychiatry.

PubMed

Teicher, M H

1995-01-01

Altered locomotor activity is a cardinal sign of several psychiatric disorders. With advances in technology, activity can now be measured precisely. Contemporary studies quantifying activity in psychiatric patients are reviewed. Studies were located by a Medline search (1965 to present; English language only) cross-referencing motor activity and major psychiatric disorders. The review focused on mood disorders and attention-deficit hyperactivity disorder (ADHD). Activity levels are elevated in mania, agitated depression, and ADHD and attenuated in bipolar depression and seasonal depression. The percentage of low-level daytime activity is directly related to severity of depression, and change in this parameter accurately mirrors recovery. Demanding cognitive tasks elicit fidgeting in children with ADHD, and precise measures of activity and attention may provide a sensitive and specific marker for this disorder. Circadian rhythm analysis enhances the sophistication of activity measures. Affective disorders in children and adolescents are characterized by an attenuated circadian rhythm and an enhanced 12-hour harmonic rhythm (diurnal variation). Circadian analysis may help to distinguish between the activity patterns of mania (dysregulated) and ADHD (intact or enhanced). Persistence of hyperactivity or circadian dysregulation in bipolar patients treated with lithium appears to predict rapid relapse once medication is discontinued. Activity monitoring is a valuable research tool, with the potential to aid clinicians in diagnosis and in prediction of treatment response.

The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Workgroup: Posttraumatic Stress Disorder Enters the Age of Large-Scale Genomic Collaboration

PubMed Central

Logue, Mark W; Amstadter, Ananda B; Baker, Dewleen G; Duncan, Laramie; Koenen, Karestan C; Liberzon, Israel; Miller, Mark W; Morey, Rajendra A; Nievergelt, Caroline M; Ressler, Kerry J; Smith, Alicia K; Smoller, Jordan W; Stein, Murray B; Sumner, Jennifer A; Uddin, Monica

2015-01-01

The development of posttraumatic stress disorder (PTSD) is influenced by genetic factors. Although there have been some replicated candidates, the identification of risk variants for PTSD has lagged behind genetic research of other psychiatric disorders such as schizophrenia, autism, and bipolar disorder. Psychiatric genetics has moved beyond examination of specific candidate genes in favor of the genome-wide association study (GWAS) strategy of very large numbers of samples, which allows for the discovery of previously unsuspected genes and molecular pathways. The successes of genetic studies of schizophrenia and bipolar disorder have been aided by the formation of a large-scale GWAS consortium: the Psychiatric Genomics Consortium (PGC). In contrast, only a handful of GWAS of PTSD have appeared in the literature to date. Here we describe the formation of a group dedicated to large-scale study of PTSD genetics: the PGC-PTSD. The PGC-PTSD faces challenges related to the contingency on trauma exposure and the large degree of ancestral genetic diversity within and across participating studies. Using the PGC analysis pipeline supplemented by analyses tailored to address these challenges, we anticipate that our first large-scale GWAS of PTSD will comprise over 10 000 cases and 30 000 trauma-exposed controls. Following in the footsteps of our PGC forerunners, this collaboration—of a scope that is unprecedented in the field of traumatic stress—will lead the search for replicable genetic associations and new insights into the biological underpinnings of PTSD. PMID:25904361

A pathway to personalization of integrated treatment: informatics and decision science in psychiatric rehabilitation.

PubMed

Spaulding, William; Deogun, Jitender

2011-09-01

Personalization of treatment is a current strategic goal for improving health care. Integrated treatment approaches such as psychiatric rehabilitation benefit from personalization because they involve matching diverse arrays of treatment options to individually unique profiles of need. The need for personalization is evident in the heterogeneity of people with severe mental illness and in the findings of experimental psychopathology. One pathway to personalization lies in analysis of the judgments and decision making of human experts and other participants as they respond to complex circumstances in pursuit of treatment and rehabilitation goals. Such analysis is aided by computer simulation of human decision making, which in turn informs development of computerized clinical decision support systems. This inspires a research program involving concurrent development of databases, domain ontology, and problem-solving algorithms, toward the goal of personalizing psychiatric rehabilitation through human collaboration with intelligent cyber systems. The immediate hurdle is to demonstrate that clinical decisions beyond diagnosis really do affect outcome. This can be done by supporting the hypothesis that a human treatment team with access to a reasonably comprehensive clinical database that tracks patient status and treatment response over time achieves better outcome than a treatment team without such access, in a controlled experimental trial. Provided the hypothesis can be supported, the near future will see prototype systems that can construct an integrated assessment, formulation, and rehabilitation plan from clinical assessment data and contextual information. This will lead to advanced systems that collaborate with human decision makers to personalize psychiatric rehabilitation and optimize outcome.

Ending AIDS as a Public Health Threat: Treatment-as-Usual Risk Reduction Services for Persons With Mental Illness in Brazil.

PubMed

Wainberg, Milton L; McKinnon, Karen; Norcini-Pala, Andrea; Hughes, Olivia K; Schrage, Ezra; Erby, Whitney; Mann, Claudio G; Cournos, Francine

2018-04-01

Persons with mental illness have higher HIV infection rates than the general population. Little is known about whether care systems for this population are effectively participating in global efforts to end AIDS as a public health threat. This study examined treatment-as-usual HIV risk reduction services within public mental health settings. The authors interviewed 641 sexually active adults attending eight public psychiatric clinics in Rio de Janeiro about participation in a sexual risk reduction program, HIV testing, HIV knowledge, and sexual behaviors. Nine percent reported participation in a risk reduction program in the past year, and 75% reported having unprotected sex in the past three months. Program participants had greater HIV knowledge (p=.04) and were more likely to have had HIV testing in the past three months (p=.02), compared with nonparticipants. Participation was not associated with sexual behaviors. Including persons with mental illness in efforts to end AIDS requires a greater commitment to implementing effective interventions in public mental health systems.

Psychiatric adverse events in randomized, double-blind, placebo-controlled clinical trials of varenicline: a pooled analysis.

PubMed

Tonstad, Serena; Davies, Simon; Flammer, Martina; Russ, Cristina; Hughes, John

2010-04-01

Varenicline (Chantix), Champix) has shown efficacy and tolerability as an aid to smoking cessation. In postmarketing surveillance, neuropsychiatric symptoms have appeared; however, their incidence and causal relationship to varenicline is not known. We assessed the incidence and relative risk (RR) of psychiatric disorders in ten randomized, double-blind, placebo-controlled trials of varenicline for smoking cessation. All smoking cessation phase II, III and IV randomized controlled clinical trials of varenicline versus placebo completed as of 31 December 2008, on file with the manufacturer (Pfizer, Inc.), were included. All studies have been published. All 3091 participants who received at least one dose of varenicline and all 2005 participants who received placebo were included in this analysis. These were men and women smoking > or =10 cigarettes/day, aged 18-75 years and without current psychiatric disease who received varenicline or placebo for 6 (one study), 12 (eight studies) or 52 (one study) weeks. Adverse events were recorded at each study visit and classified according to standard Medical Dictionary for Regulatory Activities (MedDRA) terms (version 11.0). The incidence of psychiatric disorders other than solely sleep disorders and disturbances was 10.7% in subjects treated with varenicline and 9.7% in subjects treated with placebo, with an RR of 1.02 (95% CI 0.86, 1.22). The RRs (95% CI) versus placebo of psychiatric adverse events with an incidence > or =1% in the varenicline group were 0.86 (0.67, 1.12) for anxiety disorders and symptoms, 0.76 (0.42, 1.39) for changes in physical activity, 1.42 (0.96, 2.08) for depressed mood disorders and disturbances, 1.21 (0.79, 1.83) for mood disorders and disturbances not elsewhere classified and 1.70 (1.50, 1.92) for sleep disorders and disturbances. There were no cases of suicidal ideation or behaviour in varenicline-treated subjects in the ten placebo-controlled studies analysed. However, among three trials that were excluded from the analysis because of their open-label design, two cases of suicidal ideation and one completed suicide were reported in patients who had been treated with varenicline. With the exception of sleep disorders and disturbances, there was no evidence of dose-responsivity. There was no significant increase in overall psychiatric disorders, other than sleep disorders and disturbances, in varenicline-treated subjects in this sample of smokers without current psychiatric disorders. Ongoing studies are testing the use of varenicline in psychiatric patients.

PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims: a latent class analysis.

PubMed

Hruska, Bryce; Irish, Leah A; Pacella, Maria L; Sledjeski, Eve M; Delahanty, Douglas L

2014-10-01

We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA. Copyright © 2014 Elsevier Ltd. All rights reserved.

PTSD Symptom Severity and Psychiatric Comorbidity in Recent Motor Vehicle Accident Victims: A Latent Class Analysis

PubMed Central

Hruska, Bryce; Irish, Leah A.; Pacella, Maria L.; Sledjeski, Eve M.; Delahanty, Douglas L.

2014-01-01

We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA. PMID:25124501

CLINICALLY SIGNIFICANT PSYCHOTROPIC DRUG-DRUG INTERACTIONS IN THE PRIMARY CARE SETTING

PubMed Central

English, Brett A.; Dortch, Marcus; Ereshefsky, Larry; Jhee, Stanford

2014-01-01

In recent years, the growing numbers of patients seeking care for a wide range of psychiatric illnesses in the primary care setting has resulted in an increase in the number of psychotropic medications prescribed. Along with the increased utilization of psychotropic medications, considerable variability is noted in the prescribing patterns of primary care providers and psychiatrists. Because psychiatric patients also suffer from a number of additional medical comorbidities, the increased utilization of psychotropic medications presents an elevated risk of clinically significant drug interactions in these patients. While life-threatening drug interactions are rare, clinically significant drug interactions impacting drug response or appearance of serious adverse drug reactions have been documented and can impact long-term outcomes. Additionally, the impact of genetic variability on the psychotropic drug’s pharmacodynamics and/or pharmacokinetics may further complicate drug therapy. Increased awareness of clinically relevant psychotropic drug interactions can aid clinicians to achieve optimal therapeutic outcomes in patients in the primary care setting. PMID:22707017

AIDS and drug abuse: some aspects of psychiatric consultation.

PubMed

Musacchio de Zan, A; D'Agnone, O A

1989-01-01

Current research in Buenos Aires shows that approximately 35 per cent of intravenous users are HIV positive. These patients have behaviour disorders. Usually they are sent from one specialist to another, which increases their anxiety that originated in their suspicion of a serious prognosis. They are listened to when they discuss their disease but not enough when they try to talk about themselves as people with doubts about their future. Unconsciously physicians are trying to avoid involvement in the anxiety of the patient by means of a referral to a psychiatric consultation. The psychiatrist must handle this situation as a crisis in the doctor-patient relationship (both need help) to preventing further acts, additional anxiety and psychotic reactions. These patients need strong support not only because of the seriousness of the disease but also because of the situation of abstinence. Global treatment of a patient should be unified and managed by a physician with psychological training or assessed by one liaison psychiatrist, trying to avoid any split in the health team.

T cell deficiency leads to cognitive dysfunction: Implications for therapeutic vaccination for schizophrenia and other psychiatric conditions

PubMed Central

Kipnis, Jonathan; Cohen, Hagit; Cardon, Michal; Ziv, Yaniv; Schwartz, Michal

2004-01-01

The effects of the adaptive immune system on the cognitive performance and abnormal behaviors seen in mental disorders such as schizophrenia have never been documented. Here, we show that mice deprived of mature T cells manifested cognitive deficits and behavioral abnormalities, which were remediable by T cell restoration. T cell-based vaccination, using glatiramer acetate (copolymer-1, a weak agonist of numerous self-reactive T cells), can overcome the behavioral and cognitive abnormalities that accompany neurotransmitter imbalance induced by (+)dizocilpine maleate (MK-801) or amphetamine. The results, by suggesting that peripheral T cell deficit can lead to cognitive and behavioral impairment, highlight the importance of properly functioning adaptive immunity in the maintenance of mental activity and in coping with conditions leading to cognitive deficits. These findings point to critical factors likely to contribute to age- and AIDS-related dementias and might herald the development of a therapeutic vaccination for fighting off cognitive dysfunction and psychiatric conditions. PMID:15141078

Inpatient forensic-psychiatric care: Legal frameworks and service provision in three European countries.

PubMed

Edworthy, Rachel; Sampson, Stephanie; Völlm, Birgit

2016-01-01

Laws governing the detention and treatment of mentally disordered offenders (MDOs) vary widely across Europe, yet little information is available about the features of these laws and their comparative advantages and disadvantages. The purpose of this article is to compare the legal framework governing detention in forensic psychiatric care in three European countries with long-established services for MDOs, England, Germany and the Netherlands. A literature review was conducted alongside consultation with experts from each country. We found that the three countries differ in several areas, including criteria for admission, review of detention, discharge process, the concept of criminal responsibility, service provision and treatment philosophy. Our findings suggest a profound difference in how each country relates to MDOs, with each approach contributing to different pathways and potentially different outcomes for the individual. Hopefully making these comparisons will stimulate debate and knowledge exchange on an international level to aid future research and the development of best practice in managing this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Human Immunodeficiency Virus Disease Severity, Psychiatric Symptoms, and Functional Outcomes in Perinatally Infected Youth

PubMed Central

Nachman, Sharon; Chernoff, Miriam; Williams, Paige; Hodge, Janice; Heston, Jerry; Gadow, Kenneth D.

2012-01-01

Objective To evaluate associations between human immunodeficiency virus (HIV) disease severity and psychiatric and functional outcomes in youth with perinatal HIV infection. Design Cross-sectional analysis of entry data from an observational, prospective 2-year study. Logistic and linear regression models adjusted for potential confounders were used. Setting Twenty-nine sites of the International Maternal Pediatrics Adolescent AIDS Clinical Trials Group study in the United States and Puerto Rico. Participants Youth aged 6 to 17 years who had HIV infection (N=319). Main Exposures Antiretroviral treatment and perinatal HIV infection. Main Outcome Measures Youth and primary care-givers were administered an extensive battery of measures that assessed psychiatric symptoms; cognitive, social, and academic functioning; and quality of life. Results Characteristics of HIV were a current CD4 percentage of 25% or greater (74% of participants), HIV RNA levels of less than 400 copies/mL (59%), and current highly active antiretroviral therapy (81%). Analyses indicated associations of past and current Centers for Disease Control and Prevention class C designation with less severe attention-deficit/hyperactivity disorder inattention symptoms, older age at nadir CD4 percentage and lower CD4 percentage at study entry with more severe conduct disorder symptoms, higher RNA viral load at study entry with more severe depression symptoms, and lower CD4 percentage at study entry with less severe symptoms of depression. There was little evidence of an association between specific antiretroviral therapy and severity of psychiatric symptoms. A lower nadir CD4 percentage was associated with lower quality of life, worse Wechsler Intelligence Scale for Children Coding Recall scores, and worse social functioning. Conclusion Human immunodeficiency virus illness severity markers are associated with the severity of some psychiatric symptoms and, notably, with cognitive, academic, and social functioning, all of which warrant additional study. Trial Registration clinicaltrials.gov Identifier: NCT00100542 PMID:22312169

Post-traumatic stress disorder among recently diagnosed patients with HIV/AIDS in South Africa.

PubMed

Olley, B O; Zeier, M D; Seedat, S; Stein, D J

2005-07-01

This study examined the prevalence of and factors associated with post-traumatic stress disorder in recently diagnosed HIV/AIDS patients in South Africa. One hundred and forty-nine (44 male, 105 female) recently diagnosed HIV/AIDS patients (mean duration since diagnosis = 5.8 months, SD = 4.1) were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviours were assessed. Twenty-two patients (14.8%) met criteria for PTSD. Current psychiatric conditions more likely to be associated with PTSD included major depressive disorder (29% in PTSD patients versus 7% in non-PTSD patients, p = 0.004), suicidality (54% versus 11%, p = 0.001) and social anxiety disorder (40% versus 13%, p = 0.04). Further patients with PTSD reported significantly more work impairment and demonstrated a trend towards higher usage of alcohol as a means of coping. Discriminant function analysis indicated that female gender and a history of sexual violation in the past year were significantly associated with a diagnosis of PTSD. Patients whose PTSD was a direct result of an HIV/AIDS diagnosis (8/22) did not differ from other patients with PTSD on demographic or clinical features. In the South African context, PTSD is not an uncommon disorder in patients with HIV/AIDS. In some cases, PTSD is secondary to the diagnosis of HIV/AIDS but in most cases it is seen after other traumas, with sexual violation and intimate partner violence in women being particularly important.

Computer-aided design of negative allosteric modulators of metabotropic glutamate receptor 5 (mGluR5): Comparative molecular field analysis of aryl ether derivatives.

PubMed

Selvam, Chelliah; Thilagavathi, Ramasamy; Narasimhan, Balasubramanian; Kumar, Pradeep; Jordan, Brian C; Ranganna, Kasturi

2016-02-15

The metabotropic glutamate receptors (mGlu receptors) have emerged as attractive targets for number of neurological and psychiatric disorders. Recently, mGluR5 negative allosteric modulators (NAMs) have gained considerable attention in pharmacological research. Comparative molecular field analysis (CoMFA) was performed on 73 analogs of aryl ether which were reported as mGluR5 NAMs. The study produced a statistically significant model with high correlation coefficient and good predictive abilities. Published by Elsevier Ltd.

[Online therapies - what is known about their functionality].

PubMed

Stenberg, Jan-Henry; Joutsenniemi, Kaisla; Holi, Matti

2015-01-01

Online therapies are partly automated therapies, in which psychotherapeutic contents have been complemented with computer-aided presentational and educational contents, with a therapist giving support to the progress of the patient. As methods, these therapeutic programs incorporate therapeutic methods that have proven effective, such as remodeling of thoughts, activation of behavior and exposure, empathy, strengthening of cooperative relationship and motivation, and general support for self-reflection. For instance, online therapies already constitute part of the Finnish treatment guidelines on depression. Online therapies are available throughout Finland for the essential psychiatric illnesses.

Bipolar disorder and ADHD: comorbidity and diagnostic distinctions.

PubMed

Marangoni, Ciro; De Chiara, Lavinia; Faedda, Gianni L

2015-08-01

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) are neurodevelopmental disorders with onset in childhood and early adolescence, and common persistence in adulthood. Both disorders are often undiagnosed, misdiagnosed, and sometimes over diagnosed, leading to high rates of morbidity and disability. The differentiation of these conditions is based on their clinical features, comorbidity, psychiatric family history course of illness, and response to treatment. We review recent relevant findings and highlight epidemiological, clinical, family history, course, and treatment-response differences that can aid the differential diagnosis of these conditions in an outpatient pediatric setting.

Machine Learning Applications to Resting-State Functional MR Imaging Analysis.

PubMed

Billings, John M; Eder, Maxwell; Flood, William C; Dhami, Devendra Singh; Natarajan, Sriraam; Whitlow, Christopher T

2017-11-01

Machine learning is one of the most exciting and rapidly expanding fields within computer science. Academic and commercial research entities are investing in machine learning methods, especially in personalized medicine via patient-level classification. There is great promise that machine learning methods combined with resting state functional MR imaging will aid in diagnosis of disease and guide potential treatment for conditions thought to be impossible to identify based on imaging alone, such as psychiatric disorders. We discuss machine learning methods and explore recent advances. Copyright © 2017 Elsevier Inc. All rights reserved.

Neurobehavioral Manifestations of HIV/AIDS: Diagnosis and Treatment

PubMed Central

Singer, Elyse J.; Thames, April D.

2015-01-01

Synopsis Behavioral disorders are common in HIV-infected (HIV+) persons. The differential includes pre-existing psychiatric diseases, substance abuse, direct effects of HIV infection, opportunistic infection (OI), and the adverse effects of medical therapies. Many patients have more than one contributing or co-morbid problem to explain these behavioral changes. The differential should always include consideration of psychosocial, genetic, and medical causes of disease. Treatment strategies must take into account the co-administration of antiretroviral therapy and the specific neurological problems common in the HIV+ population. PMID:26613994

[Brief psychiatric hospitalization: a possible way, a strategy to evolve?].

PubMed

Goullieux, E; Loas, G

2003-01-01

The process of disinstitutionalization combined with the economic reality is responsible for the great upheaval in taking care of psychiatric patients. The repercussions are worldwide, national, and local concerning the Philippe Pinel Psychiatric Hospital (Amiens, Somme) place of this work. So the psychiatrists of this institution have to do with the following datas: a reduction of the admissions between 1991 et 1998 (around 1,5%) and a provided reduction of the hospitalization capacities upper to 40% for the following two years! Then the connection with these two figures requires the development of new therapeutic strategies, with the existing means. In this peculiar context, a study has been carried on over 2 years: 49 psychiatric patients who benefited from a brief hospitalization (less than 48 hours) have been followed up. The interest proceeds from the high frequency of the type of clinical situation which concerns 12,5% of the admissions in the studied psychiatric department. In the same time, a pilot group of 49 patients has been drawn lots among all the admissions during the same time: patients who benefited from a more traditional hospitalization (about twelve days), with strictly a same psychiatric diagnosis as in the first group, using the ICD 10 classification. The emphasis was focussed on the patient's psychiatric curing process into the 2 groups; we have compared the item rehospitalizations in a psychiatric hospital (through the number of rehospitalization, the number of days of rehospitalization, and the necessity - or not - of a rehospitalization) with the object of estimating the benefit, the inefficiency, or even the negligence of proposing a brief hospitalization. We have also studied socio-environmental datas, antecedents and effective psychiatric follow-up into the two groups. Concerning the diagnosis, mental disorders related to alcohol abuse (F10) are the most frequent (49%) into the group brief hospitalization , which diverges from the usual results taking account hospitalizations in psychiatric services. Then we have found personality disorders (14,3%), schizophrenia (12%), adaptation disorders (10,2%), anxiety (8,2%) and opiated abuse (4,3%). By that very fact, the pilot group allows exactly the same diagnosis. There's no significant difference concerning number of hospitalizations or number of days of rehospitalization; there is even a tendency in favour of patients who have been hospitalized less than 2 days: an other hospitalization is not as frequent as in the pilot group, without any exacerbation of their pathology (no less sight of patients, same number of death). It's important to emphasize that this benefit isn't related to less severe pathology for the first group: there can be a comparison between psychiatric antecedents and seniority of mental troubles. By another way, socio-environmental datas (age, sex, social and family positions) are homogenous. Lastly, circumstances of the hospitalization - inclusion between the groups are similar: same origin of the patients, who have required themselves their admission (it means the knowledge of the psychiatric hospital, distinctly one or more previous hospitalizations). The contacts with the entourage of the patients have been managed in the same way with the same results, and medical follow-up after having left hospital were identical. So we come to the conclusion that in spite of the apparent slight of this strategy, there can be a comparison between this kind of aid and a more traditional hospitalization, in many clinical situations, all the more when the emphasis is laid on the patients psychiatric curing process. Consequently a brief hospitalization can be considered as a possible therapeutic strategy. Two facts command attention now: we must clearly define the type of patients who have really benefited of this brief hospitalization, with the object of being able to plan this strategy. By another way, it seems that a brief hospitalization, just like any hospitalization, is one part of our patients curing process for the two groups. Therefore, the choice of a psychiatric hospitalization becomes a debatable point, through the treatment of a psychiatric emergency.

Integration of Neuropsychological Services in a VA HIV Primary Care Clinic.

PubMed

Dux, Moira C; Lee-Wilk, Terry

2018-05-01

The Department of Veteran Affairs (VA) is the largest health care provider for individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), with >28,000 Veterans with HIV/AIDS enrolled in care. Advances in medical treatment have improved the life-limiting effects of the disease, though many chronic symptoms persist. Comprehensive care is critical to manage the diverse constellation of symptoms. However, many patients face challenges to receiving optimal care due to limited resources, mistrust of health care providers, and/or co-occurring medical, psychiatric, and substance use disorders. The VA is a leader in developing integrated models of care to address these barriers. The inclusion of subspecialty mental health and substance abuse treatment in HIV care has been implemented across many VAs, with evidence of improved patient outcomes. However, neuropsychology has not traditionally been included, despite the fact that cognitive dysfunction represents one of the most ubiquitous complications of HIV/AIDS. Cognitive impairment is associated with myriad negative outcomes including medication non-adherence, reduced quality of life, and increased mortality. We contend that neuropsychologists are uniquely equipped to contribute to the comprehensive care of patients with HIV/AIDS. Neuropsychologists understand the range of factors that can impact cognition and have the requisite knowledge and skills to assess and treat cognitive dysfunction. Although we focus on HIV/AIDS, neuropsychologists often play critical roles in the provision of care for other infectious diseases (e.g., hepatitis C).

Principles and practical procedures for acute psychological first aid training for personnel without mental health experience.

PubMed

Everly, George S; Flynn, Brian W

2006-01-01

Most authorities agree that mass disasters leave in their wake a need for some form of acute mental health services. However, a review of current literature on crisis intervention and disaster mental health reveals differing points of view on the methods that should be employed (Raphael, 1986; NIMH, 2002). Nevertheless, there appears to be virtual universal endorsement, by relevant authorities, of the value of acute "psychological first aid" (American Psychiatric Association, 1954; USDHHS, 2004; Raphael, 1986; NIMH, 2002; Institute of Medicine, 2003; WHO, 2003; DoD/VAPTSD, 2004; Ritchie, et al., 2004; Friedman, Hamblin, Foa, & Charney, 2004). Psychological first aid (PFA), as an acute mental health intervention, seems uniquely applicable to public health settings, the workplace, the military, mass disaster venues, and even the demands of more well circumscribed critical incidents, e.g., dealing with the psychological aftermath of accidents, robberies, suicide, homicide, or community violence. In this document, we shall introduce the notion of psychological first aid (PFA) as one aspect of a psychological continuum of care, offer a rudimentary definition of PFA, and provide the reader with a practicalframework for its implementation utilizing the individual psychological first aid (iPFA)format. The goal of this paper is to better prepare public health, public safety, and other disaster response personnel who do not possess formal clinical mental health degrees or specialized training to provide iPFA services to primary and secondary disaster victims.

Thoughts and acts of aggression/violence toward others reported in association with varenicline.

PubMed

Moore, Thomas J; Glenmullen, Joseph; Furberg, Curt D

2010-09-01

Thoughts and acts of aggression/violence toward others have been reported in postmarketing surveillance of varenicline, an aid to smoking cessation. To identify the common characteristics of these thoughts and acts of aggression/violence toward others and assess the likely relationship to varenicline treatment. We obtained 78 adverse event reports from the Food and Drug Administration MedWatch database containing medical terms describing possible acts or thoughts of aggression/violence; 4 additional cases were reported in clinical trials, and 3 others came from the published literature. We used psychiatric diagnostic criteria and an adverse event causality assessment tool to identify 26 case reports for study. The selected cases described 10 events with assault, 9 cases of homicidal ideation, and 7 cases of other thoughts or acts of aggression/violence. The most frequent common characteristics were (1) inexplicable and unprovoked event, (2) the victim was anyone nearby, (3) no indication of a prior history of similar behavior in the patient, and (4) early onset of psychiatric adverse effects, often before stopping smoking. Where dechallenge/rechallenge information was available, psychiatric adverse effects resolved in 13/14 (93%) cases after discontinuation. The clear temporal relationship, lack of prior history of this behavior, and unusual nature of these events strengthens the accumulating scientific evidence that varenicline is associated with thoughts and acts of aggression/violence. We recommend that physicians and pharmacists ensure that all patients are informed of possible psychiatric symptoms of varenicline, including violent and aggressive thoughts. All patients should be advised to contact a health-care provider immediately if these symptoms occur and varenicline should be discontinued without delay.

Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice.

PubMed

Elzakkers, Isis F F M; Danner, Unna N; Grisso, Thomas; Hoek, Hans W; van Elburg, Annemarie A

Informed consent requires adequate mental capacity to consent to treatment. Mental capacity (MC) to consent to treatment refers to the ability to make medical decisions. MC is assessed in a general psychiatric interview, but this clinical assessment is known to overestimate mental capacity in patients and the inter rater reliability is low. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) has emerged as the gold standard to assess mental capacity to consent to treatment. The MacCAT-T is a semi-structured interview designed to aid clinicians in this assessment and has shown good inter rater reliability in patients with schizophrenia and other mental disorders, but has hardly been studied in patients with anorexia nervosa. Patients with anorexia nervosa (AN) regularly avoid treatment, even when severely ill and discussion includes assessing MC to consent to treatment. The aim of this study is to compare clinical judgment and the MacCAT-T in evaluating MC in patients with AN which in turn may influence use of the MacCAT-T in daily practice. In a sample of 70 consecutively referred severely ill patients with AN with a mean BMI of 15.5 kg/m 2 and a mean duration of illness of 8.6 years, clinical assessment of MC by experienced psychiatrists and the outcome of the MacCAT-T interview were compared. Agreement (κ-value) was calculated. Agreement between clinical assessment and outcome of the MacCAT-T was questionable (κ 0.23). Unlike in other psychiatric populations, clinicians judged a high proportion of patients with AN as having diminished MC. The MacCAT-T can be useful in assessing MC in AN when used in addition to clinical judgment to aid clinicians in complex cases. Why clinicians judge a relatively high proportion of patients with AN as having diminished MC, in contrast to lower proportions in other psychiatric disorders, is an area in need of further research. Copyright © 2018 Elsevier Ltd. All rights reserved.

Change-readiness of the blind: a hospital based study in a coastal town of South India.

PubMed

Shetty, Ramya; Kulkarni, Uma D

2014-01-01

Blindness is a devastating condition with psychosocial and economic effects. The shortcomings result in a burden to the blind person, the family and society. Rehabilitation of the blind can transform their lives. The aim of this study was to assess the "change-readiness" of the blind to undergo a "change-management". The study was a semi-structured pre-tested questionnaire-based study of 50 blind subjects in a medical college hospital. The blind participants were assessed for depression using the Beck Depression Inventory II, for the perceived effect of blindness on family, social life and occupation. The participants were counseled to undergo psychiatric management, vocational training, use blind aids and learn Braille. The willingness of the participants with reasons was assessed using a verbal analogue scale. Pearson Chi-square test, ANOVA and the t-test were used for statistical analysis. Over two-thirds of the subjects were depressed. Family life, social life and occupation were perceived to be affected by 44%, 66% and 74%, respectively. Change-readiness scores were low for low vision and blind aids, vocational training, psychiatric management, change of job and learning Braille. The low score was due to the associated taboo, dependence, lack of skills, embarrassment, etc., The most valuable feature was the family cohesiveness. The results suggest that there is a need to modify health policy to include blind rehabilitation, to improve visibility of blind rehabilitation centers, to include family members and co-professionals while managing the blind so that we treat the "blind person" and not a "pair of blind eyes".

[Psychiatric disorders in adult form of Niemann-Pick disease type C].

PubMed

Maubert, A; Hanon, C; Sedel, F

2016-06-01

Niemann-Pick type C disease (NPC) is a rare genetic disease with an extremely heterogeneous clinical presentation. The adult form of this disease is usually expressed with neurological symptoms; however, non-specific psychiatric disorders are often associated. This article presents a retrospective study on a cohort of NPC patients diagnosed in France with the objectives of researching the presence of psychiatric disorders and qualifying these disorders. After carrying out a research within hospital records, a questionnaire was sent to patients or their relatives and their doctors. The cohort was made up of 22 patients. Fifty-two questionnaires were sent to 47 different doctors. We received 67% of answers from the doctors, with 42% of positive answers. The answer rate of the families was 27%. Among the 22 patients, we found the presence of psychiatric disorders in 86% of cases. Seventy-three percent of the patients presented behavior disorders. Among them, 27% exhibited psychomotor excitation or agitation, 23% aggressiveness, 18% intolerance to frustration, 27% sleep disorders and 23% apathy, listlessness and/or clinophilia. Fifty-five percent of patients presented psychotic symptoms, with 45% with delusions and 36% with hallucinations. Seventy-seven percent of patients presented with mood disorders: 36% suffered from depression and 27% from emotional lability or mood swings. Of the 22 patients, a diagnosis of psychiatric disease was made in 50% of cases. The main diagnoses were schizophrenia (27%) and depression (23%). The other diagnoses identified were acute delirium, dysthymia, infantile psychosis, intellectual disharmonic disability and personality disorder. The average age of emergence of the troubles was 17.1 years old for neurological symptoms and 20.9 years old for psychiatric symptoms. The median age was 18 years old for neurological symptoms and 20 years old for psychiatric ones. In 45% of cases, psychiatric occurred after neurological symptoms; in 27%, they occurred before and they were concomitant in 9%. In 50% of cases, psychiatric symptoms existed before the early diagnosis of NPC; in 9%, they occurred after and in 5%, they occurred during the diagnostic process. Fifty-five percent of the patients were followed by a psychiatrist, 50% of patients had been hospitalized at least once in a psychiatric department. Fifty-five percent of the patients received neuroleptics or antipsychotics, 41% received antidepressants, 41% received mood stabilizers or anticonvulsants, 45% received anxiolytics and 23% hypnotics. Whilst a small cohort, the low incidence of NPC (1/120,000 to 1/150,000) and the scale of a single-center study make the findings important. In our cohort, we found psychiatric disorders in most of the patients. The symptoms were varied and non-specific, and mainly found in late-onset forms of the disease. This incidence of disorder is much higher than the literature suggests, generally describing psychiatric disorders in approximately one third of NPC adult form. On the other hand, our results on schizophrenia are consistent with the updated recommendations for the diagnosis and management of NPC. According to our results, a retrospective study to develop a suspicion index to aid diagnosis of NPC suggests that psychotic symptoms are underestimated in this disease. In our cohort, we also found a significant rate of psychiatric hospitalizations and psychotropic drugs prescription that had not been previously described in the international literature. We did not have sufficient data on the effectiveness of symptomatic treatment in NPC; the literature was contradictory. It should be noted that despite the high rate of psychiatric patients in our cohort, only half of patients consulted a psychiatrist and a few of them have regular follow-up. To conclude, our study is in line with the current literature that suggests an under-estimation of psychiatric disorders in NPC, but also a likely under-diagnosis of NPC in psychiatric departments. All this data encourage us to keep alerting psychiatrists to identifying this disease in order to promote early and optimal care. Copyright © 2015 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Effectiveness of lorazepam-assisted interviews in an adolescent with dissociative amnesia: A case report★

PubMed Central

Seo, Yuna; Shin, Mi-Hee; Kim, Sung-Gon; Kim, Ji-Hoon

2013-01-01

To facilitate gathering information during a psychiatric interview, some psychiatrists advocate augmenting the interview using drugs. Rather than barbiturates, benzodiazepines have been used for drug-assisted interviews. Dissociative amnesia is one of the indications for these interviews. Herein, we present the case of a 15-year-old female who was diagnosed as having dissociative amnesia because of conflicts with her friends. She was administered a lorazepam-assisted interview to aid recovery of her memories. In this case, a small dose of lorazepam was sufficient to recover her memories without any adverse effects. PMID:25206490

Effectiveness of lorazepam-assisted interviews in an adolescent with dissociative amnesia: A case report.

PubMed

Seo, Yuna; Shin, Mi-Hee; Kim, Sung-Gon; Kim, Ji-Hoon

2013-01-15

To facilitate gathering information during a psychiatric interview, some psychiatrists advocate augmenting the interview using drugs. Rather than barbiturates, benzodiazepines have been used for drug-assisted interviews. Dissociative amnesia is one of the indications for these interviews. Herein, we present the case of a 15-year-old female who was diagnosed as having dissociative amnesia because of conflicts with her friends. She was administered a lorazepam-assisted interview to aid recovery of her memories. In this case, a small dose of lorazepam was sufficient to recover her memories without any adverse effects.

The growing importance of mental health: are medical curricula responding?

PubMed

Azhar, M Z

2002-12-01

Mental health is becoming an important issue. Several local and international studies have proven that the incidence of mental illness is on the rise. Doctors have also been able to make more accurate diagnoses and treat mental disorders more reliably with the aid of recent research and newer drugs. As such it is necessary for the medical curricula to respond to this shift. Medical students must now be exposed to new psychiatric disorders and ways of managing them. The time spent in psychiatry and the mode of teaching must also be revised and modified to the current needs of patients.

Computational neuropharmacology: dynamical approaches in drug discovery.

PubMed

Aradi, Ildiko; Erdi, Péter

2006-05-01

Computational approaches that adopt dynamical models are widely accepted in basic and clinical neuroscience research as indispensable tools with which to understand normal and pathological neuronal mechanisms. Although computer-aided techniques have been used in pharmaceutical research (e.g. in structure- and ligand-based drug design), the power of dynamical models has not yet been exploited in drug discovery. We suggest that dynamical system theory and computational neuroscience--integrated with well-established, conventional molecular and electrophysiological methods--offer a broad perspective in drug discovery and in the search for novel targets and strategies for the treatment of neurological and psychiatric diseases.

[New insights into the neuroscience of human altruism].

PubMed

Hurlemann, R; Marsh, N

2016-11-01

Numerous honorary initiatives for humanitarian aid towards refugees illustrate the high prevalence of altruistic behavior in the population. In medicine, an exquisite example of a human propensity for altruism is organ donation. Current perspectives on the neurobiology of altruism suggest that it is deeply rooted in the motivational architecture of the social brain. This is reflected by the social evolution of cooperation and parochialism, both of which are modulated by the evolutionarily conserved peptide hormone oxytocin. From a psychiatric perspective, altruism varies along a dimensional spectrum, with pathological hyperaltruism resulting in unexpected harm for oneself and others.

Creatine metabolism and psychiatric disorders: Does creatine supplementation have therapeutic value?

PubMed Central

Allen, Patricia J.

2012-01-01

Athletes, body builders, and military personnel use dietary creatine as an ergogenic aid to boost physical performance in sports involving short bursts of high-intensity muscle activity. Lesser known is the essential role creatine, a natural regulator of energy homeostasis, plays in brain function and development. Creatine supplementation has shown promise as a safe, effective, and tolerable adjunct to medication for the treatment of brain-related disorders linked with dysfunctional energy metabolism, such as Huntington’s Disease and Parkinson’s Disease. Impairments in creatine metabolism have also been implicated in the pathogenesis of psychiatric disorders, leaving clinicians, researchers and patients alike wondering if dietary creatine has therapeutic value for treating mental illness. The present review summarizes the neurobiology of the creatine-phosphocreatine circuit and its relation to psychological stress, schizophrenia, mood and anxiety disorders. While present knowledge of the role of creatine in cognitive and emotional processing is in its infancy, further research on this endogenous metabolite has the potential to advance our understanding of the biological bases of psychopathology and improve current therapeutic strategies. PMID:22465051

Psychological interventions in the management of common skin conditions

PubMed Central

Shenefelt, Philip D

2010-01-01

The nervous system and the skin develop next to each other in the embryo and remain intimately interconnected and interactive throughout life. The nervous system can influence skin conditions through psychoneuroimmunoendocrine mechanisms and through behaviors. Understanding the pathophysiology aids in selection of treatment plans for correcting the negative effects of the psyche on specific skin conditions. Medication options include standard psychotropic medications and alternative herbs and supplements. Other options include biofeedback, cognitive-behavioral methods, hypnosis, meditation, progressive relaxation, the placebo effect, and suggestion. When simple measures fail, combining medications with other therapeutic options may produce better results. Skin conditions that have strong psychophysiologic aspects may respond well to techniques such as biofeedback, cognitive-behavioral methods, hypnosis, meditation, or progressive relaxation that help to counteract stress. Treatment of primary psychiatric disorders that negatively influence skin conditions often results in improvement of those skin conditions. Abnormal conditions of the skin, hair, and nails can also influence the psyche negatively. Treatment of secondary psychiatric disorders such as anxiety or depression that are triggered or exacerbated by the appearance of these skin conditions or the associated discomfort may also be required. PMID:22110329

Creatine metabolism and psychiatric disorders: Does creatine supplementation have therapeutic value?

PubMed

Allen, Patricia J

2012-05-01

Athletes, body builders, and military personnel use dietary creatine as an ergogenic aid to boost physical performance in sports involving short bursts of high-intensity muscle activity. Lesser known is the essential role creatine, a natural regulator of energy homeostasis, plays in brain function and development. Creatine supplementation has shown promise as a safe, effective, and tolerable adjunct to medication for the treatment of brain-related disorders linked with dysfunctional energy metabolism, such as Huntington's Disease and Parkinson's Disease. Impairments in creatine metabolism have also been implicated in the pathogenesis of psychiatric disorders, leaving clinicians, researchers and patients alike wondering if dietary creatine has therapeutic value for treating mental illness. The present review summarizes the neurobiology of the creatine-phosphocreatine circuit and its relation to psychological stress, schizophrenia, mood and anxiety disorders. While present knowledge of the role of creatine in cognitive and emotional processing is in its infancy, further research on this endogenous metabolite has the potential to advance our understanding of the biological bases of psychopathology and improve current therapeutic strategies. Copyright © 2012 Elsevier Ltd. All rights reserved.

Computational modeling of psychiatric illnesses via well-defined neurophysiological and neurocognitive biomarkers.

PubMed

Siekmeier, Peter J

2015-10-01

A good deal of recent research has centered on the identification of biomarkers and endophenotypic measures of psychiatric illnesses using in vivo and in vitro studies. This is understandable, as these measures-as opposed to complex clinical phenotypes-may be more closely related to neurobiological and genetic vulnerabilities. However, instantiation of such biomarkers using computational models-in silico studies-has received less attention. This approach could become increasingly important, given the wealth of detailed information produced by recent basic neuroscience research, and increasing availability of high capacity computing platforms. The purpose of this review is to survey the current state of the art of research in this area. We discuss computational approaches to schizophrenia, bipolar disorder, Alzheimer's disease, fragile X syndrome and autism, and argue that it represents a promising and underappreciated research modality. In conclusion, we outline specific avenues for future research; also, potential uses of in silico models to conduct "virtual experiments" and to generate novel hypotheses, and as an aid in neuropsychiatric drug development are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Visual cortex and cerebellum hyperactivation during negative emotion picture stimuli in migraine patients.

PubMed

Wang, Mengxing; Su, Jingjing; Zhang, Jilei; Zhao, Ying; Yao, Qian; Zhang, Qiting; Zhang, Hui; Wang, Shuo; Li, Ge-Fei; Liu, Jian-Ren; Du, Xiaoxia

2017-02-09

Migraines are a common and undertreated disease and often have psychiatric comorbidities; however, the abnormal mechanism of emotional processing in migraine patients has not been well clarified. This study sought to investigate the different brain functional activation to neutral, positive and negative emotional stimuli between migraine and healthy subjects. Twenty-six adults with migraines and 26 healthy adults, group-matched for sex and age, participated in this experiment. Although there were no significant differences between two groups during the viewing of positive affective pictures vs. neutral affective pictures, there were different activation patterns during the viewing of negative to neutral affective pictures in the two groups; the control group showed both increased and decreased activation patterns, while the migraine subjects showed only increased activation. Negative affective pictures elicited stronger activation than neutral affective pictures in migraineurs, which included the bilateral cerebellum anterior lobe/culmen, the bilateral lingual gyri, the bilateral precuneus and the left cuneus. Our data indicated that migraine patients were hypersensitive to negative stimuli, which might provide clues to aid in the understanding of the pathophysiology and psychiatric comorbidities of migraines.

Estimation of the prevalence of adverse drug reactions from social media.

PubMed

Nguyen, Thin; Larsen, Mark E; O'Dea, Bridianne; Phung, Dinh; Venkatesh, Svetha; Christensen, Helen

2017-06-01

This work aims to estimate the degree of adverse drug reactions (ADR) for psychiatric medications from social media, including Twitter, Reddit, and LiveJournal. Advances in lightning-fast cluster computing was employed to process large scale data, consisting of 6.4 terabytes of data containing 3.8 billion records from all the media. Rates of ADR were quantified using the SIDER database of drugs and side-effects, and an estimated ADR rate was based on the prevalence of discussion in the social media corpora. Agreement between these measures for a sample of ten popular psychiatric drugs was evaluated using the Pearson correlation coefficient, r, with values between 0.08 and 0.50. Word2vec, a novel neural learning framework, was utilized to improve the coverage of variants of ADR terms in the unstructured text by identifying syntactically or semantically similar terms. Improved correlation coefficients, between 0.29 and 0.59, demonstrates the capability of advanced techniques in machine learning to aid in the discovery of meaningful patterns from medical data, and social media data, at scale. Copyright © 2017 Elsevier B.V. All rights reserved.

Role of the laboratory in the evaluation of suspected drug abuse.

PubMed

Gold, M S; Dackis, C A

1986-01-01

Despite the high incidence of substance abuse, it remains a common cause of misdiagnosis. In patients who have abused or who are currently abusing drugs, symptoms of a psychiatric illness may be mimicked by either the drug's presence or absence. The laboratory can aid in making a differential diagnosis and eliminating drugs from active consideration as a cause of psychosis, depression, mania, and personality changes. Treatment planning and prevention of serious medical consequences often rest on the accuracy of the admission drug screen. Testing is widely used to assess improvement in substance abuse in both inpatient and outpatient settings. In occupational settings, testing has been used as an early indicator that a problem exists and as a successful prevention tool. The appropriate use of analytic technology in drug abuse testing requires an understanding of available test methodologies. These include drug screens by thin-layer chromatography, comprehensive testing using enzyme immunoassay, and computer-assisted gas chromatography-mass spectrometry (GC-MS). Testing for specific drugs considered likely causes or precipitants of "psychiatric" complaints is available with enzyme assays, radioimmunoassay, or definitive forensic-quality testing using GC-MS.

Impact of psychiatric and social characteristics on HIV sexual risk behavior in Puerto Rican women with severe mental illness.

PubMed

Heaphy, Emily Lenore Goldman; Loue, Sana; Sajatovic, Martha; Tisch, Daniel J

2010-11-01

Latinos in the United States have been identified as a high-risk group for depression, anxiety, and substance abuse. HIV/AIDS has disproportionately impacted Latinos. Review findings suggest that HIV-risk behaviors among persons with severe mental illness (SMI) are influenced by a multitude of factors including psychiatric illness, cognitive-behavioral factors, substance use, childhood abuse, and social relationships. To examine the impact of psychiatric and social correlates of HIV sexual risk behavior in Puerto Rican women with SMI. Data collected longitudinally (from 2002 to 2005) in semi-structured interviews and from non-continuous participant observation was analyzed using a cross-sectional design. Bivariate associations between predictor variables and sexual risk behaviors were examined using binary and ordinal logistic regression. Linear regression was used to examine the association between significant predictor variables and the total number of risk behaviors the women engaged in during the 6 months prior to baseline. Just over one-third (35.9%) of the study population (N = 53) was diagnosed with bipolar disorder and GAF scores ranged from 30 to 80 with a median score of 60. Participants ranged in age from 18 to 50 years (M = 32.6 ± 8.7), three-fourths reported a history of either sexual or physical abuse or of both in childhood, and one-fourth had abused substances in their lifetimes. Bivariate analyses indicated that psychiatric and social factors were differentially associated with sexual risk behaviors. Multivariate linear regression models showed that suffering from increased severity of psychiatric symptoms and factors and living below the poverty line are predictive of engagement in a greater number of HIV sexual risk behaviors. Puerto Rican women with SMI are at high risk for HIV infection and are in need of targeted sexual risk reduction interventions that simultaneously address substance abuse prevention and treatment, childhood abuse, and the indirect effects associated with SMI such as living in poverty. Mental health programs should address risk behavior among adults with SMI in the context of specific symptomatology and comorbidities.

A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims.

PubMed

Wijesinghe, Chamara A; Williams, Shehan S; Kasturiratne, Anuradhani; Dolawaththa, Nishantha; Wimalaratne, Piyal; Wijewickrema, Buddhika; Jayamanne, Shaluka F; Isbister, Geoffrey K; Dawson, Andrew H; Lalloo, David G; de Silva, H Janaka

2015-01-01

Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims. To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming. In a single blind, randomized controlled trial, snakebite victims with systemic envenoming [n = 225, 168 males, mean age 42.1 (SD 12.4) years] were randomized into three arms. One arm received no intervention (n = 68, Group A), the second received psychological first aid and psychoeducation (dispelling prevalent cultural beliefs related to snakebite which promote development of a sick role) at discharge from hospital (n = 65, Group B), while the third received psychological first aid and psychoeducation at discharge and a second intervention one month later based on cognitive behavioural principles (n = 69, Group C). All patients were assessed six months after hospital discharge for the presence of psychological symptoms and level of functioning using standardized tools. At six months, there was a decreasing trend in the proportion of patients who were positive for psychiatric symptoms of depression and anxiety from Group A through Group B to Group C (Chi square test for trend = 7.901, p = 0.005). This was mainly due to a decreasing trend for symptoms of anxiety (chi-square for trend = 11.256, p = 0.001). There was also decreasing trend in the overall prevalence of disability from Group A through Group B to Group C (chi square for trend = 7.551, p = 0.006), predominantly in relation to disability in family life (p = 0.006) and social life (p = 0.005). However, there was no difference in the proportion of patients diagnosed with depression between the three groups (chi square for trend = 0.391, p = 0.532), and the intervention also had no effect on post-traumatic stress disorder. A brief psychological intervention, which included psychological first aid and psychoeducation plus cognitive behavioural therapy that can be provided by non-specialist doctors appeared to reduce psychiatric symptoms and disability after snakebite envenoming, but not depression or post-traumatic stress disorder. Sri Lanka Clinical Trials Registry: SLCTR/2011/003.

Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infection.

PubMed

Meijide, Héctor; Mena, Álvaro; Rodríguez-Osorio, Iria; Pértega, Sonia; Castro-Iglesias, Ángeles; Rodríguez-Martínez, Guillermo; Pedreira, José; Poveda, Eva

2017-01-01

New patterns in epidemiological characteristics of people living with HIV infection (PLWH) and the introduction of Highly Active Antiretroviral Therapy (HAART) have changed the profile of hospital admissions in this population. The aim of this study was to evaluate trends in hospital admissions, re-admissions, and mortality rates in HIV patients and to analyze the role of HCV co-infection. A retrospective cohort study conducted on all hospital admissions of HIV patients between 1993 and 2013. The study time was divided in two periods (1993-2002 and 2003-2013) to be compared by conducting a comparative cross-sectional analysis. A total of 22,901 patient-years were included in the analysis, with 6917 hospital admissions, corresponding to 1937 subjects (75% male, mean age 36±11 years, 37% HIV/HCV co-infected patients). The median length of hospital stay was 8 days (5-16), and the 30-day hospital re-admission rate was 20.1%. A significant decrease in hospital admissions related with infectious and psychiatric diseases was observed in the last period (2003-2013), but there was an increase in those related with malignancies, cardiovascular, gastrointestinal, and chronic respiratory diseases. In-hospital mortality remained high (6.8% in the first period vs. 6.3% in the second one), with a progressive increase of non-AIDS-defining illness deaths (37.9% vs. 68.3%, P<.001). The admission rate significantly dropped after 1996 (4.9% yearly), but it was less pronounced in HCV co-infected patients (1.7% yearly). Hospital admissions due to infectious and psychiatric disorders have decreased, with a significant increase in non-AIDS-defining malignancies, cardiovascular, and chronic respiratory diseases. In-hospital mortality is currently still high, but mainly because of non-AIDS-defining illnesses. HCV co-infection increased the hospital stay and re-admissions during the study period. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Change-Readiness of the Blind: A Hospital Based Study in a Coastal Town of South India

PubMed Central

Shetty, Ramya; Kulkarni, Uma D.

2014-01-01

Purpose: Blindness is a devastating condition with psychosocial and economic effects. The shortcomings result in a burden to the blind person, the family and society. Rehabilitation of the blind can transform their lives. The aim of this study was to assess the “change-readiness” of the blind to undergo a “change-management”. Materials and Methods: The study was a semi-structured pre-tested questionnaire-based study of 50 blind subjects in a medical college hospital. The blind participants were assessed for depression using the Beck Depression Inventory II, for the perceived effect of blindness on family, social life and occupation. The participants were counseled to undergo psychiatric management, vocational training, use blind aids and learn Braille. The willingness of the participants with reasons was assessed using a verbal analogue scale. Pearson Chi-square test, ANOVA and the t-test were used for statistical analysis. Results: Over two-thirds of the subjects were depressed. Family life, social life and occupation were perceived to be affected by 44%, 66% and 74%, respectively. Change-readiness scores were low for low vision and blind aids, vocational training, psychiatric management, change of job and learning Braille. The low score was due to the associated taboo, dependence, lack of skills, embarrassment, etc., The most valuable feature was the family cohesiveness. Conclusion: The results suggest that there is a need to modify health policy to include blind rehabilitation, to improve visibility of blind rehabilitation centers, to include family members and co-professionals while managing the blind so that we treat the “blind person” and not a “pair of blind eyes”. PMID:24791108

Risk factors of workplace violence at hospitals in Japan.

PubMed

Fujita, Shigeru; Ito, Shinya; Seto, Kanako; Kitazawa, Takefumi; Matsumoto, Kunichika; Hasegawa, Tomonori

2012-02-01

Patients and their relatives exposed to mental stress caused by hospitalization or illness might use violence against healthcare staff and interfere with quality healthcare. The aim of this study was to investigate incidences of workplace violence and the attributes of healthcare staff who are at high risk. A questionnaire-based, anonymous, and self-administered cross-sectional survey. Healthcare staff (n = 11,095) of 19 hospitals in Japan. Incidence rates and adjusted odd ratios of workplace violence were calculated to examine the effect of attributes of healthcare staff to workplace violence by using logistic regression analysis. The response rate for survey completion was 79.1% (8711/11,095). Among the respondents, 36.4% experienced workplace violence by patients or their relatives in the past year; 15.9% experienced physical aggression, 29.8% experienced verbal abuse, and 9.9% experienced sexual harassment. Adjusted odds ratios of physical aggression were significantly high in psychiatric wards, critical care centers/intensive care units (ICU)/cardiac care units (CCU), long-term care wards, for nurses, nursing aides/care workers, and for longer working hours. Adjusted odds ratios of verbal abuse were significantly high in psychiatric wards, long-term care wards, outpatient departments, dialysis departments, and for longer years of work experience, and for longer working hours. Adjusted odds ratios of sexual harassment were significantly high in dialysis departments, for nurses, nursing aides/care workers, technicians, therapists and females. The general ward and direct interaction with patients were common risk factors for each type of workplace violence. The mechanisms and the countermeasures for each type of workplace violence at those high-risk areas should be investigated. Copyright © 2011 Society of Hospital Medicine.

[Prevalence of psychiatric disorders in French general practice using the patient health questionnaire: comparison with GP case-recognition and psychotropic medication prescription].

PubMed

Norton, J; de Roquefeuil, G; David, M; Boulenger, J-P; Ritchie, K; Mann, A

2009-12-01

Psychiatric disorders, mainly depression and anxiety, are frequently encountered in primary care and are a major cause of distress and disability. Nearly half of cases go unnoticed and among those that are recognised, many do not receive adequate treatment. In France, there is limited research concerning the prevalence, detection and management of these conditions in primary care. To estimate the prevalence of psychiatric disorders, overall and for the main psychiatric diagnostic categories, encountered in primary care; to describe general practitioners' (GPs') case identification rate; to examine psychotropic medication prescription according to diagnosis, in a regionally representative sample of GP attenders. GP practicing standard general practice in an urban area of the city of Montpellier and a nearby semi-rural region were recruited to participate. The response rate was 32.8% (n=41). Five additional GP almost exclusively offering homeopathy and acupuncture were recruited nonrandomly for convenience purposes. In each GP surgery, consecutive patients entering the waiting room were invited by a research assistant to participate until 25 patients per GP were recruited. Each participant completed self-report questionnaires in the waiting time, including the patient health questionnaire (PHQ), which yields provisional DSM-IV diagnoses. The GP completed a brief questionnaire during the consultation, giving his/her rating of the severity of any psychiatric disorder present and action taken. The patient response rate was 89.8%. In all, 14.9% of patients reached DSM-IV criteria for major depression or anxiety disorder on the PHQ (9.1% for major depression, 7.5% for panic disorder; 6% for other anxiety disorders). For the subthreshold categories, 7.4% met criteria for other depressive disorders, 11.8% for somatoform disorders and 10.9% for probable alcohol abuse or dependence. 66.3% of patients with DSM-IV diagnoses of major depression or anxiety disorder were identified by the GP as having a psychiatric disorder. The identification rate was 51% for all depressive disorders, anxiety and somatoform disorders. Of patients receiving a prescription for anxiolytic or antidepressant medication on the survey day, 80% were classified as cases of psychiatric disorder by the GP. Only 48.8% met criteria for major depression or anxiety disorder on the PHQ. This study highlights the frequency of psychiatric disorders in a regional study of French general practice. Overall, prevalence rates were similar to those found elsewhere, except for probable alcohol abuse and dependence, which was considerably higher than in the USA PHQ validation study. As in other countries, GP identified roughly half of psychiatric cases. Furthermore, half of patients treated by anxiolytic or antidepressant medication did not meet the diagnostic criteria on the survey day for which these medications have mainly shown their efficacy. This confirms the French paradox of one of the highest psychotropic medication consumption rates in Europe despite many cases of depression remaining untreated. The PHQ could be a rapid and acceptable diagnostic aid tool for French general practice but first needs to be validated against the diagnosis of mental health professionals in this setting.

Factors associated with HIV/AIDS treatment dropouts in a special care unit in the City of Rio de Janeiro, RJ, Brazil.

PubMed

Schilkowsky, Louise Bastos; Portela, Margareth Crisóstomo; Sá, Marilene de Castilho

2011-06-01

This study aimed to identify factors associated with the health care of patients with HIV/AIDS who drop out. The study was developed in a specialized health care unit of a University hospital in Rio de Janeiro, Brazil, considering a stratified sample of adult patients including all dropout cases (155) and 44.0% of 790 cases under regular follow-up. Bivariate analyses were used to identify associations between health care dropout and demographic, socioeconomic and clinical variables. Logistic and Cox regression models were used to identify the independent effects of the explanatory variables on risk for dropout, in the latter by incorporating information on the outcome over time. Patients were, on average, 35 years old, predominantly males (66.4%) and of a low socioeconomic level (45.0%). In both models, health care dropout was consistently associated with being unemployed or having an unstable job, using illicit drugs and having psychiatric background--positive association; and with age, having AIDS, and having used multiple antiretroviral regimens--negative association. In the logistic regression, dropping out was also positively associated with time between diagnosis and the first outpatient visit, while in the Cox model, the hazard for dropping out was positively associated with being single, and negatively associated with a higher educational level. The results of this work allow for the identification of HIV/AIDS patients more likely to drop out from health care.

Psychosocial impairment in DSM-5 intermittent explosive disorder.

PubMed

Rynar, Lauren; Coccaro, Emil F

2018-03-30

The purpose of this study was to document the functional severity of DSM-5 IED in a clinical research sample. IED and control groups were compared on psychosocial functioning, life satisfaction, and on a variety of cognitive and behavioral issues. IED study participants reported significantly worse psychosocial function, quality of life, and higher job dysfunction than both psychiatric and healthy control study participants. The presence of DSM-5 IED is associated with significant psychosocial and functional impairment. Early intervention may aid in minimizing the consequences of impulsive aggressive behavior, and improving psychosocial functioning and quality of life. Copyright © 2018 Elsevier B.V. All rights reserved.

Bipolar disorder in adolescence.

PubMed

DeFilippis, Melissa; Wagner, Karen Dineen

2013-08-01

Bipolar disorder is a serious psychiatric condition that may have onset in childhood. It is important for physicians to recognize the symptoms of bipolar disorder in children and adolescents in order to accurately diagnose this illness early in its course. Evidence regarding the efficacy of various treatments is necessary to guide the management of bipolar disorder in youth. For example, several medications commonly used for adults with bipolar disorder have not shown efficacy for children and adolescents with bipolar disorder. This article reviews the prevalence, diagnosis, course, and treatment of bipolar disorder in children and adolescents and provides physicians with information that will aid in diagnosis and treatment.

Psychopathological Dimensions in Substance Abusers with and without HIV/AIDS and Healthy Matched Group.

PubMed

Rezaei, Sajjad; Taramian, Sonbol; Kafie, Seyed Mousa

2013-01-01

Inattention to symptoms of mental disorders and substance abuse in patients with HIV/AIDS and other at-risk groups, may lead to irreversible damages. The purpose of this study was to compare the psychopathological dimensions in substance abusers with and without HIV/AIDS and healthy matched groups. In a cross-sectional and analytical study, selected samples (by available, consecutive, and objective methods) were 43 HIV-positive substance abusers, 49 HIV negative substance abusers under methadone maintenance therapy (MMT) in the counseling clinic of Behavioral Diseases and Addiction Abandonment, and 45 ordinary individuals. All of them were evaluated by matched confounding variables via Symptom Checklist-90-Revised (SCL-90-R). Results indicated a significant difference between these groups in the Global Severity Index (GSI), Positive Symptom Distress Index (PSDI), and Positive Symptom Total (PST) (P < 0.001). Two by two the comparison of the three groups from psychopathological dimensions revealed that substance abusers with HIV/AIDS persistently suffer more mental problems in all dimensions compared with healthy individuals (P < 0.05). In addition, in comparison with HIV negative substance abusers, they also suffer more mental problems in other dimensions, including somatization, interpersonal sensitivity, depression, anxiety, phobia, and psychoticism (P < 0.05). Yet, the difference in paranoid ideation, hostility, and obsessive-compulsive cases was insignificant. Two by two, the comparison between healthy individuals and substance abusers without HIV/AIDS showed higher levels of depression and psychoticism in substance abusers (P < 0.05), but no difference in other dimensions. Comorbidity of substance abuse and HIV diagnosis intensify mental disorder symptoms. Moreover, lack of prevention and implementation of appropriate psychological and psychiatric interventions after substance abuse and HIV lead to extended establishment of mental disorder symptoms.

Psychopathological Dimensions in Substance Abusers with and without HIV/AIDS and Healthy Matched Group

PubMed Central

Rezaei, Sajjad; Taramian, Sonbol; Kafie, Seyed Mousa

2013-01-01

Background Inattention to symptoms of mental disorders and substance abuse in patients with HIV/AIDS and other at-risk groups, may lead to irreversible damages. The purpose of this study was to compare the psychopathological dimensions in substance abusers with and without HIV/AIDS and healthy matched groups. Methods In a cross-sectional and analytical study, selected samples (by available, consecutive, and objective methods) were 43 HIV-positive substance abusers, 49 HIV negative substance abusers under methadone maintenance therapy (MMT) in the counseling clinic of Behavioral Diseases and Addiction Abandonment, and 45 ordinary individuals. All of them were evaluated by matched confounding variables via Symptom Checklist-90-Revised (SCL-90-R). Findings Results indicated a significant difference between these groups in the Global Severity Index (GSI), Positive Symptom Distress Index (PSDI), and Positive Symptom Total (PST) (P < 0.001). Two by two the comparison of the three groups from psychopathological dimensions revealed that substance abusers with HIV/AIDS persistently suffer more mental problems in all dimensions compared with healthy individuals (P < 0.05). In addition, in comparison with HIV negative substance abusers, they also suffer more mental problems in other dimensions, including somatization, interpersonal sensitivity, depression, anxiety, phobia, and psychoticism (P < 0.05). Yet, the difference in paranoid ideation, hostility, and obsessive-compulsive cases was insignificant. Two by two, the comparison between healthy individuals and substance abusers without HIV/AIDS showed higher levels of depression and psychoticism in substance abusers (P < 0.05), but no difference in other dimensions. Conclusion Comorbidity of substance abuse and HIV diagnosis intensify mental disorder symptoms. Moreover, lack of prevention and implementation of appropriate psychological and psychiatric interventions after substance abuse and HIV lead to extended establishment of mental disorder symptoms. PMID:24494168

A Live Threat Violence Simulation Exercise for Psychiatric Outpatient Departments: A Valuable Aid to Training in Violence Prevention.

PubMed

Feinstein, Robert E; Yager, Joel

2017-10-30

Violence in psychiatric outpatient settings is a ubiquitous concern. This article describes the development, implementation, and evaluation of a live threat violence simulation exercise, designed to reduce the risk of future outpatient clinic violence and minimize the effects of future incidents on staff. The psychiatric outpatient clinic at the University of Colorado Hospital developed, implemented, and evaluated a 4-hour live violence threat simulation exercise as a companion to a 7-hour violence prevention program. The simulation includes an orientation, two threat simulation scenarios, three debriefings, satisfaction surveys, problem identification, action plans, and annual safety and process improvements. The authors have conducted live violence simulation exercises from 2011-2016, and have collected survey data about our annual simulation exercise from 2014-2016. Each year ≥ 52% of participants responded, and each year ≥ 90% of respondents rated the simulation as "very helpful/helpful", ≥ 86% believed themselves to be "much better/better" prepared to deal with violent episodes, and < 2% of participants experienced post-simulation side effects such as worries about past trauma; anxiety; sleep problems; increase in workplace concerns. From 2011-2016, the clinic experienced 4 major violent episodes and 36 episodes of potential violence with no staff injuries and minimal psychological sequelae to one staff member. Violence prevention efforts and the development of close police/staff relationships may have contributed to these fortunate outcomes. Satisfaction surveys suggest that the simulations are very helpful/helpful, with participants feeling much better/ better prepared to manage violence. The exercises led the authors to initiate staff safety related behavioral changes as well as physical space and safety processes improvements. The violence prevention program and simulation exercises have promoted excellent relationships with police and a consistent safety record over six years. This approach may be useful for other psychiatric outpatient departments.

[Does routine outcome monitoring have a promising future? An investigation into the use of shared decision-making combined with ROM for patients with a combination of physical and psychiatric symptoms].

PubMed

van der Feltz-Cornelis, C M; Andrea, H; Kessels, E; Duivenvoorden, H J; Biemans, H; Metz, M

2014-01-01

Although routine outcome monitoring (ROM) has been developed and widely used in the course of patient centered outcome research in the Netherlands, so far the technique has hardly ever been used to improve the treatment of individual patients. To describe how a rom technique based on the principles of shared decision-making (SDM) was developed and evaluated at the Center for Body, Mind and Health at GGz Breburg, a specialised mental health institution in the Netherlands. We have developed a conceptual model for SDM that involves patient participation and the use of evidence-based decision-aids with cut-off scores. According to the conceptual model for SDM that we developed, the patient and the health professional involved took 'shared' decisions in three phases; the decisions related to triage, the drawing-up of a treatment plan and a follow-up treatment course. At the end of the 6 month intake-phase 7 of the 67 patients who were deemed eligible for ROM/SDM were dropped from the study because they were incapable of performing ROM assessments. Due to diagnostic advice and referral at the end of the intake-phase, 25 patients did not require further treatment. Of the remaining 35 patients, 33 delivered at least one follow-up ROM assessment during the subsequent treatment phases. In these patients somatic and psychiatric symptoms were found to be significantly reduced. ROM combined with sdm can be used successfully with patients who have a combination of physical and psychiatric symptoms and the technique can be applied by the professional in charge. Very few patients dropped out of the follow-up measurements and somatic as well as depressive or psychiatric symptoms diminished significantly. These findings indicate that a Randomised Clinical Trial is warranted in order to test the effectiveness of sdm combined with ROM as a decision-making instrument.

Mental health treatment patterns in perinatally HIV-infected youth and controls.

PubMed

Chernoff, Miriam; Nachman, Sharon; Williams, Paige; Brouwers, Pim; Heston, Jerry; Hodge, Janice; Di Poalo, Vinnie; Deygoo, Nagamah Sandra; Gadow, Kenneth D

2009-08-01

Youths perinatally infected with HIV often receive psychotropic medication and behavioral treatment for emotional and behavioral symptoms. We describe patterns of intervention for HIV-positive youth and youth in a control group in the United States. Three hundred nineteen HIV-positive youth and 256 controls, aged 6 to 17 years, enrolled in the International Maternal Adolescent AIDS Clinical Trials 1055, a prospective, 2-year observational study of psychiatric symptoms. One hundred seventy-four youth in the control group were perinatally exposed to HIV, and 82 youth were uninfected children living in households with HIV-positive members. Youth and their primary caregivers completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced symptom-rating scales. Children's medication and behavioral psychiatric intervention histories were collected at entry. We evaluated the association of past or current psychiatric treatment with HIV status, baseline symptoms, and impairment by using multiple logistic regression, controlling for potential confounders. HIV-positive youth and youth in the control group had a similar prevalence of psychiatric symptoms (61%) and impairment (14% to 15%). One hundred four (18%) participants received psychotropic medications (stimulants [14%], antidepressants [6%], and neuroleptic agents [4%]), and 127 (22%) received behavioral treatment. More HIV-positive youth than youth in the control group received psychotropic medication (23% vs 12%) and behavioral treatment (27% vs 17%). After adjusting for symptom class and confounders, HIV-positive children had twice the odds of children in the control group of having received stimulants and >4 times the odds of having received antidepressants. Caregiver-reported symptoms or impairment were associated with higher odds of intervention than reports by children alone. HIV-positive children are more likely to receive mental health interventions than control-group children. Pediatricians and caregivers should consider available mental health treatment options for all children living in families affected by HIV.

"Psychiatric disorders in smokers seeking treatment for tobacco dependence: Relations with tobacco dependence and cessation": Correction to Piper et al. (2010).

PubMed

2017-09-01

Reports an error in "Psychiatric disorders in smokers seeking treatment for tobacco dependence: Relations with tobacco dependence and cessation" by Megan E. Piper, Stevens S. Smith, Tanya R. Schlam, Michael F. Fleming, Amy A. Bittrich, Jennifer L. Brown, Cathlyn J. Leitzke, Mark E. Zehner, Michael C. Fiore and Timothy B. Baker ( Journal of Consulting and Clinical Psychology , 2010[Feb], Vol 78[1], 13-23). There was an error in the Method section in the World Mental Health Survey Initiative version of the CIDI subsection. The authors characterized one of the anxiety conditions analyzed as "panic disorder". However, this should have been labeled as "panic attacks", consequently making the occurrence rates and relations the authors reported actually pertain to panic attacks, social phobia, and generalized anxiety disorder. (The following abstract of the original article appeared in record 2010-00910-005.) Objective: The present research examined the relation of psychiatric disorders to tobacco dependence and cessation outcomes. Data were collected from 1,504 smokers (58.2% women; 83.9% White; mean age = 44.67 years, SD = 11.08) making an aided smoking cessation attempt as part of a clinical trial. Psychiatric diagnoses were determined with the Composite International Diagnostic Interview structured clinical interview. Tobacco dependence was assessed with the Fagerström Test of Nicotine Dependence (FTND) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Diagnostic groups included those who were never diagnosed, those who had ever been diagnosed (at any time, including in the past year), and those with past-year diagnoses (with or without prior diagnosis). Some diagnostic groups had lower follow-up abstinence rates than did the never diagnosed group ( ps < .05). At 8 weeks after quitting, strong associations were found between cessation outcome and both past-year mood disorder and ever diagnosed anxiety disorder. At 6 months after quitting, those ever diagnosed with an anxiety disorder ( OR = .72, p = .02) and those ever diagnosed with more than one psychiatric diagnosis ( OR = .74, p = .03) had lower abstinence rates. The diagnostic categories did not differ in smoking heaviness or the FTND, but they did differ in dependence motives assessed with the WISDM. Information on recent or lifetime psychiatric disorders may help clinicians gauge relapse risk and may suggest dependence motives that are particularly relevant to affected patients. These findings also illustrate the importance of using multidimensional tobacco dependence assessments. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Psychopathology and film: a valuable interaction?].

PubMed

van Duppen, Z; Summa, M; Fuchs, T

2015-01-01

Film or film fragments are often used in psychopathology education. However, so far there have been very few articles that have discussed the benefits and limitations of using films to explain or illustrate psychopathology. Although numerous films involves psychopathology in varying degrees, it is not clear how we can use films for psychopathology education. To examine the advantages, limitations and possible methods of using film as a means of increasing our knowledge and understanding of psychiatric illnesses. We discuss five examples that illustrate the interaction of film and psychopathology. On the one hand we explain how the psychopathological concepts are used in each film and on the other hand we explain which aspects of each film are valuable aids for teaching psychopathology. The use of film makes it possible to introduce the following topics in psychopathological teaching programme: holistic psychiatric reasoning, phenomenology and the subjective experience, the recognition of psychopathological prototypes and the importance of context. There is undoubtedly an analogy between the method we have chosen for teaching psychopathology with the help of films and the holistic approach of the psychiatrist and his or her team. We believe psychopathology education can benefit from films and we would recommend our colleagues to use it in this way.

On a front line.

PubMed Central

Jones, L.

1995-01-01

Like the patients, doctors in Sarajevo depend largely on humanitarian aid; everyone in the public sector has worked without pay for almost three years. The hospital is on a front line; yet the psychiatric department continues to function, even conducting large scale studies of psychosocial aspects of war in Bosnia-Hercegovina. The type of inpatient morbidity and treatment patterns have changed. A plethora of psychosocial rehabilitation programmes has emerged, including counselling, drop in centres, and attending to special needs of elderly people, schoolchildren, and women. The most prominent psychological symptoms were exhaustion at the prospect of a third winter of war and bewilderment at the Western stereotype of Bosnians as Muslim fundamentalists. Images p1052-a p1053-a PMID:7728062

Video self-portraits: a novel approach to group psychotherapy with young adults.

PubMed

Cox, E; Lothstein, L M

1989-04-01

A group therapy model was formulated for exploring the intersubjective processes of adolescents and young adults whose group bonds had been fragmented by their severe emotional illnesses. The model involved having adolescents and young adults who were psychiatric inpatients make video self-portraits; that is, videotapes which focused on various aspects of their emotional pathology. These tapes were then presented before a larger group of nine patients for discussion. The video team method is shown to aid in self-disclosure and facilitate the working through of severe emotional conflicts in this age group. It is an especially useful method with more severely disturbed patients for whom narcissistic self pathology is a prominent feature.

Interacting Neural Processes of Feeding, Hyperactivity, Stress, Reward, and the Utility of the Activity-Based Anorexia Model of Anorexia Nervosa

PubMed Central

Ross, Rachel A.; Mandelblat-Cerf, Yael; Verstegen, Anne M.J.

2017-01-01

Anorexia nervosa (AN) is a psychiatric illness with minimal effective treatments and a very high rate of mortality. Understanding the neurobiological underpinnings of the disease is imperative for improving outcomes and can be aided by the study of animal models. The activity-based anorexia rodent model (ABA) is the current best parallel for the study of AN. This review describes the basic neurobiology of feeding and hyperactivity seen in both ABA and AN, and compiles the research on the role that stress-response and reward pathways play in modulating the homeostatic drive to eat and to expend energy, which become dysfunctional in ABA and AN. PMID:27824637

Interacting Neural Processes of Feeding, Hyperactivity, Stress, Reward, and the Utility of the Activity-Based Anorexia Model of Anorexia Nervosa.

PubMed

Ross, Rachel A; Mandelblat-Cerf, Yael; Verstegen, Anne M J

Anorexia nervosa (AN) is a psychiatric illness with minimal effective treatments and a very high rate of mortality. Understanding the neurobiological underpinnings of the disease is imperative for improving outcomes and can be aided by the study of animal models. The activity-based anorexia rodent model (ABA) is the current best parallel for the study of AN. This review describes the basic neurobiology of feeding and hyperactivity seen in both ABA and AN, and compiles the research on the role that stress-response and reward pathways play in modulating the homeostatic drive to eat and to expend energy, which become dysfunctional in ABA and AN.

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury

PubMed Central

Haarbauer-Krupa, Juliet; Taylor, Christopher A.; Yue, John K.; Winkler, Ethan A.; Pirracchio, Romain; Cooper, Shelly R.; Burke, John F.; Stein, Murray B.

2017-01-01

Abstract Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69–7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42–4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79–0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care. PMID:26936513

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury.

PubMed

Haarbauer-Krupa, Juliet; Taylor, Christopher A; Yue, John K; Winkler, Ethan A; Pirracchio, Romain; Cooper, Shelly R; Burke, John F; Stein, Murray B; Manley, Geoffrey T

2017-01-01

Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69-7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42-4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79-0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care.

Influence of Psychiatric and Personality Disorders on Smoking Cessation among Individuals in Opiate Dependence Treatment

PubMed Central

Cooperman, Nina A.; Lu, Shou-En; Richter, Kimber P.; Bernstein, Steven L.; Williams, Jill M.

2016-01-01

Objective We aimed to evaluate how psychiatric and personality disorders influence smoking cessation goals and attempts among people with opiate dependence who smoke. This information could aid the development of more effective cessation interventions for these individuals. Methods Participants (N=116) were recruited from two methadone clinics, completed the Millon Clinical Multiaxial Inventory–III, and were asked about their smoking behavior and quitting goals. We used the Least Absolute Shrinkage and Selection Operator (LASSO) method, a technique commonly used for studies with small sample sizes and large number of predictors, to develop models predicting having a smoking cessation goal, among those currently smoking daily, and ever making a quit attempt, among those who ever smoked. Results Almost all participants reported ever smoking (n = 115, 99%); 70% (n = 80) had made a serious quit attempt in the past; 89% (n = 103) reported current daily smoking; and, 59% (n = 61) had a goal of quitting smoking and staying off cigarettes. Almost all (n = 112, 97%) had clinically significant characteristics of a psychiatric or personality disorder. White race, anxiety, and a negativistic personality facet (expressively resentful) were negative predictors of having a cessation goal. Overall narcissistic personality pattern and a dependent personality facet (interpersonally submissive) were positive predictors of having a cessation goal. Somatoform disorder, overall borderline personality pattern, and a depressive personality facet (cognitively fatalistic) were negative predictors of ever making a quit attempt. Individual histrionic (gregarious self-image), antisocial (acting out mechanism), paranoid (expressively defensive), and sadistic (pernicious representations) personality disorder facets were positive predictors of ever making a quit attempt. Each model provided good discrimination for having a smoking cessation goal or not (C-statistic of .76, 95% CI[0.66, 0.85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI[0.70, 0.88]). Conclusions Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking. PMID:27064523

The (Mis)appropriation of HIV/AIDS advocacy strategies in Global Mental Health: towards a more nuanced approach.

PubMed

Howell, Alison; Mills, China; Rushton, Simon

2017-07-01

Mental health is increasingly finding a place on global health and international development agendas. Advocates for Global Mental Health (GMH), and international organizations such as the World Health Organization (WHO) and the World Bank, argue that treatments available in high-income countries should also be made available in low- and middle-income countries. Such arguments are often made by comparing mental health to infectious diseases, including the relative disease and economic burdens they impose, and pointing to the applicability of the right to access treatment for mental health, not only infectious diseases. HIV/AIDS advocacy in particular has been held up by GMH advocates as offering an appropriate strategy for generating global commitment. There is a need to assess how health issues are framed not only in relation to social goods outside of health (such as human rights, security or development), but also in relation to other health or disease models, and how health policy and practice is shaped as a result. The article debates the merits and consequences of likening mental health to HIV/AIDS, and identifies four major problems with the model for GMH advocacy being developed through these analogies: 1. An inappropriately universalizing global approach to context-specific problems; 2. A conception of human rights that focuses on the right to access treatment at the expense of the right to refuse it; 3. A tendency to treat poverty as a psychiatric issue, rather than recognizing that mental distress can be the result of poverty and other forms of inequality; 4. The prioritization of destigmatization of disease over social justice models. There are significant problems with the wholesale adoption of an (often simplified) version of HIV/AIDS advocacy as a model for GMH. Yet critical engagement with the important and nuanced differences between HIV/AIDS and mental health may nevertheless point to some possibilities for productive engagement and cross-fertilisation between advocates, activists and scholars in both fields.

Operationalizing the assessment and management of violence risk in the short-term.

PubMed

Doyle, Michael; Logan, Caroline

2012-01-01

Assessing risk of violence in the short term is crucial for managing and preventing violence, especially in institutions such as psychiatric units and prisons. Despite a lack of consensus on the definition of "short term", a number of recent tools and guidelines have been developed to aid short-term clinical decision-making. Whereas the supporting evidence for the new tools is impressive, limitations remain in terms of the focus on prediction, limited consideration of strengths, and poor integration with formulation and risk management. The Short-Term Assessment of Risk and Treatability (START) is a brief clinical guide for the dynamic assessment of risks, strengths and treatability. It focuses on short-term risks and the characteristics of the individual that, if changed, might lead to an increase or decrease in risk. The START has the potential to operationalize the structured professional judgment (SPJ) approach in order to inform the evaluation of multiple risk domains relevant to everyday psychiatric clinical practice. However, explicit guidance on integrating risk assessment, formulation and management is limited in the START and this paper describes the SPJ approach, reviews recent developments in approaches to risk, and considers how the START can be used to inform SPJ approaches and link risk assessment, formulation, and management. Copyright © 2012 John Wiley & Sons, Ltd.

Lessons from psychiatry in the Arab world--a Lebanese trainee psychiatrist's qualitative views on the provision of mental healthcare services for Palestinian refugees in Lebanon and an interview with a consultant psychiatrist on the effects of the Arab spring on the mental health of Libyans.

PubMed

Hankir, Ahmed; Sadiq, Asad

2013-09-01

In this manuscript, a Lebanese trainee psychiatrist qualitatively analyses and discusses the provision of mental healthcare services for Palestinian refugees in Lebanon. There are more than 250,000 Palestinian people sporadically dispersed in the refugee camps in Sidon, Beirut and other major cities in the Levant. Displacement, conflict, trauma, unemployment and poverty are but some of the myriad factors that influence Palestinian refugee mental health. This article traces the historical, political and socioeconomic determinants of health for Palestinians exiled in Lebanon and describes the pivotal role that the non-Govenmental Organisation Medical Aid for Palestinians is playing in helping to alleviate the psychiatric distress of Palestinian sufferers of mental illness. The latter half of the manuscript contains an interview with a consultant psychiatrist about his experiences volunteering in the war-torn lands of Libya post Arab Spring. He expounds on how he feels mental healthcare services in Libya are woefully inadequate and broaches on his perception of how the resilience and the 'family-centric' model of the Libyan people has conferred a certain degree of protection towards developing severe psychiatric illness.

Assessment of psychological pain in major depressive episodes.

PubMed

Mee, Steven; Bunney, Blynn G; Bunney, William E; Hetrick, William; Potkin, Steven G; Reist, Christopher

2011-11-01

Severe psychological or mental pain is defined as an experience of unbearable torment which can be associated with a psychiatric illness (e.g., major depressive disorder) or a tragic loss such as the death of a child. A brief self-rating scale (Mee-Bunney Psychological Pain Assessment Scale [MBPPAS]) was developed to assess the intensity of psychological pain. The scale was used to measure psychological pain in 73 major depressive episode (MDE) patients and 96 non-psychiatric controls. In addition to the MBPPAS, all subjects completed four additional instruments: Suicidal Behavior Questionnaire (SBQ), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and the Brief Pain Inventory (BPI). Known-groups, content and convergent validity, and internal reliability of the scale were established. MDE and control subjects were ranked according to MBPPAS scores. A threshold was set at 32 representing 0.5 SD above the mean for MDEs. MDE subjects above the threshold of 32 had significantly higher SBQ scores than those below. A significant linear correlation between psychological pain and SBQ suicidality scores was observed. This is the first study to contrast psychological pain in controls and patients with MDE. Our results suggest that psychological pain is a useful and unique construct in patients with MDE that can be reliably assessed and may aid in the evaluation of suicidal risk. Published by Elsevier Ltd.

Prevention and treatment of HIV addicted patients: a biopsychosocial approach.

PubMed

Iskandar, Shelly; van Crevel, Reinout; Siregar, I M P; Achmad, T H; van der Ven, A J A M; de Jong, C A J

2009-07-01

Injecting drug use is the main route of HIV transmission in many parts of Indonesia. Efforts to prevent HIV-transmission through injecting drug use mostly focus on subjects who actively inject. In scientific publications, the term 'injecting drug users' tends to be used without a clear definition and without specifying the pattern of drug use as current or former drug use, frequency, duration, type of injected drug(s) or context (e.g. imprisonment). Actually, injecting drug users (IDUs) have different drug use patterns, risk behavior, somatic co-morbidity, psychiatric co-morbidity, and psychosocial problems. In fact, these patients are suffering from addiction as a chronic brain disease in co-occurrence with somatic and psychiatric disorder and many social problems. Failing in addressing the problems comprehensively will lead to the failure of drug treatment. This is why addiction can be best studied and treated from a biopsychosocial perspective. Accordingly, treatment goals can be differentiated in crisis intervention, cure or recovery (detoxification, relapse prevention), and care or partial remission (stabilization and harm reduction). In summary, injecting drug use in Indonesia is not a single entity and patient oriented prevention and care for IDUs, especially focusing on their addiction, should be addressed to prevent the transmission of HIV/AIDS.

Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol.

PubMed

Kalichman, Seth C; Grebler, Tamar; Amaral, Christina M; McKerney, Megan; White, Denise; Kalichman, Moira O; Cherry, Chauncey; Eaton, Lisa

2014-10-01

Food insecurity is associated with HIV treatment non-adherence and poor health outcomes for people living with HIV/AIDS. Given the poor nutritional status common to people who drink alcohol, food insecurity may be particularly problematic for HIV positive individuals who drink alcohol. To examine food insecurity among HIV positive men and women who drink alcohol and its association with antiretroviral therapy (ART) adherence, health outcomes and health service utilization. Adults living with HIV (N = 183) in Atlanta, Georgia who reported alcohol use in the previous week and were receiving ART participated in a 12-month cohort. Participants were recruited from infectious disease clinics and social services to complete computerized interviews, monthly-unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. Forty-three percent of participants experienced food insecurity during at least one month of the study period. Food insecurity was independently associated with suboptimal ART adherence and less suppressed HIV viral load over. Individuals who experienced food insecurity also had histories of more medical and psychiatric hospitalizations, and greater mental health problems. Food insecurity is prevalent among alcohol using people receiving ART and food insecurity is associated with treatment non-adherence, poor health outcomes, and increased medical and psychiatric hospitalizations.

Work factors and psychological distress in nurses' aides: a prospective cohort study

PubMed Central

Eriksen, Willy; Tambs, Kristian; Knardahl, Stein

2006-01-01

Background Nurses' aides (assistant nurses), the main providers of practical patient care in many countries, are doing both emotional and heavy physical work, and are exposed to frequent social encounters in their job. There is scarce knowledge, though, of how working conditions are related to psychological distress in this occupational group. The aim of this study was to identify work factors that predict the level of psychological distress in nurses' aides. Methods The sample of this prospective study comprised 5076 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4076 (80.3 %) completed a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were measured at baseline. Psychological distress (anxiety and depression) was assessed at baseline and follow-up by the SCL-5, a short version of Hopkins Symptom Checklist-25. Results In a linear regression model of the level of psychological distress at follow-up, with baseline level of psychological distress, work factors, and background factors as independent variables, work factors explained 2 % and baseline psychological distress explained 34 % of the variance. Exposures to role conflicts, exposures to threats and violence, working in apartment units for the aged, and changes in the work situation between baseline and follow-up that were reported to result in less support and encouragement were positively associated with the level of psychological distress. Working in psychiatric departments, and changes in the work situation between baseline and follow-up that gave lower work pace were negatively associated with psychological distress. Conclusion The study suggests that work factors explain only a modest part of the psychological distress in nurses' aides. Exposures to role conflicts and threats and violence at work may contribute to psychological distress in nurses' aides. It is important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy. It is also important that health service organisations focus on reducing role conflicts, and that leaders listen to and consider the views of the staff. PMID:17132172

Clinical Pharmacology in Sleep Medicine

PubMed Central

Proctor, Ashley; Bianchi, Matt T.

2012-01-01

The basic treatment goals of pharmacological therapies in sleep medicine are to improve waking function by either improving sleep or by increasing energy during wakefulness. Stimulants to improve waking function include amphetamine derivatives, modafinil, and caffeine. Sleep aids encompass several classes, from benzodiazepine hypnotics to over-the-counter antihistamines. Other medications used in sleep medicine include those initially used in other disorders, such as epilepsy, Parkinson's disease, and psychiatric disorders. As these medications are prescribed or encountered by providers in diverse fields of medicine, it is important to recognize the distribution of adverse effects, drug interaction profiles, metabolism, and cytochrome substrate activity. In this paper, we review the pharmacological armamentarium in the field of sleep medicine to provide a framework for risk-benefit considerations in clinical practice. PMID:23213564

When Patients Are Normal People: Strategies for Managing Dual Relationships

PubMed Central

Jackson, W. Clay

2002-01-01

A significant number of generalist physicians, particularly those in rural areas, often find themselves participating in the care of patients for whom the therapeutic relationship overlaps with another relationship (e.g., social or professional). Although psychiatrists and psychologists are typically advised to avoid such “dual relationships,” no such prohibition exists for generalists. Little, if any, guidance exists to aid in the management of such dual relationships for the generalist who provides treatment for psychiatric conditions for his or her patients. The author, a generalist with experience in the treatment of mood disorders, describes potential challenges faced by the generalist who chooses to provide care for “dual relationship” patients and outlines strategies for successfully meeting these challenges. PMID:15014737

Quality of life in HIV/AIDS.

PubMed

Basavaraj, K H; Navya, M A; Rashmi, R

2010-07-01

Given the longevity achievable with current prophylactic and therapeutic strategies for persons with HIV infection, quality of life (QOL) has emerged as a significant medical outcome measure, and its enhancement has an important goal. This review highlights the relevance and complexity of physical, psychological, and social factors as determinants of health-related quality of life in HIV-infected persons. Existing data suggest that physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Consequently, the impact of HIV infection on the dimensions of QOL, including physical and emotional well-being, social support systems, and life roles, has emerged as a key issue for persons infected with HIV.

Quality of life in HIV/AIDS

PubMed Central

Basavaraj, K. H.; Navya, M. A.; Rashmi, R.

2010-01-01

Given the longevity achievable with current prophylactic and therapeutic strategies for persons with HIV infection, quality of life (QOL) has emerged as a significant medical outcome measure, and its enhancement has an important goal. This review highlights the relevance and complexity of physical, psychological, and social factors as determinants of health-related quality of life in HIV-infected persons. Existing data suggest that physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Consequently, the impact of HIV infection on the dimensions of QOL, including physical and emotional well-being, social support systems, and life roles, has emerged as a key issue for persons infected with HIV. PMID:21716787

Diffusion Magnetic Resonance Imaging: What Water Tells Us about Biological Tissues

PubMed Central

Le Bihan, Denis; Iima, Mami

2015-01-01

Since its introduction in the mid-1980s, diffusion magnetic resonance imaging (MRI), which measures the random motion of water molecules in tissues, revealing their microarchitecture, has become a pillar of modern neuroimaging. Its main clinical domain has been the diagnosis of acute brain stroke and neurogical disorders, but it is also used in the body for the detection and management of cancer lesions. It can also produce stunning maps of white matter tracks in the brain, with the potential to aid in the understanding of some psychiatric disorders. However, in order to exploit fully the potential of this method, a deeper understanding of the mechanisms that govern the diffusion of water in tissues is needed. PMID:26204162

[Mental health in the hospital. Analysis of conditions of risk by department, age and gender, for the creation of best practices for the health of nurses].

PubMed

Salerno, Silvana; Dimitri, Laura; Livigni, Lucilla; Magrini, Andrea; Talamanca, Irene Figà

2015-01-01

Nurses mental health is still a major and unachieved goal in many public hospital settings. Hospital work organization analysis shows differences in health professions, hospital units, age and gender. To analyse work organisation and its effects on nurses mental health in three high risks hospital units (Oncoematology, First Aid, General Medicine) in order to improve good practices for nurses health. The Method of Organizational Congruences (72 hours of observation) has been used to detect organizational constraints and their possible effects on nurses' mental health. General Health Questionnaire (Goldberg D., 12 items) and the Check up Surveys for burnout (Leiter MP and Maslach C.) have been used to evaluate the mental health status of the 80 nurses employed (78% women). High emotional work load in oncoematology Unit, high monotony and repetitiveness with lower emotional load in first Aid Unit, High mental and physical workload in General Medicine Unit. Burnout was significantly higher in General Medicine Unit, followed by First Aid Unit and oncoematology Unit. Female nurses reported more chronic diseases than males. The GHQ showed high frequency of minor psychiatric disorders (58%) in all units, higher in General Medicine Unit (78%). The overall results show how organizational constraints and mental health conditions differ per hospital units, age groups and gender. Good nursing practices, to prevent mental health problems, should therefore be developed specifically in each hospital unit according to these results.

Responding to Trauma at Sea: A Case Study in Psychological First Aid, Unique Occupational Stressors, and Resiliency Self-Care.

PubMed

Millegan, Jeffrey; Delaney, Eileen M; Klam, Warren

2016-11-01

The U.S. Navy deploys Special Psychiatric Rapid Intervention Teams (SPRINT) to sites of military disasters to assist survivors and the command. SPRINT functions primarily as a consultant to help commands effectively respond to the mental health needs of their service members following a traumatic event. Utilizing the principles of psychological first aid, the overall goal of SPRINT is to mitigate long-term mental health dysfunction and facilitate recovery at both the individual and unit level. We present a case study of a SPRINT mission to a deployed U.S. Navy ship in response to a cluster of suicides and subsequent concerns about the well-being of the remaining crew. Throughout this mission, important themes emerged, such as the impact of accumulated operational stressors and the subsequent development of mental health stigma. Also, this case study demonstrates the potential effectiveness of introducing resiliency self-care meditation training to remote environments that lack ready access to mental health resources. From here, SPRINT can provide a model for immediate disaster mental health response that has potential relevancy beyond the military. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Understanding stigma in chronic health conditions: implications for nursing.

PubMed

Engebretson, Joan

2013-10-01

This article explores the social processes in stigmatization and the theoretical background on the impact in chronic illness. Review of literature from social sciences and applications to health issues. Understanding the social utility of stigmatization in preserving social cohesion and protecting the social order is an important function. However, this process can be harmful when applied to persons with chronic illness, such as HIV-AIDS, and psychiatric illness. These individuals often become shamed, ostracized, isolated, discredited, and socially and economically marginalized. Recent theoretical work on stigma has identified several issues and patient responses that may have implications in many other chronic conditions. Stigma is based on visible or nonvisible health conditions and can be both externally imposed or perceived in a process of self-stigma. Understanding stigma can aid clinicians in providing supportive help for patients with chronic illness. Stigma has been well researched in a few chronic illnesses; however, future studies in other conditions are much needed. Recognizing the underlying social factors has potential use in health-promoting behaviors. Sensitivity to stigma allows health professionals to critically reflect on ways the healthcare environment may add to stigma for their patients. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Perceived family support and depression among people living with HIV/AIDS in the Kathmandu Valley, Nepal.

PubMed

Shrestha, Sadhana; Poudel, Krishna C; Poudel-Tandukar, Kalpana; Kobayashi, Jun; Pandey, Basu Dev; Yasuoka, Junko; Otsuka, Keiko; Jimba, Masamine

2014-01-01

Depression is emerging as a highly prevalent psychiatric condition among people living with HIV/AIDS (PLWHA). Perceived family support (PFS) buffers depression among chronic disease patients. However, a similar relationship among PLWHA is unexplored. To examine the relationship between PFS and depression among PLWHA in the Kathmandu Valley, Nepal. In this cross-sectional study, depression was measured by Beck Depression Inventory Ia. Perceived family support was measured by Nepali Family Support and Difficulties Scale. The status of depression was compared between 208 PLWHA and 208 HIV-negative participants. The relationship between PFS and depression was examined only among PLWHA. Among each of the 208 participants, the number of depressed PLWHA (n = 61,29.3%) was higher than that of HIV-negative participants (n = 13,6.2%; P < .001). Perceived family support had a negative association with depression in PLWHA (adjusted odds ratio [AOR] = 0.20, 95% confidence interval [CI] = 0.08-0.53). In Nepal, PLWHA display a higher level of depression than HIV-negative people, and a lower level of PFS is associated with depression among PLWHA. Improved family support might be helpful in reducing depression among Nepalese PLWHA.

The association of nursing care perception with coping skills and posttraumatic growth in mental disorders.

PubMed

Şimşek Arslan, B; Buldukoglu, K

2018-05-01

WHAT IS KNOWN ON THE SUBJECT?: Although it is well known that coping with mental disorder is a traumatic experience, studies of the relationships between posttraumatic growth and the variables that can affect it are rarely found in the literature. The studies that do exist usually focus on posttraumatic growth after posttraumatic stress disorder has developed as a result of traumatic life events such as earthquakes, wars, accidents or physical disease. In the literature, there exist few studies of patients diagnosed with psychosis. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study shows that posttraumatic growth can be seen in patients after the diagnosis of mental disorders. Patients who use effective coping methods show more posttraumatic growth. In addition, patients who are satisfied with the nursing care received in the clinic show more posttraumatic growth. This indicates that care delivered by psychiatric nurses contributes to the posttraumatic growth of the patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric nurses who recognize that suffering a mental disorder is a traumatic experience and that patients can grow from this experience can contribute to the posttraumatic growth of those in their care. When they see signs of posttraumatic growth, nurses can teach patients how to cope with that stress effectively and how to share their feelings, thoughts and experiences related to the situation. In addition, psychosocial interventions such as trauma-focused cognitive behavioural therapy and eye movement desensitization can be used to aid posttraumatic growth. Introduction Although it is recognized that suffering a mental illness is a traumatic experience, the fact that this can lead to posttraumatic growth and the variables that may affect the situation are rarely discussed in the literature. Aim This study was conducted to determine the effects of coping styles and nursing care perceptions on posttraumatic growth in mental disorders. Method The descriptive study was conducted at a psychiatric clinic with a personal information form and three-scale test. Results In the study, completed with 122 psychiatric inpatients, it was found that patients were using effective methods to cope with stress, were satisfied with nursing care and had high posttraumatic growth. Moreover, it was found that effective coping styles and satisfaction with nursing care positively affected the posttraumatic growth level of patients. Discussion The results support the proposition that using effective coping styles and seeking professional support after traumatic life events influence posttraumatic growth levels. Implications for practice Psychiatric nurses should be aware of the fact that developing a mental disorder is a traumatic life event after which posttraumatic growth can occur. They should encourage posttraumatic growth by teaching effective coping methods, providing psychiatric care and using psychosocial interventions such as trauma-focused cognitive behavioural therapy and eye movement desensitization. © 2018 John Wiley & Sons Ltd.

PROBLEMS OF HOMOSEXUALITY

PubMed Central

Reider, Norman

1957-01-01

Moral, religious and legal attitudes in attempts to control sexual behavior have interfered with a clear view of the medical and psychological aspects of homosexuality. This phenomenon is probably much less destructive of social aspects of our society and culture than is generally believed, since it is actually more widespread than is generally acknowledged. Homosexuality probably has hormonal and undoubtedly social and psychological factors, the latter of which are the only ones which can be worked with successfully in our present state of knowledge. A general practitioner's task is to aid those who wish and need help with this problem in finding psychiatric treatment in the same way that persons with any other emotional disturbance are referred. This should be carried out without bias just as with any other emotional disturbance. PMID:13426813

Characterization of Medication Use in a Multicenter Sample of Pediatric Inpatients with Autism Spectrum Disorder.

PubMed

Wink, Logan K; Pedapati, Ernest V; Adams, Ryan; Erickson, Craig A; Pedersen, Kahsi A; Morrow, Eric M; Kaplan, Desmond; Siegel, Matthew

2017-05-17

Nearly 11% of youth with Autism Spectrum Disorder (ASD) undergo psychiatric hospitalization, and 65% are treated with psychotropic medication. Here we characterize psychotropic medication usage in subjects enrolled in the Autism Inpatient Collection. Participant psychotropic medication usage rates topped 90% at admission and discharge, though there was a decline at 2-month follow-up. Antipsychotics, ADHD medications, and sleep aids were the most commonly reported classes of medications. The impact of age, gender, and non-verbal IQ on medication usage rates was minimal, though age and IQ may play a role in prescribing practices. Future work is indicated to explore medication usage trends, the impact of clinical factors on medication use rates, and the safety of psychotropic medications in youth with ASD.

Practice parameter on disaster preparedness.

PubMed

Pfefferbaum, Betty; Shaw, Jon A

2013-11-01

This Practice Parameter identifies best approaches to the assessment and management of children and adolescents across all phases of a disaster. Delivered within a disaster system of care, many interventions are appropriate for implementation in the weeks and months after a disaster. These include psychological first aid, family outreach, psychoeducation, social support, screening, and anxiety reduction techniques. The clinician should assess and monitor risk and protective factors across all phases of a disaster. Schools are a natural site for conducting assessments and delivering services to children. Multimodal approaches using social support, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions. Copyright © 2013. Published by Elsevier Inc.

Posttraumatic idioms of distress among Darfur refugees: Hozun and Majnun.

PubMed

Rasmussen, Andrew; Katoni, Basila; Keller, Allen S; Wilkinson, John

2011-09-01

Although psychosocial programming is seen as essential to the humanitarian response to the Darfur conflict, aid groups lack culturally-appropriate assessment instruments for monitoring and evaluation. The current study used an emic-etic integrated approach to: (i) create a culturally-appropriate measure of distress (Study 1), and (ii) test the measure in structured interviews of 848 Darfuris living in two refugee camps in Chad (Study 2). Traditional healers identified two trauma-related idioms, hozun and majnun, which shared features with but were not identical to posttraumatic stress disorder and depression. Measures of these constructs were reliable and correlated with trauma, loss, and functional impairment. Exploratory factor analysis resulted in empirical symptom clusters conceptually parallel to general Western psychiatric constructs. Findings are discussed in terms of their implications for psychosocial programming.

Listen to them draw: screening children in primary care through the use of human figure drawings.

PubMed

Tielsch, Anna H; Allen, Patricia Jackson

2005-01-01

This literature review focuses on the Human Figure Drawing (HFD) methods put forth by Elizabeth Koppitz as a screening instrument. Children's drawings have potential as a mental health screening aide for health care practitioners in the primary care setting. This paper focuses on self-portrait drawings as a screening technique for emotional well-being, anxiety, and depression in school-aged children (6-12 years old). Using Koppitz's emotional indicators checklist for mental health, practitioners can use the child's HFD as a quick screening tool. Although the HFD is not diagnostic and can not be used as the sole indicator for anxiety or depression, two or more emotional indicators may signal to the clinician that further psychiatric assessment and referral is needed.

In defense of genuine ignorance: supporting vitality and relevance in graduate curricula.

PubMed

Goren, S; Peter, L; Fischer, S

1992-01-01

Genuine ignorance, defined by John Dewey as curiosity and openmindedness in opposition to repetition of catch phrases and familiar propositions, is nurtured in graduate nursing curricula in which the educational process is congruent with course content. Preparation for advanced practice in the mental health environment of the foreseeable future required abandonment of the familiar medical model in favor of conceptual models consistent with current thinking in psychiatric nursing and exposure to current problems (homelessness, family violence, AIDS) and current problem solving strategies (brief treatment, family preservation). Involvement in practice-based research and operationalizing new perspectives on familiar clinical problems, are suggested as strategies for developing the advanced practitioner. Two of the authors, former graduate students, describe the impact of changed perspectives and research activity on their own practice.

[Level of Development of Clinical Ethics Consultation in Psychiatry - Results of a Survey Among Psychiatric Acute Clinics and Forensic Psychiatric Hospitals].

PubMed

Gather, Jakov; Kaufmann, Sarah; Otte, Ina; Juckel, Georg; Schildmann, Jan; Vollmann, Jochen

2018-04-17

The aim of this article is to assess the level of development of clinical ethics consultation in psychiatric institutions in North Rhine-Westphalia. Survey among medical directors, directors of nursing and administrative directors of all psychiatric acute clinics and forensic psychiatric hospitals in North Rhine-Westphalia. 113 persons working in psychiatric acute clinics responded (reponse rate: 48 %) and 13 persons working in forensic psychiatric hospitals (response rate 54 %). We received at least one response from 89 % of all psychiatric acute clinics and from 100 % of all forensic psychiatric hospitals. 90 % of the responding psychiatric acute clinics and 29 % of the responding forensic psychiatric hospitals have already implemented clinical ethics consultation. Clinical ethics consultation is more widespread in psychiatric institutions than was hitherto assumed. Future medical ethics research should therefore give greater attention to the methodology and the quality of clinical ethics consultation in psychiatric practice. © Georg Thieme Verlag KG Stuttgart · New York.

Types of childhood trauma and spirituality in adult patients with depressive disorders.

PubMed

Song, Jun-Mi; Min, Jung-Ah; Huh, Hyu-Jung; Chae, Jeong-Ho

2016-08-01

The aim of this study was to investigate the differences in spirituality among adult patients with depressive disorders, who had suffered various types of abuse or neglect in childhood. A total of 305 outpatients diagnosed with depressive disorders completed questionnaires on socio-demographic variables, childhood trauma history, and spirituality. We used the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to measure five different types of childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12) to assess spirituality. Depressive symptoms and total CTQ-SF scores showed a negative correlation with spirituality. In the regression model, being older and belonging to a religion significantly predicted greater spirituality. Depressive symptoms significantly predicted lower spirituality. From among the five types of childhood trauma assessed by the CTQ-SF, only emotional neglect significantly predicted lower spirituality. A history of childhood emotional neglect was significantly related to lower spirituality, especially in the case of the Meaning aspect of spirituality. This finding suggests the potential harmful influence of childhood emotional neglect on the development of spirituality in psychiatric patients. Investigating different aspects of childhood trauma might be important in order to develop a more comprehensive psychiatric intervention that aids in the development of spirituality. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between short-term structured risk assessment outcomes and seclusion.

PubMed

van de Sande, Roland; Noorthoorn, Eric; Wierdsma, Andre; Hellendoorn, Edwin; van der Staak, Cees; Mulder, Cornelius L; Nijman, Henk

2013-12-01

Research findings indicate that the symptoms and behaviour of acute psychiatric patients can fluctuate drastically within hours, and that structured daily risk assessments can reduce the risk of aggressive incidents and the duration of seclusion. The aim of this study was to investigate the validity of two structured observation tools, the Brøset Violence Checklist (BVC) and the Kennedy Axis V), as an aid in seclusion-related clinical decision-making. In this study, 7403 day-to-day risk assessments were collected over 10 725 admission days (72% of the maximum number of structured assessments). A total of 7055 daily assessment scores from 301 acute psychiatric patients were used for the multilevel analysis. The sample demonstrated that dynamic and static factors were related to seclusion. Dynamic factors included dysfunctional scores on the item 'confusion' of the Brøset Violence Checklist, and psychological impairment and impairment of social skills on the Kennedy Axis V. Static factors included non-Western descent, male sex, age less than 35 years, unmarried, and to some extent, a personality disorder. McFadden's pseudo R(2) value showed that most of the final model was related to the dynamic factors. We concluded that the incorporation of the BVC and the Kennedy Axis V into standard practice was helpful in identifying patients at high risk of seclusion. © 2013 Australian College of Mental Health Nurses Inc.

Invasion. A hospital in transition following the 1983 Grenadian intervention.

PubMed

Walker, K; DeVooght, J

1989-01-01

Stress, confusion, and a sense of loss were inevitable during the hospital relocation, especially given the large number of clients, ward communities, and staff needed to move and adjust to change. Despite the fact that the change was perceived as a positive and progressive step in psychiatric-mental health care in Grenada, there were many obstacles and much resistance to overcome. As expected, staff's and clients' fears centered around themes of impending loss and abandonment. An understanding of the transition process, along with the availability of experienced hospital staff for support and guidance, greatly aided the relocation process. Relocation still presented problems and Mt. Gay Hospital continues to struggle to carry out the lasting and beneficial changes that will best promote a therapeutic and culturally sensitive client/staff environment. Despite the fact that the hospital relocation was not entirely self-determined, but partially imposed by political circumstances, a positive resolution of the crisis occurred. The crisis brought about the change that, in this circumstance, is seen as synonymous with growth. It acted as a catalyst to bring about help from unexpected and much needed sources (U.S.A.I.D./Project Hope), which may not have otherwise been available to facilitate such a change. Richmond Hill Mental Hospital took control and advantage of a crisis situation and made it serve its immediate and pressing need for a new psychiatric hospital.

[A documentation procedure for community social psychiatry services--a pilot project in Bielefeld and Minden].

PubMed

Hellmeier, W; Genin, G; Klewe-Niemann, S

1996-04-01

The status of health reporting (on community levels) has improved considerably during recent years. It is being increasingly used as an instrument for planning, controlling and evaluating political processes. In addition to individual studies the statistics within the departments of the health authorities are an important factor for meaningful health reporting on a local level. The IDIS (from Jan. 1st, 1995 LOGD) and the social psychiatric services on the Minden-Lübbecke district and the city of Bielefeld have developed a programme for automation-aided management of the statistics for social psychiatric services on a local level. Details on the personal situation and illnesses of the clients as well as on the activities of the services staff are recorded and analysed. Based on the WHO programme EPI-info 6.01 the documentation programme SPD-STAT was developed. This programme is menudriven and, in addition to the functions for the statistical data input and retrieval of fixed table sets, also offers the possibility of processing data with the full functionality of the ANALYSIS-module of EPI-Info. Thus interactive ad-hoc evaluations for current questions are made possible. Using SPD-STAT in as many local regions in NRW as possible may be a big step forward for health reporting on local levels as well as for health reporting on a state level.

[Evaluations for informed consent for various long-term psychiatric treatments].

PubMed

Catanesi, Roberto; Carabellese, Felice; Candelli, Chiara; La Tegola, Donatella; Taratufolo, Rosa

2010-01-01

The study was created with two distinct objectives: the first, an investigation into the quality of informed consent in patients assited by the mental health department for the Region of Puglia. The second, to look at the possibility of implementing a systematic use of tested monitoring of the daily practices of the psychiatric services. The use of the structured MacCAT-T (modified) interview was implemented. The interview was carried out on 708 patients across all areas of the mental health deparment for the Region of Puglia: 77 SPDC patients, 336 outpatients and 295 patients residing in rehabilitation centres. 31.2% of patients voluntarily hospitalised in SPDC did not know the motivations for their hospitalisation. 46.1% of patients in rehabilitation centres were also unaware of the reasons for their stay. Further problems arose in data regarding the prognosis of the disorders: 62.3% of SPDC patients, 65% of patients in rehabilitation centres and 39% of outpatients coud not describe the prognosis of their disorder. As a result of the study, the authors therefore propose: consensus monitoring through a standardised method providing targets for service improvement. The monitoring however, must be made integral in the daily activities of clinical observation. Applying the practice of consent evaluation would provide adequate support in requiring then suitable methods of legal protection, such as administrative support, which could then aid in creating correct legal continuity in treatment.

[AIDS, developing countries and ethnopsychiatry].

PubMed

Ehrhardt, N; Defourny, J; Bertrand, J

1995-04-01

This work briefly assesses the history of the AIDS epidemic in different geographic regions and examines factors that render developing countries particularly vulnerable. It reviews the three main techniques of traditional therapeutic systems and examines their implications for psychiatric treatment of AIDS patients from developing countries. Young age structures, low rates of condom usage, women's lack of education and of sexual bargaining power, and the deficiencies of health and educational facilities are among factors that increase risks of HIV in developing countries. Health education geared to specific audiences should encourage condom use and other preventive measures. Among factors to encourage condom use, group decision making appears to be of greatest potential influence on behavior in sub-Saharan Africa and among African immigrants to Europe. To encourage preventive measures and to understand reactions of non-Western populations to HIV, it is desirable to understand the deeper meanings of their cultures and of traditional therapies. It is difficult and misguided to pose a diagnosis according to the criteria of Western psychiatry. Western psychiatry has been proven incompetent in its attempts to treat members of traditional societies, whether immigrants or in their countries of origin. And attempts to integrate traditional healing into a western medical system have not been successful. Traditional systems accomplish therapeutic goals by three major techniques, possession, shamanism, and clairvoyance, or their numerous variants. It is recommended that group sessions be held with immigrants requiring treatment, in which the principal therapist is assisted by translators, who help create a space for the patient intermediate between the two cultures, where the therapies can coexist without conflict.

Suicidal Ideation, Attempt, and Determining Factors among HIV/AIDS Patients, Ethiopia.

PubMed

Bitew, Huluagresh; Andargie, Gashaw; Tadesse, Agitu; Belete, Amsalu; Fekadu, Wubalem; Mekonen, Tesfa

2016-01-01

Background . Suicide is a serious cause of mortality worldwide and is considered as a psychiatric emergency. Suicide is more frequent in peoples living with HIV/AIDS than in general population. Objective . To assess the proportion and determining factors of suicidal ideation and attempt among peoples living with HIV/AIDS in Ethiopia. Methods . Institutional based cross-sectional study was conducted from May to June 2015 by selecting 393 participants using systematic random sampling technique. Suicide manual of Composite International Diagnostic Interview (CIDI) was used to collect data. Logistic regression was carried out and odds ratio with 95% confidence intervals was computed. Results . The proportion of suicidal ideation and attempt was 33.6% and 20.1%, respectively. Female sex (AOR = 2.6, 95%CI: 1.27-5.22), marital status (AOR = 13.5, 95%CI: 4.69-39.13), depression (AOR = 17.0, 95%CI: 8.76-33.26), CD4 level (AOR = 2.57, 95%CI: 1.34-4.90), and presence of opportunistic infection (AOR = 5.23, 95%CI: 2.51-10.88) were associated with suicidal ideation, whereas marital status (AOR = 8.44, 95%CI: 3.117-22.84), perceived HIV stigma (AOR = 2.9, 95%CI: 1.45-5.99), opportunistic infection (AOR = 2.37, 95%CI: 1.18-4.76), and poor social support (AOR = 2.9, 95%CI: 1.58-5.41) were significantly associated with suicidal attempt. Conclusion . Suicidal ideation and attempt were high among HIV positive patients. Therefore early screening, treatment, and referral of suicidal patients are necessary in HIV clinics.

Annotation: Development of facial expression recognition from childhood to adolescence: behavioural and neurological perspectives.

PubMed

Herba, Catherine; Phillips, Mary

2004-10-01

Intact emotion processing is critical for normal emotional development. Recent advances in neuroimaging have facilitated the examination of brain development, and have allowed for the exploration of the relationships between the development of emotion processing abilities, and that of associated neural systems. A literature review was performed of published studies examining the development of emotion expression recognition in normal children and psychiatric populations, and of the development of neural systems important for emotion processing. Few studies have explored the development of emotion expression recognition throughout childhood and adolescence. Behavioural studies suggest continued development throughout childhood and adolescence (reflected by accuracy scores and speed of processing), which varies according to the category of emotion displayed. Factors such as sex, socio-economic status, and verbal ability may also affect this development. Functional neuroimaging studies in adults highlight the role of the amygdala in emotion processing. Results of the few neuroimaging studies in children have focused on the role of the amygdala in the recognition of fearful expressions. Although results are inconsistent, they provide evidence throughout childhood and adolescence for the continued development of and sex differences in amygdalar function in response to fearful expressions. Studies exploring emotion expression recognition in psychiatric populations of children and adolescents suggest deficits that are specific to the type of disorder and to the emotion displayed. Results from behavioural and neuroimaging studies indicate continued development of emotion expression recognition and neural regions important for this process throughout childhood and adolescence. Methodological inconsistencies and disparate findings make any conclusion difficult, however. Further studies are required examining the relationship between the development of emotion expression recognition and that of underlying neural systems, in particular subcortical and prefrontal cortical structures. These will inform understanding of the neural bases of normal and abnormal emotional development, and aid the development of earlier interventions for children and adolescents with psychiatric disorders.

Psychiatric effects of antiepileptic drugs in adults.

PubMed

Dussaule, Claire; Bouilleret, Viviane

2018-06-01

Epileptic and psychiatric diseases share overlaps. Indeed, anxiety and depression are common comorbidities in epilepsy, and patients with psychiatric disease are at risk of epilepsy. Some antiepileptic drugs (AED) have psychiatric side effects; conversely, some AED could be used to treat psychiatric pathologies. Based on current literature data, the aim of this study is to determine the psychiatric effects induced by the most frequently prescribed AED in epileptic adults. Some AED will have positive mood or anxiolytic effects like sodium channel blockers, valproate and benzodiazepines; conversely, others might induce negative psychiatric effect, especially depression, anxiety or aggression, like levetiracetam, perampanel, topiramate, zonisamide, and barbiturates. The main risk factor for presenting these side effects is a personal history of psychiatric pathology. We therefore recommend monitoring the occurrence of psychiatric side effects, especially when using the most at risk AED and/or in case of psychiatric history. Moreover, in this latter case, it is preferable to use AED with positive psychiatric effects. The use of anxiety and depression scales could be useful detection tools.

Pharmacological treatment of disruptive behavior in Smith-Magenis syndrome.

PubMed

Laje, Gonzalo; Bernert, Rebecca; Morse, Rebecca; Pao, Maryland; Smith, Ann C M

2010-11-15

Smith-Magenis syndrome (SMS) is a complex genetic syndrome caused by an interstitial deletion of chromosome 17p11.2. Children and adults with SMS appear to have unique neurobehavioral problems that include: sleep disturbance, self-injurious and maladaptive behaviors, stereotypies, and sensory integration disorders. We gathered retrospective psychotropic use information from parents or other caregivers of 62 individuals with SMS who were asked about use of psychotropic medication from a list of commonly used psychiatric medications. For those drugs identified, respondents were asked to rate the experience with the particular medication using a likert-type scale. Drugs were grouped into seven main categories: (1) stimulants; (2) antidepressants; (3) antipsychotics; (4) sleep aides; (5) mood stabilizers; (6) alpha 2 agonists; and (7) benzodiazepines. Relative frequencies, means and standard deviations pertaining to age and medication effect were derived for each medication category. Six of the seven medication categories examined showed no meaningful deviations from the "no change" score. The benzodiazepine group showed a mild detrimental effect. There were no gender differences in efficacy. Use of psychotropic medication started early in life (mean age 5 years), particularly with sleep aides. Although no medication category was identified as efficacious in SMS, all the categories reported herein may be considered as an option for brief symptomatic relief.

Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings.

PubMed

Pekurinen, Virve; Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta

2017-10-18

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression.

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

[Decentralization of psychiatric health service].

PubMed

Dabrowski, S

1996-01-01

The article discusses two stages of de-centralization of psychiatric hospitals: the first consists in further division into sub-districts, the second one includes successive establishment of psychiatric wards in general hospitals. With the growth of their number these wards are to take over more and more general psychiatric tasks from the specialized psychiatric hospitals. These wards will not substitute psychiatric hospitals completely. The hospitals, though decreasing in size and number, will be a necessary element of the de-centralized and versatile psychiatric care for a long time to come.

Analytical validation of a psychiatric pharmacogenomic test.

PubMed

Jablonski, Michael R; King, Nina; Wang, Yongbao; Winner, Joel G; Watterson, Lucas R; Gunselman, Sandra; Dechairo, Bryan M

2018-05-01

The aim of this study was to validate the analytical performance of a combinatorial pharmacogenomics test designed to aid in the appropriate medication selection for neuropsychiatric conditions. Genomic DNA was isolated from buccal swabs. Twelve genes (65 variants/alleles) associated with psychotropic medication metabolism, side effects, and mechanisms of actions were evaluated by bead array, MALDI-TOF mass spectrometry, and/or capillary electrophoresis methods (GeneSight Psychotropic, Assurex Health, Inc.). The combinatorial pharmacogenomics test has a dynamic range of 2.5-20 ng/μl of input genomic DNA, with comparable performance for all assays included in the test. Both the precision and accuracy of the test were >99.9%, with individual gene components between 99.4 and 100%. This study demonstrates that the combinatorial pharmacogenomics test is robust and reproducible, making it suitable for clinical use.

Sleep electroencephalography and heart rate variability interdependence amongst healthy subjects and insomnia/schizophrenia patients.

PubMed

Chaparro-Vargas, Ramiro; Schilling, Claudia; Schredl, Michael; Cvetkovic, Dean

2016-01-01

The quantification of interdependencies within autonomic nervous system has gained increasing importance to characterise healthy and psychiatric disordered subjects. The present work introduces a biosignal processing approach, suggesting a computational resource to estimate coherent or synchronised interactions as an eventual supportive aid in the diagnosis of primary insomnia and schizophrenia pathologies. By deploying linear, nonlinear and statistical methods upon 25 electroencephalographic and electrocardiographic overnight sleep recordings, the assessment of cross-correlation, wavelet coherence and [Formula: see text]:[Formula: see text] phase synchronisation is focused on tracking discerning features amongst the clinical cohorts. Our results indicate that certain neuronal oscillations interact with cardiac power bands in distinctive ways responding to standardised sleep stages and patient groups, which promotes the hypothesis of subtle functional dynamics between neuronal assembles and (para)sympathetic activity subject to pathophysiological conditions.

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. Copyright © 2014 Elsevier Inc. All rights reserved.

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…

The quality of life and psychiatric morbidity in patients operated for Arnold-Chiari malformation type I.

PubMed

Bakim, Bahadir; Goksan Yavuz, Burcu; Yilmaz, Adem; Karamustafalioglu, Oguz; Akbiyik, Meral; Yayla, Sinan; Yuce, Ismail; Alpak, Gokay; Tankaya, Onur

2013-10-01

There are some case reports that highlight the association of Arnold-Chiari malformation (ACM) with psychiatric symptoms. We assessed the association between ACM and psychiatric symptoms and risk factors in terms of psychiatric morbidity and evaluated the quality of life after surgery. This study consisted of sixteen patients who underwent decompression operation at the Department of Neurosurgery of Sisli Etfal Hospital. The MINI plus, Short-Form McGill Pain Questionnaire and WHOQOL-BREF-TR were administered to patients. About 43.8% of the patients had a psychiatric disorder. About 50% of the patients had co-existing syringomyelia of which 50% with syringomyelia had a psychiatric disorder. Patients with syringomyelia without any psychiatric disorder had significantly lower scores on physical domain of WHOQOL-BREF-TR (p = 0.02) than the patients without syringomyelia and psychiatric disorder. Subjects with a psychiatric disorder had lower scores on four domains of WHOQOL-BREF-TR. The patients with psychiatric diagnoses had significantly higher scores on affective pain index (p = 0.021) and total pain index (p = 0.037) than the patients without any psychiatric disorder. The presence of a psychiatric condition influences not only the physical aspect but also deteriorates the psychological and social relations and environmental aspect. Moreover the presence of a psychiatric disorder increases the perception of pain and causes more discomfort.

[Gdansk HIV-AIDS project, yesterday, today and future].

PubMed

Zielińska, W

1995-09-01

Medical care project for HIV positive and AIDS patients in Gdańsk voivodship was established in 1988 in the Clinic for Infectious Diseases of Gdańsk Medical University. The aim of this modern and multidirectional program was to provide full medical care for HIV/AIDS patients and introduce effective prophylaxis against spread of HIV infection. According to the project-clinical ward, outpatient clinic for HIV positive and AIDS patients, diagnostic and laboratory units, were established. Close cooperation including specialistic and general medical care, was set with detoxication ward, rehabilitation centers for drug addicts, prison medical services and the Korczak Orphanage. Education of medical staff and some social groups was provided (teachers, teenagers of secondary schools, journalists, police employees). Clinical ward for HIV positive patients who are in need of inpatient medical care is localized in the Clinic for Infectious Diseases of Gdańsk Medical University. The ward has 16 double - bed Melcer's boxes which are used for other HIV/AIDS patients according to present needs. Free beds are used for HIV negative patients. HIV/AIDS Outpatient Clinic is localized in Venerologic Outpatient Unit. This was because of some psychological, social, professional and organization aspects. Outpatient Clinic staff is responsible for first patients' examination. Serological diagnostics of HIV infection is follow up for everyone (anonymous testing is possible); testing for STD is available also. Diagnostic laboratory base for clinical ward and other units are the laboratories of Gdańsk Voivodship Hospital for Infectious Diseases. Clinic for Infectious Diseases supervises all co-operating units. These are the following: 10-beds detoxication ward for drug addicts in Psychiatric - Neurological Hospital "Srebrzysko", 70-80 places in rehabilitation centers for drug addicts in Zapowiednik and Smazyno, remand prison ward for HIV positive patients (this is the first ward established in Poland, thanks to our initiative, in 1990). One of very important units of our Center is the Korczak Orphanage for children aged 0-7 years, which is subjected to Voivodship Health Department. This orphanage is the place for children with positive HIV serology from the whole Poland. Children who need inpatient medical care, among them AIDS children, are admitted to the Clinic for Infectious Diseases and can be diagnosed and consulted in all units of Gdańsk Medical University. In 1992 the co-operation with Gdańsk homosexual society represented by the Gdańsk Initiative (a submit of Lambda organization), was established. Education program is the next very important part of the Clinical and Diagnostic HIV/AIDS Center work. Until now medical staff and Education Department staff were mainly concerned. It is planned to establish Voivodship Social Needs Outpatient Clinic which would continue all hitherto activities, which would be extended by social law counseling. Such outpatient clinic would facilitate education activity. It would be the base for medical research on social pathology and HIV/AIDS related problems.

Psychiatric units in Brazilian general hospitals: a growing philanthropic field.

PubMed

Botega, Neury José

2002-06-01

Some countries, mainly in North America and Europe, have adopted psychiatric wards in the general hospital as an alternative to the classic psychiatric hospital. In Brazil there are 6,169 general hospitals, 1.3% of which with a psychiatric unit. This service strategy is scarcely developed in the country and comprises only 4% of all psychiatric admissions. There was no information on the facilities and functioning of the psychiatric units in general hospitals. To determine the main characteristics of psychiatric units in Brazilian general hospitals and to assess the current trends in the services provided. A mailing survey assessed all 94 Brazilian general hospitals which made psychiatric admissions. A two-page questionnaire was designed to determine the main characteristics of each institution and of the psychiatric unit. Seventy-nine (84%) questionnaires were returned. In contrast to the 1970s and 1980s, in the last decade the installation of psychiatric units has spread to smaller philanthropic institutions that are not linked to medical schools. A fifth of hospitals admit psychiatric patients to medical wards because there is no specialist psychiatric ward. They try to meet all the local emergency demands, usually alcohol-dependent patients who need short term admission. This could signal the beginning of a program through which mental health professionals may become an integral part of general health services. The inauguration of psychiatric wards in philanthropic hospitals, as well as the admission of psychiatric patients in their medical wards, is a phenomenon peculiar to this decade. The installation of psychiatric services in these and other general hospitals would overcome two of major difficulties encountered: prejudice and a lack of financial resources.

Psyche at the end of life: Psychiatric symptoms are prevalent in patients admitted to a palliative care unit.

PubMed

Masel, Eva K; Berghoff, Anna S; Mladen, Aleksandra; Schur, Sophie; Maehr, Bruno; Kirchhoff, Magdalena; Simanek, Ralph; Bauer, Martin; Watzke, Herbert H; Amering, Michaela

2016-06-01

Our aim was to evaluate the frequency and treatment of psychiatric symptoms in patients at palliative care units (PCUs). Patients admitted to one of five participating PCUs in Austria were included. The short version of the Patient Health Questionnaire (PHQ-D) was used to evaluate their mental health status. Pain intensity was rated on a numeric rating scale (NRS) from 0 to 10 by patients and physicians. Patients with a previously diagnosed psychiatric disorder were compared to those without or with newly diagnosed psychiatric symptoms, based on PHQ-D results. Pain and psychopharmacological medication were assessed. Opioid doses were converted into oral morphine equivalents (OMEs). Some 68 patients were included. Previously undetected psychiatric symptoms were identified in 38% (26 of 68), preexisting psychiatric comorbidities were evident in 25% (17), and no psychiatric symptoms were observed in 37% (25). Patients with a preexisting psychiatric comorbidity received antidepressants and benzodiazepines significantly more often than patients without or with previously undetected psychiatric symptoms (p < 0.001). Patient and physician median NRS ratings of pain intensity correlated significantly (p = 0.001). Median NRS rating showed no significant difference between patients with preexisting, previously undetected, or without psychiatric symptoms. OMEs did not differ significantly between preexisting, without, or previously undetected psychiatric symptoms. Patients with undetected and preexisting psychiatric comorbidities had a greater impairment in their activities of daily living than patients without psychiatric symptoms (p = 0.003). Undetected psychiatric comorbidities are common in patients receiving palliative care. Screening for psychiatric symptoms should be integrated into standard palliative care to optimize treatment and reduce the psychosocial burden of the disease.

Separate may not be equal: A preliminary investigation of clinical correlates of electronic psychiatric record accessibility in academic medical centers

PubMed Central

Kozubal, Dana E.; Samus, Quincy M.; Bakare, Aishat A.; Trecker, Carrilin C.; Wong, Hei-Wah; Guo, Huiying; Cheng, Jeffrey; Allen, Paul X.; Mayer, Lawrence S.; Jamison, Kay R.; Kaplin, Adam I.

2014-01-01

Objectives Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. Methods Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible to non-psychiatric physicians. Electronic hospital records and accessibility statuses were correlated with patient care outcomes obtained from the University Health System Consortium Clinical Database available for 13 of the 18 top US hospitals. Results 44% of hospitals surveyed maintained most or all of their psychiatric records electronically and 28% made psychiatric records accessible to non-psychiatric physicians; only 22% did both. Compared with hospitals where psychiatric records were not stored electronically, the average 7-day readmission rate of psychiatric patients was significantly lower at hospitals with psychiatric EMR (5.1% vs. 7.0%, p = .040). Similarly, the 14 and 30-day readmission rates at hospitals where psychiatric records were accessible to non-psychiatric physicians were lower than those of their counterparts with non-accessible records (5.8% vs. 9.5%, p = .019, 8.6% vs. 13.6%, p = .013, respectively). The 7, 14, and 30-day readmission rates were significantly lower in hospitals where psychiatric records were both stored electronically and made accessible than at hospitals where records were either not electronic or not accessible (4% vs 6.6%, 5.8% vs 9.1%, 8.9 vs 13%, respectively, all with p = 0.045). Conclusions Having psychiatric EMR that were accessible to non-psychiatric physicians correlated with improved clinical care as measured by lower readmission rates specific for psychiatric patients. PMID:23266060

Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings

PubMed Central

Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta

2017-01-01

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression. PMID:29057802

Comorbid psychiatric disorders in female adolescents with first-onset anorexia nervosa.

PubMed

Bühren, K; Schwarte, R; Fluck, F; Timmesfeld, N; Krei, M; Egberts, K; Pfeiffer, E; Fleischhaker, C; Wewetzer, C; Herpertz-Dahlmann, B

2014-01-01

Patients with anorexia nervosa (AN) exhibit high rates of psychiatric comorbidity. To disentangle the effects of duration of illness on comorbid psychiatric symptoms, we investigated the rates of comorbid psychiatric disorders, suicidality and self-harm behaviour in adolescent patients with a first onset of AN. In adolescent females (n = 148) with a first onset of AN, body mass index, psychiatric comorbidity (according to DSM-IV), depressive symptoms, suicidality and self-injurious behaviour were assessed. Seventy patients (47.3%) met the criteria for at least one comorbid psychiatric disorder. The binge-purging subtype was associated with increased rates of psychiatric comorbidity, suicidality and self-injurious behaviour. The severity of eating disorder-specific psychopathology influenced current psychiatric comorbidity and suicidal ideation. Prevalence rates of comorbid psychiatric disorders and suicidal ideation are considerably lower among adolescents with AN compared with adults. An early and careful assessment, along with adequate treatment of the eating disorder, might prevent the development of severe psychiatric comorbidities. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

Psychiatric research: what ethical concerns do LRECs encounter? A postal survey. Local research ethics committees.

PubMed

Osborn, D P J; Fulford, K W M

2003-02-01

Psychiatric research can occasionally present particular ethical dilemmas, but it is not clear what kind of problems local research ethics committees (LRECs) actually experience in this field. We aimed to assess the type of problems that committees encounter with psychiatric research, using a postal survey of 211 LRECs. One hundred and seven (51%) of those written to replied within the time limit. Twenty eight (26%) experienced few problems with psychiatric applications. Twenty six (24%) emphasised the value of a psychiatric expert on the committee. The most common issues raised were informed consent (n=64, 60%) and confidentiality (n=17, 16%). The use of placebos (and washout periods) (n=18, 17%), the validity of psychiatric questionnaires (n=16, 15%) and overuse of psychiatric "jargon" (n=14, 13%) in psychiatric applications also raised concern. Our results suggest that LRECs have specific concerns regarding methodology, consent, and confidentiality in psychiatric research, and that they find psychiatric input invaluable.

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 must...

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…

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 must...

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 must...

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 must...

42 CFR 440.160 - Inpatient psychiatric services for individuals under age 21.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient psychiatric services for individuals... Definitions § 440.160 Inpatient psychiatric services for individuals under age 21. “Inpatient psychiatric... physician; (b) Are provided by— (1) A psychiatric hospital that undergoes a State survey to determine...

42 CFR 456.482 - Medical, psychiatric, and social evaluations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 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 must...

Computers and information technologies in psychiatric nursing.

PubMed

Repique, Renee John R

2007-04-01

There is an assumption that psychiatric nurses are late adopters of technology because psychiatric nursing has been traditionally viewed as a nontechnological nursing specialty. This article will review current nursing literature to outline the value and significance of computers and information technologies to psychiatric nursing. Existing bodies of research literature related to computers and information technology for psychiatric nurses. Three areas of psychiatric nursing are identified and the specific advantages and benefits of computers and information technologies in each of these areas are discussed. In addition, the importance of informatics competencies for psychiatric nursing practice is reiterated in order to accelerate its acquisition.

Understanding psychiatric nursing care with nonsuicidal self-harming patients in acute psychiatric admission units: the views of psychiatric nurses.

PubMed

O'Donovan, Aine; Gijbels, Harry

2006-08-01

Self-harm in the absence of suicidal intent is an underexplored area in psychiatric nursing research. This article reports on findings of a study undertaken in two acute psychiatric admission units in Ireland. The purpose of this study was to gain an understanding of the practices of psychiatric nurses in relation to people who self-harm but who are not considered suicidal. Semistructured interviews were held with eight psychiatric nurses. Content analysis revealed several themes, some of which will be presented and discussed in this article, namely, the participants' understanding of self-harm, their approach to care, and factors in the acute psychiatric admission setting, which impacted on their care. Recommendations for further research are offered.

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.

Psychosomatic Medicine for Non-Psychiatric Residents: Video Education and Incorporation of Technology.

PubMed

Saunders, J; Gopalan, P; Puri, N; Azzam, P N; Zhou, L; Ghinassi, F; Jain, A; Travis, M; Ryan, N D

2015-12-01

Psychiatric education for non-psychiatric residents varies between training programs, and may affect resident comfort with psychiatric topics. This study's goals were to identify non-psychiatric residents' comfort with psychiatric topics and to test the effectiveness of a video intervention. Residents in various departments were given a survey. They were asked to rank their comfort level with multiple psychiatric topics, answer questions about medical decision making capacity (MDMC), watch a 15-min video about MDMC, and answer a post-test section. In total, 91 Internal Medicine, General Surgery, and Obstetrics and Gynecology residents responded to the study. Of the 91 residents, 55 completed the pre- and post-test assessments. There was no significant difference in correct responses. Residents' comfort levels were assessed, and a significant improvement in comfort level with MDMC was found. This study highlights potential opportunities for psychiatric education, and suggests brief video interventions can increase resident physicians' comfort with a psychiatric topic.

Hospital financial performance under the prospective payment system by type of admission: psychiatric versus medical/surgical.

PubMed Central

Freiman, M P

1990-01-01

We performed detailed simulations of DRG-based payments to general hospitals for treatment of nonexempt psychiatric and medical/surgical patients under Medicare's prospective payment system (PPS). We then compared these results to calculated costs for the same patients. Hospitals without specialized psychiatric units tend to fare better financially on their psychiatric than on their medical/surgical caseloads, although the levels of gain for these two types of patients are correlated. Hospitals with nonexempt psychiatric units generally have similar rates of gain on psychiatric and medical/surgical patients. Comparing psychiatric treatment in "scatter-bed" sites with that provided in nonexempt units, the higher rate of gain under PPS for treatment in scatter beds results largely from shorter lengths of stay. We discuss hospital behavior and the relationships between treatment of psychiatric illness under DRG-based payment and its treatment in exempt psychiatric units, which are excluded from DRG-based payment. PMID:2123839

Longitudinal relationships among activity in attention redirection neural circuitry and symptom severity in youth.

PubMed

Bertocci, Michele A; Bebko, Genna; Dwojak, Amanda; Iyengar, Satish; Ladouceur, Cecile D; Fournier, Jay C; Versace, Amelia; Perlman, Susan B; Almeida, Jorge R C; Travis, Michael J; Gill, Mary Kay; Bonar, Lisa; Schirda, Claudiu; Diwadkar, Vaibhav A; Sunshine, Jeffrey L; Holland, Scott K; Kowatch, Robert A; Birmaher, Boris; Axelson, David; Horwitz, Sarah M; Frazier, Thomas; Arnold, L Eugene; Fristad, Mary A; Youngstrom, Eric A; Findling, Robert L; Phillips, Mary L

2017-05-01

Changes in neural circuitry function may be associated with longitudinal changes in psychiatric symptom severity. Identification of these relationships may aid in elucidating the neural basis of psychiatric symptom evolution over time. We aimed to distinguish these relationships using data from the Longitudinal Assessment of Manic Symptoms (LAMS) cohort. Forty-one youth completed two study visits (mean=21.3 months). Elastic-net regression (Multiple response Gaussian family) identified emotional regulation neural circuitry that changed in association with changes in depression, mania, anxiety, affect lability, and positive mood and energy dysregulation, accounting for clinical and demographic variables. Non-zero coefficients between change in the above symptom measures and change in activity over the inter-scan interval were identified in right amygdala and left ventrolateral prefrontal cortex. Differing patterns of neural activity change were associated with changes in each of the above symptoms over time. Specifically, from Scan1 to Scan2, worsening affective lability and depression severity were associated with increased right amygdala and left ventrolateral prefrontal cortical activity. Worsening anxiety and positive mood and energy dysregulation were associated with decreased right amygdala and increased left ventrolateral prefrontal cortical activity. Worsening mania was associated with increased right amygdala and decreased left ventrolateral prefrontal cortical activity. These changes in neural activity between scans accounted for 13.6% of the variance; that is 25% of the total explained variance (39.6%) in these measures. Distinct neural mechanisms underlie changes in different mood and anxiety symptoms overtime.

Reproductive Psychiatry Residency Training: A Survey of Psychiatric Residency Program Directors.

PubMed

Osborne, Lauren M; MacLean, Joanna V; Barzilay, Erin Murphy; Meltzer-Brody, Samantha; Miller, Laura; Yang, Sarah Nagle

2018-04-01

The reproductive life cycle has unique influences on the phenotypic expression of mental illness in women. Didactic and clinical training focused on these sex-specific influences should be a vital component of the education of future psychiatrists. The authors sought to determine the current state of and attitudes toward reproductive psychiatry in resident education. The authors administered a web-based survey to psychiatry residency training directors. They assessed the availability of both mandated and optional didactic and clinical training experiences in reproductive psychiatry. Fifty residency program directors answered the survey, for a response rate of 28%. More than half of residency program directors (59%) reported requiring some training in reproductive psychiatry. Both the breadth and depth of topics covered varied greatly among programs. Lack of time (48%) and lack of qualified faculty (26%) were the most frequently cited barriers to more training. Only 40% of residency directors surveyed agreed that all residents should be competent in reproductive psychiatry. These findings suggest that specific training in reproductive psychiatry is inconsistent in US residency programs, and that training that does exist varies considerably in clinical time and content. Given that women comprise more than 50% of all psychiatric patients and most women will menstruate, give birth, and undergo menopause, future psychiatrists would benefit from more systematic instruction in this area. The authors propose the development of a national, standardized reproductive psychiatry curriculum to address this gap and aid in producing psychiatrists competent to treat women at all stages of life.

SeCD electronic folder: CADMIO's application for the medical folder of a service for the care of drug addicts.

PubMed

Della Valle, R M; Baldoni, A; De Rossi, M; Ferri, F

1998-01-01

In this paper we will describe the SeCD (Service for the Care of Drug addicts) electronic folder, a specific application of CADMIO [1] (Computer Aided Design for Medical Information Objects) system. CADMIO is a system for the definition, construction and management of multimedia clinical folders. The Ser.T. (Servizio per la Tossicodipendenza/Service for Drug Addicts) has earned a very special place within the Italian clinical structures as well as any service for drug addicts has done in the rest of the world. Such a structure has special needs and the characteristics of its medical folders are very different from any other folder. Actually, a Ser.T. has to keep updated the patient situation either from the clinical point of view as well as the psychiatric one. Moreover, it must keep track of the clinician subjective considerations about the patient psychic state and his situation in regard of the law. So, we had to redesign some of the features of the existing CADMIO application, to accommodate such highly not structured data into objects easily manipulated by an informative system. The objectives we hope to achieve were mainly two: To show that a well designed adaptive system can be easily exploited to support even very complex and poorly structured data types and actions To design data structures able to accommodate medical, psychiatric and administrative data in an homogeneous manner.

Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts.

PubMed

Teusch, L; Scherbaum, N; Böhme, H; Bender, S; Eschmann-Mehl, G; Gastpar, M

1995-05-01

Little is known about sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. In the present study schizophrenic patients (n = 45, mostly under neuroleptic treatment), neurotic patients (n = 50, mostly treated without medication), methadone-substituted opiate addicts (n = 37), and normal controls (n = 41) were included. They were interviewed with the aid of a sex-differentiated semistructured questionnaire on sexual function. All the methadone-substituted opiate addicts and nearly all the schizophrenic patients suffered from dysfunctions in at least one criterion. The three clinical groups differed significantly from the controls in sexual interest, emotional arousal, physiological arousal (erectile function/vaginal lubrication), performance (ejaculatory function/vaginism, dyspareunia), and orgasm satisfaction. Characteristic patterns of dysfunction were found in the male patients. The schizophrenic patients had significantly more dysfunctions of interest, physiological arousal, performance, and orgasm than the controls. Emotional arousal, erectile and ejaculatory functions, and orgasm satisfaction were impaired more frequently in the male schizophrenics than in the neurotic patients. Reduced sexual interest, emotional arousal, and orgasm satisfaction were reported more frequently by the methadone-substituted opiate addicts than by the neurotic men. Emotional arousal was even more frequently reduced than in the schizophrenic men. There was no correlation between sexual dysfunction and particular neuroleptics or neuroleptic or methadone dosage. The results are compared with the literature and suggestions made for further investigations.

ASD, a Psychiatric Disorder, or Both? Psychiatric Diagnoses in Adolescents with High-Functioning ASD

ERIC Educational Resources Information Center

Mazefsky, Carla A.; Oswald, Donald P.; Day, Taylor N.; Eack, Shaun M.; Minshew, Nancy J.; Lainhart, Janet E.

2012-01-01

Varied presentations of emotion dysregulation in autism complicate diagnostic decision making and may lead to inaccurate psychiatric diagnoses or delayed autism diagnosis for high-functioning children. This pilot study aimed to determine the concordance between prior psychiatric diagnoses and the results of an autism-specific psychiatric interview…

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…

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…

Joint crisis plans and psychiatric advance directives in German psychiatric practice.

PubMed

Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

2014-05-01

This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

Psychiatric comorbidity in injecting drug users in Asia and Africa.

PubMed

Iskandar, Shelly; Kamal, Rama; De Jong, Cor A

2012-05-01

The prevalence of psychiatric co-morbidity in injecting drug users (IDUs) in the Western countries is high and is associated with lower quality of life and reduces the effectiveness of treatment programs. The aim of this study is to provide a review about psychiatric comorbidity in IDUs in Asia and Africa, where HIV prevalence is high and still increasing. Studies focusing on psychiatric comorbidity in Asia and Africa are scarce. The prevalence of psychiatric comorbidity is comparable with the prevalence in western countries. Psychiatric disorders can occur before or during drug abuse and are also associated with substance abuse and physical comorbidity and its treatments. Childhood trauma followed by post-traumatic disorders is a significant risk factor for substance abuse. Psychiatric co-occurring disorders influence the adherence to the physical and drug use treatment. Evidence-based treatment for psychiatric comorbidity in IDUs is still limited. A better understanding of the prevalence of psychiatric disorders in IDUs and its impact on the overall treatments is growing. However, more studies focusing on the treatment for psychiatric comorbidity in IDUs in Asia and Africa are needed.

Psychiatric Illness in Takotsubo (Stress) Cardiomyopathy: A Review.

PubMed

Nayeri, Arash; Rafla-Yuan, Eric; Krishnan, Srikanth; Ziaeian, Boback; Cadeiras, Martin; McPherson, John A; Wells, Quinn S

Takotsubo cardiomyopathy (TC), also known as stress-induced cardiomyopathy, has been increasingly described in relation to psychiatric illness. We performed a literature review to identify the key findings related to psychiatric illness in TC that may be relevant to the practice of mental health and other health care providers. The association of psychiatric illness with TC in addition to the spectrum of psychiatric illness found in TC, the role of exacerbation or treatment of psychiatric illness in triggering TC, different modes of presentation, prognostic implications, and long-term management of psychiatric illness in TC are discussed. Additionally, we review the limitations of the pre-existing literature and suggest areas of future research. There is a strong association between pre-existing psychiatric illness, particularly anxiety and mood spectrum disorders, and TC. Acute exacerbation of psychiatric illness, rapid uptitration or overdose of certain psychotropic agents, and electroconvulsive therapy may trigger TC. Further studies are needed to better evaluate the prognostic significance and long-term management of psychiatric illness in TC. Copyright © 2018 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.

Chronic psychiatric patients without psychiatric care: a pilot study.

PubMed

Längle, G; Welte, W; Rösger, U; Günthner, A; U'Ren, R

2000-10-01

The study is based on the hypothesis that in any catchment area there are patients with chronic mental illness who are unknown to a comprehensive psychiatric/psychosocial care system. A standardized questionnaire was sent to all general practitioners in a circumscribed catchment area in southwestern Germany in an attempt to identify such a group, to ascertain what the practitioners considered to be the needs of these patients, and to find out why the patients were not receiving specialized psychiatric care. Of 97 general practitioners contacted, 62 returned the questionnaire. Within a study period of 3 months, 89 patients were identified as having a significant psychiatric disorder, of whom 53% were older than 60 years and 15% were schizophrenic. General practitioners most frequently said that provision of specialized psychiatric care was the most pressing need of these patients, followed by a need for psychosocial services. They also said that the major reason patients did not participate in the mental health system was patient refusal of such services. Having identified the existence of a group of chronic psychiatric patients who are not receiving specialized psychiatric care, further in-depth field studies to pursue some of the issues raised in this pilot study will be necessary to determine whether further efforts to reach psychiatric patients without defined psychiatric care would be worthwhile. These issues include estimates of the prevalence of such patients in a defined population, patients' more specific reasons for refusal of psychiatric care, and the quality of psychiatric care they receive from general practitioners in comparison with patients who receive more conventional psychiatric care.

Skin diseases in patients with primary psychiatric conditions: a hospital based study.

PubMed

Moftah, Nayera H; Kamel, Abeer M; Attia, Hussein M; El-Baz, Mona Z; Abd El-Moty, Hala M

2013-09-01

Although the relationship between skin diseases in patients with primary psychiatric conditions is important for patient management, studies on this issue are limited. To detect the frequency and type of cutaneous disorders among patients with primary psychiatric conditions. This analytic cross-sectional study was conducted on a total of 400 subjects - 200 patients with primary psychiatric disorders and 200 age and sex matched individuals free from primary psychiatric disorders. Patients included in the study were diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders (DMS IV) Criteria. A specially designed questionnaire including socio-demographic data, medical history, family history and dermatological examination was applied. The data were statistically analyzed. There was a significant statistical increase in the prevalence of skin diseases in general and infectious skin diseases in particular in psychiatric patients compared with non-psychiatric patients (71.5% versus 22%, P<0.001) and (48% versus 11%, P<0.001), respectively. Parasitic infestations (42.7%) were the most common infectious skin diseases in psychiatric patients (P<0.001). Infectious skin diseases in psychiatric patients were seen most in patients diagnosed with schizophrenia (83.6%) and least in obsessive compulsive disorders (30%)(P<0.001). Psychogenic skin disorders were found in 8.4% of psychiatric patients with skin diseases; delusional parasitosis was the most common (50%). Health education of psychiatric patients and/or of their caregiver and periodic monthly inspection of psychiatric patients are highly indicated for the prevention and control of infectious skin diseases in primary psychiatric patients. Copyright © 2013 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

The guideline "consultation psychiatry" of the Netherlands Psychiatric Association.

PubMed

Leentjens, Albert F G; Boenink, Annette D; Sno, Herman N; Strack van Schijndel, Rob J M; van Croonenborg, Joyce J; van Everdingen, Jannes J E; van der Feltz-Cornelis, Christina M; van der Laan, Niels C; van Marwijk, Harm; van Os, Titus W D P

2009-06-01

In 2008, the Netherlands Psychiatric Association authorized a guideline "consultation psychiatry." To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and, if so, which forms are most effective? How should a psychiatric consultations be performed? What increases adherence to recommendations given by the consulting psychiatrist? Systematic literature review. Both in general practice and in hospital settings psychiatric consultation is effective. In primary care, the effectiveness of psychiatric consultation is almost exclusively studied in the setting of "collaborative care." Procedural guidance is given on how to perform a psychiatric consultation. In this guidance, psychiatric consultation is explicitly looked upon as a complex activity that requires a broad frame of reference and adequate medical and pharmacological expertise and experience and one that should be performed by doctors. Investing in a good relation with the general practitioner, and the use of a "consultation letter" increased efficacy in general practice. In the hospital setting, investing in liaison activities and an active psychiatric follow-up of consultations increased adherence to advice. Psychiatric consultations are effective and constitute a useful contribution to the patients' treatment. With setting a standard consultations will become more transparent and checkable. It is hoped that this will increase the quality of consultation psychiatry.

Migraine and its psychiatric comorbidities.

PubMed

Minen, Mia Tova; Begasse De Dhaem, Olivia; Kroon Van Diest, Ashley; Powers, Scott; Schwedt, Todd J; Lipton, Richard; Silbersweig, David

2016-07-01

Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. In this manuscript, we provide an overview of the link between migraine and several comorbid psychiatric disorders, including depression, anxiety and post-traumatic stress disorder. We present data on psychiatric risk factors for migraine chronification. We discuss the evidence, theories and methods, such as brain functional imaging, to explain the pathophysiological links between migraine and psychiatric disorders. Finally, we provide an overview of the treatment considerations for treating migraine with psychiatric comorbidities. In conclusion, a review of the literature demonstrates the wide variety of psychiatric comorbidities with migraine. However, more research is needed to elucidate the neurocircuitry underlying the association between migraine and the comorbid psychiatric conditions and to determine the most effective treatment for migraine with psychiatric comorbidity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

(W)righting women: constructions of gender, sexuality and race in the psychiatric chart.

PubMed

Daley, Andrea; Costa, Lucy; Ross, Lori

2012-01-01

This paper examines the interpretative nature of psychiatry in relation to gender, sexuality and race within the particular time and place of one urban, Canadian, clinical psychiatric setting. We bring women's psychiatric inpatient charts and a critical feminist perspective into dialogue in an effort to focus on gender, sexuality and race in psychiatric narratives on women's madness. The research used a qualitative, retrospective research design to examine the psychiatric narrative as a technique of power as it operates on women. This paper focuses on the overarching theme of 'medicalisation', identified from the analysis of women's psychiatric inpatient charts, including two subthemes: (1) language and composition and (2) decontextualisation. Our analysis suggests that psychiatric chart documentation practices that reproduce gendered, sexualised, and racialised biases and assumptions and decontextualise the social and structural context of women's experiences of madness serve to create the paradox of women's visibility/erasure in psychiatric charts. The paper concludes with an exploration of the significance of women's authorship legitimacy in psychiatric chart documentation.

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

PSYCHIATRIC DISORDERS AND SLEEP

PubMed Central

Krystal, Andrew D.

2012-01-01

SYNOPSIS Psychiatric disorders and sleep are related in important ways. In contrast to the longstanding view of this relationship which viewed sleep problems as symptoms of psychiatric disorders, there is growing experimental evidence that the relationship between psychiatric disorders and sleep is complex and includes bi-directional causation. In this article we provide the evidence that supports this point of view, reviewing the data on the sleep disturbances seen in patients with psychiatric disorders but also reviewing the data on the impact of sleep disturbances on psychiatric conditions. Although much has been learned about the psychiatric disorders-sleep relationship, additional research is needed to better understand these relationships. This work promises to improve our ability to understand both of these phenomena and to allow us to better treat the many patients with sleep disorders and with psychiatric disorders. PMID:23099143

Training to Provide Psychiatric Genetic Counseling: How Does It Impact Recent Graduates' and Current Students' Readiness to Provide Genetic Counseling for Individuals with Psychiatric Illness and Attitudes towards this Population?

PubMed

Low, Ashley; Dixon, Shannan; Higgs, Amanda; Joines, Jessica; Hippman, Catriona

2018-02-01

Mental illness is extremely common and genetic counselors frequently see patients with mental illness. Genetic counselors report discomfort in providing psychiatric genetic counseling (GC), suggesting the need to look critically at training for psychiatric GC. This study aimed to investigate psychiatric GC training and its impact on perceived preparedness to provide psychiatric GC (preparedness). Current students and recent graduates were invited to complete an anonymous survey evaluating psychiatric GC training and outcomes. Bivariate correlations (p<.10) identified variables for inclusion in a logistic regression model to predict preparedness. Data were checked for assumptions underlying logistic regression. The logistic regression model for the 286 respondents [χ 2 (8)=84.87, p<.001] explained between 37.1% (Cox & Snell R 2 =.371) and 49.7% (Nagelkerke R 2 =.497) of the variance in preparedness scores. More frequent psychiatric GC instruction (OR=5.13), more active methods for practicing risk assessment (OR=4.43), and education on providing resources for mental illness (OR=4.99) made uniquely significant contributions to the model (p<.001). Responses to open-ended questions revealed interest in further psychiatric GC training, particularly enabling "hands on" experience. This exploratory study suggests that enriching GC training through more frequent psychiatric GC instruction and more active opportunities to practice psychiatric GC skills will support students in feeling more prepared to provide psychiatric GC after graduation.

Incremental predictive validity of the Addiction Severity Index psychiatric composite score in a consecutive cohort of patients in residential treatment for drug use disorders.

PubMed

Thylstrup, Birgitte; Bloomfield, Kim; Hesse, Morten

2018-01-01

The Addiction Severity Index (ASI) is a widely used assessment instrument for substance abuse treatment that includes scales reflecting current status in seven potential problem areas, including psychiatric severity. The aim of this study was to assess the ability of the psychiatric composite score to predict suicide and psychiatric care after residential treatment for drug use disorders after adjusting for history of psychiatric care. All patients treated for drug use disorders in residential treatment centers in Denmark during the years 2000-2010 with complete ASI data were followed through national registers of psychiatric care and causes of death (N=5825). Competing risks regression analyses were used to assess the incremental predictive validity of the psychiatric composite score, controlling for previous psychiatric care, length of intake, and other ASI composite scores, up to 12years after discharge. A total of 1769 patients received psychiatric care after being discharged from residential treatment (30.3%), and 27 (0.5%) committed suicide. After adjusting for all covariates, psychiatric composite score was associated with a higher risk of receiving psychiatric care after residential treatment (subhazard ratio [SHR]=3.44, p<0.001), and of committing suicide (SHR=11.45, p<0.001). The ASI psychiatric composite score has significant predictive validity and promises to be useful in identifying patients with drug use disorders who could benefit from additional mental health treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age.

PubMed

Sourander, Andre; Gyllenberg, David; Brunstein Klomek, Anat; Sillanmäki, Lauri; Ilola, Anna-Marja; Kumpulainen, Kirsti

2016-02-01

Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear. To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age. Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015. Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment. Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms. Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.

The United States Supreme Court and psychiatry in the 1990s.

PubMed

Ciccone, J R

1999-03-01

In the 1990s, the Supreme Court has decided several cases that have had an impact on psychiatry and psychiatric patients in the criminal justice system, on psychiatric hospitalization, and on psychotherapist-patient privilege. Of the seven cases discussed in this article, Chief Justice Rehnquist and Justice Scalia voted similarly in all seven cases. Since joining the court, Justice Thomas has voted with them. Justice Scalia interprets the Constitution, using what has been termed "textualism": avoid reference to legislative history, and interpret the Constitution according to the plain language meaning of the relevant section. Chief Justice Rehnquist and Justices Scalia and Thomas are inclined to protect states' rights from court decisions that expand US Constitutional power in cases involving civil plaintiffs and criminal defendants. They seek to protect states from being sued in federal courts, and, if there is doubt, lean toward not interfering with state prerogatives. They tend to not find unenumerated rights and prefer clear-cut rules over amorphous standards. Justices Kennedy and O'Connor, at times joined by Justice Souter in the middle of the court, provide the deciding votes in many cases. They seem to prefer a case-by-case pragmatism over a global jurisprudential philosophy. Approaching cases one at a time, they usually avoid broad philosophic pronouncements when they join with Chief Justice Rehnquist. Justice Stevens, joined by Justices Breyer and Ginsburg since they have been appointed to the court, is more likely to favor a broader reading of the 14th Amendment's Due Process and Equal Protection clauses. Of the seven cases, Kennedy and O'Connor voted with the majority in five cases, the dissent in one case (Zinermon v Burch), and split their votes in one case (Foucha v Louisiana, with O'Connor siding with the Court and Kennedy with the dissent). Commager, a noted historian, believed that political issues can be explored, explained, and debated and that the people of the new American democracy, armed with knowledge and freedom to defend, argue, and choose, will make the right decisions for their common welfare. This theory applies equally to the court: Whenever questions involving psychiatry and psychiatric patients are brought to the court, American psychiatry must make its views known in that forum. To do so requires awareness and knowledge of the cases that involve psychiatry and psychiatric patients that the court has decided, including those decided in the 1990s. To participate effectively, psychiatrists must understand the political landscape in which the cases arrive at the court's doorstep and the composition and leanings of the court and examine carefully the fact patterns (understanding that some fact patterns are more sympathetic than others). This awareness should result in amicus briefs that are scholarly, rely on empiric data, and are scrupulously honest about the limitations of our knowledge. In this way, psychiatrists may fully participate in the debate and aid the court in its exploration and analysis of the issues involving psychiatry and psychiatric patients.

Purinergic system in psychiatric diseases.

PubMed

Cheffer, A; Castillo, A R G; Corrêa-Velloso, J; Gonçalves, M C B; Naaldijk, Y; Nascimento, I C; Burnstock, G; Ulrich, H

2018-01-01

Psychiatric disorders are debilitating diseases, affecting >80 million people worldwide. There are no causal cures for psychiatric disorders and available therapies only treat the symptoms. The etiology of psychiatric disorders is unknown, although it has been speculated to be a combination of environmental, stress and genetic factors. One of the neurotransmitter systems implicated in the biology of psychiatric disorders is the purinergic system. In this review, we performed a comprehensive search of the literature about the role and function of the purinergic system in the development and predisposition to psychiatric disorders, with a focus on depression, schizophrenia, bipolar disorder, autism, anxiety and attention deficit/hyperactivity disorder. We also describe how therapeutics used for psychiatric disorders act on the purinergic system.

Job-related stress in psychiatric assistant nurses.

PubMed

Yada, Hironori; Abe, Hiroshi; Omori, Hisamitsu; Ishida, Yasushi; Katoh, Takahiko

2018-01-01

We aimed to clarify how stress among psychiatric assistant nurses (PANs) differed from Registered Nurses (PRNs). Cross-sectional survey study was conducted with PRNs and PANs working in six psychiatric hospitals in Japan. The Psychiatric Nurse Job Stressor Scale (PNJSS) and the job stressor and stress reaction subscales of the Brief Job Stress Questionnaire measured stress in 68 PANs and 140 PRNs. The results were statistically analysed. Psychiatric assistant nurses had significantly higher scores than PRNs on the job stressor subscales in psychiatric nursing ability, interpersonal relations and in the stress reaction subscales of irritability and somatic symptoms. "Psychiatric nursing ability," "Communication" and "Use of techniques" were associated with almost all stress reactions in PANs than in PRNs.

Psychiatric disabilities and the Americans with Disabilities Act: implications for policy and practice.

PubMed

Pardeck, J T

1998-01-01

People with psychiatric disabilities are often victims of job discrimination. The Americans with Disabilities Act (ADA) of 1990 makes it very clear that job discrimination based on a psychiatric impairment is illegal. The Equal Employment Opportunity Commission (EEOC) reports that psychiatric disability is one of the leading causes why persons file discrimination complaints. Given this situation, an analysis is offered of what constitutes a psychiatric disability under the ADA. An overview, an analysis, and examples of the kinds of accommodations employers can be expected to provide people with psychiatric disabilities are offered. The policy and practice implications of the employment provisions (Title I) in the area of psychiatric disabilities are presented.

Competency of Psychiatric Residents in the Treatment of People with Severe Mental Illness before and after a Community Psychiatry Rotation

ERIC Educational Resources Information Center

Randall, Melinda; Romero-Gonzalez, Mauricio; Gonzalez, Gerardo; Klee, Anne; Kirwin, Paul

2011-01-01

Objective: Psychiatric rehabilitation is an evidence-based service with the goal of recovery for people with severe mental illness. Psychiatric residents should understand the services and learn the principles of psychiatric rehabilitation. This study assessed whether a 3-month rotation in a psychiatric rehabilitation center changes the competency…

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

PubMed

Kohn, Robert; Szabo, Christopher P; Gordon, Alan; Allwood, Clifford W

2004-03-01

The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

Psychiatric disorders, acne and systemic retinoids: comparison of risks.

PubMed

Le Moigne, M; Bulteau, S; Grall-Bronnec, Marie; Gerardin, M; Fournier, Jean-Pascal; Jonville-Bera, A P; Jolliet, Pascale; Dreno, Brigitte; Victorri-Vigneau, C

2017-09-01

The link between isotretinoin, treatment of a severe form of acne, and psychiatric disorders remains controversial, as acne itself could explain the occurrence of psychiatric disorders. This study aims at assessing the disproportionality of psychiatric adverse events reported with isotretinoin in the French National PharmacoVigilance Database, compared with other systemic acne treatments and systemic retinoids. Data were extracted from the French National PharmacoVigilance Database for systemic acne treatments, systemic retinoids and drugs used as comparators. Each report was subjected to double-blind analysis by two psychiatric experts. A disproportionality analysis was performed, calculating the number of psychiatric ADRs divided by the total number of notifications for each drug of interest. Concerning acne systemic treatments: all 71 reports of severe psychiatric disorders involved isotretinoin, the highest proportion of mild/moderate psychiatric adverse events was reported with isotretinoin (14.1%). Among systemic retinoids, the highest proportion of severe and mild/moderate psychiatric events occurred with isotretinoin and alitretinoin. Our study raises the hypothesis that psychiatric disorders associated with isotretinoin are related to a class effect of retinoids, as a signal emerges for alitretinoin. Complementary studies are necessary to estimate the risk and further determine at-risk populations.

All the world’s a (clinical) stage: Rethinking bipolar disorder from a longitudinal perspective

PubMed Central

Frank, Ellen; Nimgaonkar, Vishwajit L.; Phillips, Mary L.; Kupfer, David J.

2014-01-01

Psychiatric disorders have traditionally been classified using a static, categorical approach. However, this approach falls short in facilitating understanding of the development, common comorbid diagnoses, prognosis, and treatment of these disorders. We propose a “staging” model of bipolar disorder that integrates genetic and neural information with mood and activity symptoms to describe how the disease progresses over time. From an early, asymptomatic, but “at risk” stage to severe, chronic illness, each stage is described with associated neuroimaging findings as well as strategies for mapping genetic risk factors. Integrating more biologic information relating to cardiovascular and endocrine systems, refining methodology for modeling dimensional approaches to disease, and developing outcome measures will all be crucial in examining the validity of this model. Ultimately, this approach should aid in developing targeted interventions for each group that will reduce the significant morbidity and mortality associated with bipolar disorder. PMID:25048003

Anxiety and hospitalization in adolescence: relations to attachment style and parental support.

PubMed

Vulliez-Coady, Lauriane; Vidal, Chrystelle; Vivot, Aurore; Monnin, Julie; Nezelof, Sylvie; Bifulco, Antonia

2013-09-01

This exploratory study examined attachment style and state/trait anxiety in adolescents - 30 recently hospitalized psychiatric patients, and 49 school controls. All were aged 13-18, with the majority (67%) female. The attachment style interview (ASI, Bifulco et al. 2002) was administered, together with the Recent Life Events questionnaire (Brugha & Cragg 1990) and the STAI anxiety questionnaire (Spielberger et al. 1983). Results showed the hospitalised group to have significantly more negative interactions with parents and poorer support than the comparison group. They had significantly more insecure attachment style (96% s 37%). Among the hospitalized adolescents, both the Anxious and the Avoidant attachment style group had higher anxiety scores on the STAI-trait scores than on the STAI-state scores assessed during the first days of hospitalisation. This suggests adolescents, even those with Avoidant attachment feel less anxious after admission. Implications for assessing attachment style in adolescent patients to aid with care planning is discussed.

Availability of Health-Related Programs in Private and Public Prisons.

PubMed

Baćak, Valerio; Ridgeway, Greg

2018-01-01

Little is known about the resources available to protect inmates' health in private prisons compared to their public counterparts. This is the first national-level study that exclusively examined the availability of health-related programs in private and public prisons in the United States. We applied propensity score weighting and doubly robust estimation to compare private prisons to comparable public prisons. Data were self-reported by prison administrators as part of the 2005 Census of State and Federal Adult Correctional Facilities. We found that private prisons offered fewer substance dependency, psychological/psychiatric, and HIV/AIDS-related programs. But the differences were progressively reduced when the comparison was limited to public prisons most similar on a variety of facility-level characteristics. The extent to which the two types of prisons differ is closely tied to the characteristics of the facilities that are compared.

Evaluation of potential kidney donors with the personality assessment inventory: normative data for a unique population.

PubMed

Hurst, Duane F; Locke, Dona E C; Osborne, David

2010-09-01

Many transplant centers require personality assessment and/or psychiatric clearance prior to allowing an individual to donate a kidney. This is a unique cohort for personality assessment, and there is no normative information available for this population on standardized self-report measures such as the Personality Assessment Inventory (PAI). We evaluated a prospective sample of 434 kidney donor candidates with development of normative T-scores relevant to this specific comparison group. Compared to the original normative group from the PAI manual, potential kidney donors are 5-7 T-score points above the mean on PIM, RXR, DOM, and WRM and 4-6 points below the mean on the majority of the remaining scales. Raw score/T score conversion tables are provided. The normative data provided here is meant to supplement the original normative information and aid psychologists in evaluation of this unique medical population.

The current state of GPCR-based drug discovery to treat metabolic disease.

PubMed

Sloop, Kyle W; Emmerson, Paul J; Statnick, Michael A; Willard, Francis S

2018-02-02

One approach of modern drug discovery is to identify agents that enhance or diminish signal transduction cascades in various cell types and tissues by modulating the activity of GPCRs. This strategy has resulted in the development of new medicines to treat many conditions, including cardiovascular disease, psychiatric disorders, HIV/AIDS, certain forms of cancer and Type 2 diabetes mellitus (T2DM). These successes justify further pursuit of GPCRs as disease targets and provide key learning that should help guide identifying future therapeutic agents. This report reviews the current landscape of GPCR drug discovery with emphasis on efforts aimed at developing new molecules for treating T2DM and obesity. We analyse historical efforts to generate GPCR-based drugs to treat metabolic disease in terms of causal factors leading to success and failure in this endeavour. © 2018 The British Pharmacological Society.

The Proton Pump Inhibitor Nonresponder: a Behavioral Approach to Improvement and Wellness.

PubMed

Riehl, Megan E; Chen, Joan W

2018-06-09

Gastroesophageal reflux disease (GERD) is a difficult to treat medical condition, where nearly 40% of patients are refractory to standard medical intervention, which typically begins with a proton pump inhibitor (PPI). These PPI nonresponders represent a population of patients, where treatment planning must be individualized; multidisciplinary and psychiatric comorbidities should be considered. This review highlights treatment options that include neuromodulators, lifestyle, and psychological interventions for the PPI nonresponder. Mental health specialists in the field of psychogastroenterology can aid in the management of esophageal hypersensitivity, which can drive the symptom experience of a PPI nonresponder. Considerations for comorbid anxiety and depression in this population require careful assessment and treatment. Physicians are encouraged to create realistic expectations for symptom management and offer multidisciplinary options for treatment early in care. Patients will frequently benefit from working with a GI psychologist and find value in behavioral interventions.

Huntington's Disease: Relationship Between Phenotype and Genotype.

PubMed

Sun, Yi-Min; Zhang, Yan-Bin; Wu, Zhi-Ying

2017-01-01

Huntington's disease (HD) is an autosomal dominant inherited neurodegenerative disease with the typical manifestations of involuntary movements, psychiatric and behavior disorders, and cognitive impairment. It is caused by the dynamic mutation in CAG triplet repeat number in exon 1 of huntingtin (HTT) gene. The symptoms of HD especially the age at onset are related to the genetic characteristics, both the CAG triplet repeat and the modified factors. Here, we reviewed the recent advancement on the genotype-phenotype relationship of HD, mainly focus on the characteristics of different expanded CAG repeat number, genetic modifiers, and CCG repeat number in the 3' end of CAG triplet repeat and their effects on the phenotype. We also reviewed the special forms of HD (juvenile HD, atypical onset HD, and homozygous HD) and their phenotype-genotype correlations. The review will aid clinicians to predict the onset age and disease course of HD, give the genetic counseling, and accelerate research into the HD mechanism.

Treatment of Opioid Dependent Pregnant Women: Clinical and Research Issues

PubMed Central

Jones, H.E.; Martin, P.R.; Heil, S.H.; Stine, S.M.; Kaltenbach, K.; Selby, P.; Coyle, M.G.; O’Grady, K.E.; Arria, A.M.; Fischer, G.

2008-01-01

This paper addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance is provided to aid clinical decision-making, based on both research evidence and the collective clinical experience of the authors which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project. MOTHER is a double-blind, double-dummy, flexible–dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the opioid dependence treatment among pregnant women and their neonates. The paper begins with a discussion of appropriate assessment during pregnancy, and then addresses clinical management stages, including maintenance medication selection, induction and stabilization, opioid agonist medication management before, during and after delivery, pain management, breast-feeding, and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed. PMID:18248941

WHY NOT POT?

PubMed Central

Pappas, Katherine

2016-01-01

In this review, we provide a historical perspective on marijuana, and survey contemporary research investigating its potential negative effects on the brain. We discuss the evidence regarding cannabis dependence, driving under the influence of cannabis, underachievement, inducing (or worsening) certain psychiatric conditions, and the potential for progression to use of more dangerous drugs—summarized by the acronym DDUMB, a cognitive tool that may help healthcare providers in their risk/benefit discussions with patients who use cannabis. We also review and discuss the impact of marijuana use on target populations, including adolescents (who are at increased risk of harm); heavy users; and people suffering from—or at high risk of— mental illness. While cannabis presents certain subjective, healthrelated, and pecuniary benefits to users, growers, and other entities, it is also associated with several brainbased risks. Understanding these risks aids clinicians and their patients in making informed and balanced decisions regarding the initiation or continuance of marijuana use. PMID:27354924

Epidemiology of psychiatric disability without posttraumatic stress disorder among U.S. Army and Marine Corps personnel evaluated for disability discharge.

PubMed

Piccirillo, Amanda L; Packnett, Elizabeth R; Boivin, Michael R; Cowan, David N

2015-12-01

Psychiatric disorders are a common reason for disability discharge from the U.S. military. Research on psychiatric disorders in military personnel evaluated for disability discharge has historically focused on posttraumatic stress disorder (PTSD), yet 40% of service members evaluated for a psychiatric-related disability do not have PTSD. This study's objective was to describe characteristics and correlates of disability in Army and Marine Corps personnel diagnosed with psychiatric disorders other than PTSD. In this cross-sectional study, the chi-square and Wilcoxon-Mann-Whitney tests compared the distribution of demographic, disability and deployment characteristics between those evaluated for non-PTSD psychiatric disability (N = 9125) versus those evaluated for any other non-psychiatric condition (N = 78,072). Multivariate logistic regression examined associations between disability retirement and demographic and disability characteristics. Results show a significantly higher prevalence of disability retirement, deployment, and comorbidity among Army and Marine Corps personnel evaluated for disability discharge related to a non-PTSD psychiatric disorder. Mood disorders, anxiety disorders and dementia were the most commonly evaluated psychiatric disorders. Characteristics associated with increased odds of non-PTSD psychiatric-related disability retirement includes being in the Marine Corps (OR = 1.24), being black (OR = 1.29) or other race (OR = 1.33), having a combat-related condition (OR = 2.50), and older age. Service members evaluated for a non-PTSD psychiatric disability have similar rates of disability retirement as those evaluated for PTSD, suggesting non-PTSD psychiatric disorders cause a severe and highly compensated disability. Additional research is needed describing the epidemiology of specific non-PTSD psychiatric disorders, such as depression, in service members evaluated for disability discharge. Copyright © 2015 Elsevier Ltd. All rights reserved.

All-Cause Mortality in Women With Severe Postpartum Psychiatric Disorders

PubMed Central

Johannsen, Benedicte Marie Winther; Larsen, Janne Tidselbak; Laursen, Thomas Munk; Bergink, Veerle; Meltzer-Brody, Samantha; Munk-Olsen, Trine

2017-01-01

Objective The postpartum period is associated with a high risk of psychiatric episodes. The authors studied mortality in women with first-onset severe psychiatric disorders following childbirth and compared their mortality rates with those in women from the background population including other female psychiatric patients (mothers and childless women). Method In a register-based cohort study with linked information from Danish population registers, the authors identified women with first psychiatric inpatient or outpatient contacts 0–3 months postpartum. The main outcome measure was mortality rate ratios (MRRs): deaths from natural causes (diseases and medical conditions) or unnatural causes (suicides, accidents, and homicides). The cohort included 1,545,857 women representing 68,473,423 person-years at risk. Results In total, 2,699 women had first-onset psychiatric disorders 0–3 months postpartum, and 96 of these died during follow-up. Women with postpartum psychiatric disorders had a higher MRR (3.74; 95% CI=3.06–4.57) than non-postpartum-onset mothers (MRR=2.73; 95% CI=2.67–2.79) when compared with mothers with no psychiatric history. However, childless women with psychiatric diagnoses had the highest MRR (6.15; 95% CI=5.94–6.38). Unnatural cause of death represented 40.6% of fatalities among women with postpartum psychiatric disorders, and within the first year after diagnosis, suicide risk was drastically increased (MRR=289.42; 95% CI=144.02–581.62) when compared with mothers with no psychiatric history. Conclusions Women with severe postpartum psychiatric disorders had increased MRRs compared with mothers without psychiatric diagnoses, and the first year after diagnosis represents a time of particularly high relative risk for suicide in this vulnerable group. PMID:26940804

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality.

PubMed

Simonsen, Rikke Kildevæld; Giraldi, Annamaria; Kristensen, Ellids; Hald, Gert Martin

2016-01-01

There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978-2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978-2010. Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.

Do race, ethnicity, and psychiatric diagnoses matter in the prevalence of multiple chronic medical conditions?

PubMed

Cabassa, Leopoldo J; Humensky, Jennifer; Druss, Benjamin; Lewis-Fernández, Roberto; Gomes, Arminda P; Wang, Shuai; Blanco, Carlos

2013-06-01

The proportion of people in the United States with multiple chronic medical conditions (MCMC) is increasing. Yet, little is known about the relationship that race, ethnicity, and psychiatric disorders have on the prevalence of MCMCs in the general population. This study used data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N=33,107). Multinomial logistic regression models adjusting for sociodemographic variables, body mass index, and quality of life were used to examine differences in the 12-month prevalence of MCMC by race/ethnicity, psychiatric diagnosis, and the interactions between race/ethnicity and psychiatric diagnosis. Compared to non-Hispanic Whites, Hispanics reported lower odds of MCMC and African Americans reported higher odds of MCMC after adjusting for covariates. People with psychiatric disorders reported higher odds of MCMC compared with people without psychiatric disorders. There were significant interactions between race and psychiatric diagnosis associated with rates of MCMC. In the presence of certain psychiatric disorders, the odds of MCMC were higher among African Americans with psychiatric disorders compared to non-Hispanic Whites with similar psychiatric disorders. Our study results indicate that race, ethnicity, and psychiatric disorders are associated with the prevalence of MCMC. As the rates of MCMC rise, it is critical to identify which populations are at increased risk and how to best direct services to address their health care needs.

[Psychiatric disorders in patients with Cushing's disease before and after neurosurgery].

PubMed

Gnjidiae, Zivko; Karloviae, Dalibor; Buljan, Danijel; Malencia, Masa; Kovak-Mufiae, Ana; Kostanjsak, Lidija

2011-01-01

Cushing's disease which is a consequence of ACTH-secreting pituitary adenoma leads to hypercortisolism. Cushing's disease is associated with several psychiatric disturbances. The aim of the present study was to identify which psychiatric disorders were present in patients with Cushing's disease over a 2-year period and to monitor their general psychiatric condition. Additionally, the study aimed to examine the relationship between the duration of Cushing's disease, and the severity of psychiatric conditions based on psychiatric rating scales. The study included 39 patients with Cushing's disease that underwent neurosurgery for ACTH-secreting pituitary adenomas. The transsphenoidal approach (the standard microsurgery technique) was performed in all patients. ACTH-secreting pituitary adenomas were confirmed based on immunohistochemistry in all patients. Psychiatric conditions in the patients were identified using the Clinical Global Impression Scale (CGI) and ICD 10 diagnostic criteria at 3 time points: prior to surgery, and 6 and 48 months post surgery. The Cushing's disease patients exhibited statistically significant improvement in their psychiatric condition, according to the CGI, 6 and 48 months post surgery. There wasn't any significant correlation between the duration of Cushing's disease and psychiatric status, as measured by the CGI prior to surgery, 6 months post surgery, or 48 months post surgery. Patients with Cushing's disease had a significant level psychiatric disturbance that remitted after surgery. There wasn't a significant correlation between the duration of Cushing's disease and psychiatric status.

Childhood bullying behavior and later psychiatric hospital and psychopharmacologic treatment: findings from the Finnish 1981 birth cohort study.

PubMed

Sourander, Andre; Ronning, John; Brunstein-Klomek, Anat; Gyllenberg, David; Kumpulainen, Kirsti; Niemelä, Solja; Helenius, Hans; Sillanmäki, Lauri; Ristkari, Terja; Tamminen, Tuula; Moilanen, Irma; Piha, Jorma; Almqvist, Fredrik

2009-09-01

No prospective population-based study examining predictive associations between childhood bullying behavior and long-term mental health outcomes in both males and females exists. To study predictive associations between bullying and victimization in childhood and later psychiatric hospital and psychopharmacologic treatment. Nationwide birth cohort study from age 8 to 24 years. Five thousand thirty-eight Finnish children born in 1981 with complete information about bullying and victimization at age 8 years from parents, teachers, and self-reports. National register-based lifetime information about psychiatric hospital treatments and psychopharmacologic medication prescriptions. When controlled for psychopathology score, frequent victim status at age 8 years among females independently predicted psychiatric hospital treatment and use of antipsychotic, antidepressant, and anxiolytic drugs. Among males, frequent bully-victim and bully-only statuses predicted use of antidepressant and anxiolytic drugs. Frequent bully-victim status among males also predicted psychiatric hospital treatment and use of antipsychotics. However, when the analysis was controlled with total psychopathology score at age 8 years, frequent bully, victim, or bully-victim status did not predict any psychiatric outcomes among males. Boys and girls who display frequent bullying behavior should be evaluated for possible psychiatric problems, as bullying behaviors in concert with psychiatric symptoms are early markers of risk of psychiatric outcome. Among females, frequent childhood victimization predicts later psychiatric problems irrespective of psychiatric problems at baseline.

Psychiatric treatment in prison: a missed opportunity?

PubMed

Smith, S S; Baxter, V J; Humphreys, M S

2003-04-01

National Health Service Executive guidelines require psychiatric services to maintain links with prisoners previously subject to the Care Programme Approach (CPA) and to participate in discharge planning. We are unaware of previous studies assessing the involvement of general psychiatric services with patients in prison or prisoners' perceptions of their needs. Consecutive referrals to a prison psychiatric liaison service over a three-month period were screened for previous psychiatric contact. Half of those interviewed reported previous psychiatric contact. Two-thirds were in contact with services at the time of detention. One-third believed services knew of their imprisonment. Ninety-three per cent believed they would require psychiatric support after release. Few patients received input from general psychiatric services during imprisonment despite a high level of perceived need. Improved liaison would help facilitate both care in prison and discharge planning in the spirit of CPA and the government directive.

Psychiatric morbidity and non-participation in breast cancer screening.

PubMed

Jensen, Line Flytkjær; Pedersen, Anette Fischer; Bech, Bodil Hammer; Andersen, Berit; Vedsted, Peter

2016-02-01

Organised breast cancer screening is currently one of the best strategies for early-stage breast cancer detection. However, early detection has proven challenging for women with psychiatric disease. This study aims to investigate psychiatric morbidity and non-participation in breast cancer screening. We conducted an observational cohort study including women invited to the first organised screening round in the Central Denmark Region. Data on psychiatric diagnosis, psychoactive prescription medicine and consultation with private psychiatrists were obtained from Danish registries and assessed for a period of up to 10 years before the screening date. The cohort comprised 144,264 women whereof 33.0% were registered with an indication of psychiatric morbidity. We found elevated non-participation propensity among women with a psychiatric diagnosis especially for women with schizophrenia and substance abuse. Also milder psychiatric morbidity was associated with higher non-participation likelihood as women who had redeemed psychoactive prescription medicine or have had minimum one consultation with a private psychiatrist were more likely not to participate. Finally, we found that the chronicity of psychiatric morbidity was associated with non-participation and that woman who had a psychiatric morbidity defined as 'persistent' had higher likelihood of non-participation than women with recently active morbidity or inactive psychiatric morbidity. This study showed a strong association between psychiatric morbidity and an increased likelihood of non-participation in breast cancer screening in a health care system with universal and tax-funded health services. This knowledge may inform interventions targeting women with psychiatric morbidity as they have poorer breast cancer prognosis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Does childbirth cause psychiatric disorders? A population-based study paralleling a natural experiment.

PubMed

Munk-Olsen, Trine; Agerbo, Esben

2015-01-01

Childbirth is associated with increased risk of first-time psychiatric episodes, and an unwanted pregnancy has been suggested as a possible etiologic contributor. To what extent childbirth causes psychiatric episodes and whether a planned pregnancy reduces the risk of postpartum psychiatric episodes has not been established. We conducted a cohort study using data derived from Danish population registers, including all women having in vitro fertilization (IVF) treatment and their partners with recorded information in the IVF register covering fertility treatments in Denmark at all public and private treatment sites from January 1994 to December 2005. We compared parents and childless persons to examine whether childbirth is directly associated with onset of first-time psychiatric episodes, with incidence rate ratios (risk of first psychiatric inpatient or outpatient treatment) as the main outcome measures. The incidence rate for any type of psychiatric disorder 0 to 90 days postpartum was 11.3 per 1000 person-years (95% confidence interval = 8.2-15.0), and 3.8 (3.4-4.3) among women not giving birth. IVF-treated mothers had an increased risk of a psychiatric episode postpartum (incidence rate ratio [IRR] = 2.9 [2.0-4.2]) compared with the risk of psychiatric episodes in childless women. Risk of psychiatric episodes later than 90 days postpartum was decreased (IRR = 0.9 [0.7-1.0]). Using a study design paralleling a natural experiment, our results showed that childbirth is associated with first-time psychiatric disorders in new mothers, indicating that a planned pregnancy does not reduce risks of or prevent postpartum psychiatric episodes.

The impact of sleep and psychiatric symptoms on alcohol consequences among young adults.

PubMed

Miller, Mary Beth; Van Reen, Eliza; Barker, David H; Roane, Brandy M; Borsari, Brian; McGeary, John E; Seifer, Ronald; Carskadon, Mary A

2017-03-01

Independent lines of research have documented links between psychiatric symptoms and poor sleep quality, psychiatric symptoms and alcohol use, and alcohol use and poor sleep quality. The current study examined the synergistic effect of poor sleep quality and psychiatric symptoms on alcohol-related consequences in heavy-drinking young adults. Matriculating college students reporting at least one heavy drinking episode over the first nine weeks of the semester (N=385, 52% female) were categorized as experiencing 'good' (n=280) versus 'poor' sleep quality (n=105) and screening 'positive' (n=203) or 'negative' (n=182) for a psychiatric disorder. Sleep quality was assessed using the Pittsburgh Sleep Quality Index; psychiatric diagnosis was assessed using the Psychiatric Diagnostic Screening Questionnaire; and alcohol-related consequences were assessed using the Brief Young Adult Alcohol Consequences Questionnaire. General linear models were used to examine the main effects and interaction between sleep quality and psychiatric symptoms on alcohol-related consequences. Sleep quality moderated the association between psychiatric screen and alcohol-related consequences among heavy-drinking college students, such that psychiatric symptoms were associated with more alcohol-related consequences in the context of poor sleep quality. The combination of poor sleep quality and psychiatric symptoms is associated with increased alcohol-related consequences among heavy-drinking college students. Given the significant interaction between these symptoms, healthcare providers are encouraged to screen for the presence of sleep and psychiatric disorders among heavy-drinking young adults and to provide empirically-supported treatments as appropriate. Copyright © 2016 Elsevier Ltd. All rights reserved.

Competency of psychiatric residents in the treatment of people with severe mental illness before and after a community psychiatry rotation.

PubMed

Randall, Melinda; Romero-Gonzalez, Mauricio; Gonzalez, Gerardo; Klee, Anne; Kirwin, Paul

2011-01-01

psychiatric rehabilitation is an evidence-based service with the goal of recovery for people with severe mental illness. Psychiatric residents should understand the services and learn the principles of psychiatric rehabilitation. This study assessed whether a 3-month rotation in a psychiatric rehabilitation center changes the competency level of second-year psychiatric residents in evidence-based treatment of severe mental illness. the study is a prospective, case-control comparison using the validated Competency Assessment Instrument (CAI), which measures 15 provider competencies critical to recovery, rehabilitation, and empowerment for people with severe mental illness, providing a score for each competency. Participants were second-year psychiatric residents attending a 3-month rotation at the Community Reintegration Program, a psychiatric rehabilitation day program. The authors administered the CAI at the beginning and the end of the residents' 3-month rotation in order to assess change in their competency in psychiatric rehabilitation. The authors also administered the CAI to a comparison group of second-year psychiatric residents who did not rotate through the Community Reintegration Program, and therefore had no formal training in psychiatric rehabilitation. a 3-month rotation in psychiatric rehabilitation significantly improved residents' competency in the domains of goal functioning, client preferences, holistic approach, skills, and team value relative to nonrotating residents. a brief community psychiatry rotation in the second year of residency likely improves some skills in the treatment of people with severe mental illness. Future research should evaluate year-long electives and public psychiatry fellowships.

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. Copyright © 2015 Elsevier Inc. All rights reserved.

Risk of new psychiatric episodes in the year following divorce in midlife: cause or selection? A nationwide register-based study of 703,960 individuals.

PubMed

Björkenstam, Emma; Hallqvist, Johan; Dalman, Christina; Ljung, Rickard

2013-12-01

To examine if divorce is associated with an increased risk of psychiatric disorder. A register-based cohort study of all married or divorced individuals aged 45-54 in Sweden in 2006. After exclusion of 129,669 individuals with a history of psychiatric care in 1987-2005, we followed 703,960 persons for psychiatric disorder during 2007, measured as psychiatric inpatient care, outpatient care and use of psychotropic medication. Marital trajectories were taken into consideration. Data were analysed using Poisson regression. Divorced women and men had a higher risk for psychiatric inpatient care compared to married (ORwomen = 3.2, 95%CI = 1.6-6.3, ORmen = 3.3, 95%CI = 2.0-5.4). The longer the marriage, the lower the risk for psychiatric disorders. Lower educational level increased the risk for psychiatric inpatient care. In conclusion, our study supports both the selection hypothesis, linking healthy individuals to long and stable marriages, and the social causation hypothesis, linking the stress of recent divorce to increased psychiatric disorder for both women and men.

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…

42 CFR 441.182 - Maintenance of effort: Computation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.182 Maintenance of effort: Computation. (a) For expenditures for inpatient psychiatric services... total State Medicaid expenditures in the current quarter for inpatient psychiatric services and...

Prevalence of psychiatric morbidity in visually impaired children.

PubMed

Bakhla, Ajay Kumar; Sinha, Vinod Kumar; Verma, Vijay; Sarkhel, Sujit

2011-03-01

This study was done to measure psychiatric morbidity and associated sociodemographic variables among visually impaired children. 92 students of age range 6 to 20 years from four schools for the blind, in Ranchi, were screened with verbal Hindi translation of General Health Questionnaire 60. Diagnostic Interview Schedule Parent version was applied to establish psychiatric diagnosis on primary caretakers of those who scored above cutoff. Fourteen scored above cut off and psychiatric diagnoses of 8 children were established. The prevalence of psychiatric morbidity among visually impaired children was found to be 8.69% No sociodemographic variable was associated with the occurrence of psychiatric illness.

Perceptions Among Psychiatric Staff of Creating a Therapeutic Alliance With Patients on Community Treatment Orders.

PubMed

Jansson, Susanne; Fridlund, Bengt

2016-10-01

A therapeutic alliance with a continuing collaboration between a patient and psychiatric staff is a resource for helping patients cope with the demands of coercive legislation. Knowledge exists describing coercion in inpatient care while the knowledge regarding the perceptions of creating a therapeutic alliance with patients on Community Treatment Orders (CTO) among psychiatric staff is scarce. To describe perceptions among psychiatric staff of creating a therapeutic alliance with patients on CTOs, an exploratory design using a phenomenographic method was employed. Thirteen semi-structured audio-taped interviews were conducted with psychiatric staff responsible for patients on CTOs. The staff worked in five different outpatient clinics and the interviews were conducted at their workplaces. The analysis resulted in in four metaphors: the persevering psychiatric staff, the learning psychiatric staff, the participating psychiatric staff, and the motivating psychiatric staff. Patients on CTOs were more time-consuming for psychiatric staff in care and treatment. Long-term planning is required in which the creation of a therapeutic alliance entails the patient gradually gaining greater self-awareness and wanting to visit the outpatient clinic. The professional-patient relationship is essential and if a therapeutic alliance is not created, the patient's continued care and treatment in the community is vulnerable.

Perpetuating stigma? Differences between advertisements for psychiatric and non-psychiatric medication in two professional journals.

PubMed

Foster, Juliet L H

2010-02-01

Continuing debates regarding advertising and the pharmaceutical industry, and others detailing the continued stigmatization of mental health problems. To establish whether there are any differences in advertisements for psychiatric and non-psychiatric medication aimed at health professionals. Quantitative (t-tests, Chi-squared) and qualitative analysis of all unique advertisements for medication that appeared in two professional journals (the British Medical Journal and the British Journal of Psychiatry) between October 2005 and September 2006 was undertaken. Close attention was paid to both images and text used in the advertisements. Significant differences were found between advertisements for psychiatric and non-psychiatric medication in both quantitative and qualitative analysis: advertisements for psychiatric medication contain less text and are less likely to include specific information about the actual drug than non-psychiatric medication advertisements; images used in advertisements for psychiatric medication are more negative than those used for non-psychiatric medication, and are less likely to portray people in everyday situations. A distinction between mental health problems and other forms of ill health is clearly being maintained in medication advertisements; this has potentially stigmatizing consequences, both for professional and public perceptions. There are also troubling implications in light of the debates surrounding Direct to Consumer Advertising.

Estimating psychiatric manpower requirements based on patients' needs.

PubMed

Faulkner, L R; Goldman, C R

1997-05-01

To provide a better understanding of the complexities of estimating psychiatric manpower requirements, the authors describe several approaches to estimation and present a method based on patients' needs. A five-step method for psychiatric manpower estimation is used, with estimates of data pertinent to each step, to calculate the total psychiatric manpower requirements for the United States. The method is also used to estimate the hours of psychiatric service per patient per year that might be available under current psychiatric practice and under a managed care scenario. Depending on assumptions about data at each step in the method, the total psychiatric manpower requirements for the U.S. population range from 2,989 to 358,696 full-time-equivalent psychiatrists. The number of available hours of psychiatric service per patient per year is 14.1 hours under current psychiatric practice and 2.8 hours under the managed care scenario. The key to psychiatric manpower estimation lies in clarifying the assumptions that underlie the specific method used. Even small differences in assumptions mean large differences in estimates. Any credible manpower estimation process must include discussions and negotiations between psychiatrists, other clinicians, administrators, and patients and families to clarify the treatment needs of patients and the roles, responsibilities, and job description of psychiatrists.

When the safe place does not protect: reports of victimisation and adverse experiences in psychiatric institutions.

PubMed

Dos Santos Mesquita, Cristina; da Costa Maia, Ângela

2016-12-01

Psychiatric patients report higher levels of victimisation and are at risk for further victimisation in different contexts, such as psychiatric institutions. Studies in this field tend to focus on hospital staff as victims, experiencing classic forms of victimisation (e.g. physical assault, threats, verbal abuse), through qualitative studies. This is a quantitative retrospective study that aims to know the occurrence of psychiatric victimisation and other adverse experiences in Portuguese psychiatric patients. Ninety-five psychiatric patients, between 20 and 79 years old (M - 45.18, SD - 13.06), with a history of psychiatric hospitalisation answered the Experiences in Psychiatric Institution Inventory. Participants were recruited in four psychiatric hospitals. Inpatients were approached during their hospitalisation; outpatients were approached in scheduled appointment days. Only 23 (24.2%) participants reported no victimisation. Total Experiences of Self varied from 0 to 7 (M - 1.75, SD - 1.72), Total Witnessed Experiences varied from 0 to 7 (M - 1.17, SD - 1.64), and Total Global Experiences varied from 0 to 14 (M - 2.92, SD - 3.01). These results show that victimisation and adverse experiences in psychiatric contexts are frequent and go beyond classic forms of victimisation. A deeper knowledge of these experiences and their impact in the mental health of psychiatric patients may promote quality of care provided and lead to more effective treatments, thus reducing the number and length of hospitalisations, and the financial burden for public health services. © 2016 Nordic College of Caring Science.

Sleep complaints and psychiatric symptoms in children evaluated at a pediatric mental health clinic.

PubMed

Ivanenko, Anna; Crabtree, Valerie McLaughlin; Obrien, Louise Margaret; Gozal, David

2006-01-15

To examine the association of sleep problems with psychiatric symptoms in children evaluated at a university-based outpatient child psychiatry clinic. Parents of 174 children attending psychiatric services completed a 47-item Childhood Sleep Questionnaire and the Behavioral Assessment System for Children. Psychiatric diagnosis was obtained through retrospective chart review. Sleep characteristics were compared among 4 diagnostic subcategories: attention-deficit/hyperactivity disorder (ADHD) alone (n=29), ADHD with comorbid mood and anxiety disorders (ADHD+; n=50), mood and anxiety disorders alone (n=67), and other psychiatric disorders (n= 28). Data from sleep habits survey of 174 community children without reported psychiatric history served as controls. Children with psychiatric disorders had a significantly higher prevalence of sleep complaints compared with nonpsychiatric controls. Children with ADHD had frequent nocturnal awakenings, bad dreams, and bedtime struggles. In addition, the presence of leg jerks during sleep was particularly frequent in patients with ADHD compared with any other psychiatric disorder. More frequent nighttime awakenings were present in children with mood and anxiety disorders. Sleep duration and sleep latency strongly correlated with aggression, hyperactivity, and depression. Restless sleep scores highly correlated with all psychiatric symptoms. Sleep problems are highly prevalent among children with psychiatric disorders. Children with ADHD and comorbid anxiety or mood disorders are more likely to report sleep disturbances. Restless sleep, long sleep latency, short sleep duration, and frequent nocturnal awakenings correlate with the severity of psychiatric symptoms.

Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients.

PubMed

Batista-Neves, Susana; Quarantini, Lucas C; Galvão-de Almeida, Amanda; Cardeal, Maurício; Lacerda, Acioly L; Paraná, Raymundo; Reis de-Oliveira, Irismar; Bressan, Rodrigo A; Miranda-Scippa, Angela

2009-02-01

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51%) patients did not have any psychiatric diagnosis, while 44 (49%) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1%) had a current mental disorder, out of which 22 (84.6%) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

Mood stability in Parkinson disease following deep brain stimulation: a 6-month prospective follow-up study.

PubMed

Chopra, Amit; Abulseoud, Osama A; Sampson, Shirlene; Lee, Kendall H; Klassen, Bryan T; Fields, Julie A; Matsumoto, Joseph Y; Adams, Andrea C; Stoppel, Cynthia J; Geske, Jennifer R; Frye, Mark A

2014-01-01

Deep brain stimulation for Parkinson disease has been associated with psychiatric adverse effects including anxiety, depression, mania, psychosis, and suicide. The purpose of this study was to evaluate the safety of deep brain stimulation in a large Parkinson disease clinical practice. Patients approved for surgery by the Mayo Clinic deep brain stimulation clinical committee participated in a 6-month prospective naturalistic follow-up study. In addition to the Unified Parkinson's Disease Rating Scale, stability and psychiatric safety were measured using the Beck Depression Inventory, Hamilton Depression Rating Scale, and Young Mania Rating scale. Outcomes were compared in patients with Parkinson disease who had a psychiatric history to those with no co-morbid psychiatric history. The study was completed by 49 of 54 patients. Statistically significant 6-month baseline to end-point improvement was found in motor and mood scales. No significant differences were found in psychiatric outcomes based on the presence or absence of psychiatric comorbidity. Our study suggests that patients with Parkinson disease who have a history of psychiatric co-morbidity can safely respond to deep brain stimulation with no greater risk of psychiatric adverse effect occurrence. A multidisciplinary team approach, including careful psychiatric screening ensuring mood stabilization and psychiatric follow-up, should be viewed as standard of care to optimize the psychiatric outcome in the course of deep brain stimulation treatment. © 2013 Published by The Academy of Psychosomatic Medicine on behalf of The Academy of Psychosomatic Medicine.

42 CFR 412.426 - Transition period.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Services of Inpatient Psychiatric Facilities § 412.426 Transition period. (a) Duration of transition period... psychiatric facility receives a payment comprised of a blend of the estimated Federal per diem payment amount... new inpatient psychiatric facilities. New inpatient psychiatric facilities, are facilities that under...

42 CFR 441.13 - Prohibitions on FFP: Institutionalized individuals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... institution for mental diseases, except an individual who is under age 22 and receiving inpatient psychiatric... receiving inpatient psychiatric services), payments to institutions for the mentally retarded or persons with related conditions and to psychiatric facilities or programs providing inpatient psychiatric...

Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway.

PubMed

Sørlie, Tore; Sørgaard, Knut W; Bogdanov, Anatoly; Bratlid, Trond; Rezvy, Grigory

2015-08-04

More knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures. An explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality. The observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (χ(2) = 168.1, p < 0,001). Norwegian suicidal ideators and attempters had more depressed moods, more personality disorders, and greater problems with alcohol/drugs, but fewer psychotic disorders, cognitive problems or overactivity than non-suicidal patients. Russian suicidal ideators and attempters were younger, more often unemployed, had more depressed mood and adjustment disorders, but had fewer psychotic disorders and less alcohol/drug use than the non-suicidal patients. Rates of suicidal ideation and non-fatal attempts in Norwegian patients were intermediate between those previously reported for patients admitted for the first time and those typical of chronic patients. However, the significantly lower rates of suicidal ideation and non-fatal attempts in our Russian cohort as compared with the Norwegian, contrasted with what might be expected in a region with much higher suicide rates than in northern Norway. We suggest that suicide-related stigma in Russia may reduce both patient reporting and clinicians' recognition of suicidality. In both cohorts, overlapping risk profiles of ideators and attempters may indicate that ideators should be carefully evaluated and monitored, particularly those with depressed moods, alcohol/substance abuse disorders, and inadequate treatment continuity.

Expanding the scope of psychiatric nursing practice: devaluing the essence of psychiatric nursing?

PubMed

Hogan, Beverly Kay

2012-09-01

Psychiatric Nurse Practitioners are quickly becoming sought after employees, especially in public mental health systems where a shrinking number of psychiatrists necessitate alternate access to prescribers. In addition, new guidelines necessitate greater attention to the follow up and monitoring of the medical problems of psychiatric patients. These events are occurring in the midst of declining reimbursement and rising litigation concerns in psychiatry. At the same time there is an increased focus on a recovery orientation to psychiatry alongside the primacy of psychotropic medicine as the most cost effective treatment, which can become competing aims for practitioners. It is important for psychiatric nurses and psychiatric nurse practitioners to consider how these opportunities might also have a negative impact on the core foundation of psychiatric nursing.

Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis.

PubMed

Gillberg, I Carina; Helles, Adam; Billstedt, Eva; Gillberg, Christopher

2016-01-01

We examined comorbid psychiatric and neurodevelopmental disorders in fifty adult males (mean age 30 years) with Asperger syndrome (AS) diagnosed in childhood and followed up prospectively for almost two decades (13-26 years). Only three of the 50 men had never met criteria for an additional psychiatric/neurodevelopmental diagnosis and more than half had ongoing comorbidity (most commonly either ADHD or depression or both). Any psychiatric comorbidity increased the risk of poorer outcome. The minority of the AS group who no longer met criteria for a full diagnosis of an autism spectrum disorder were usually free of current psychiatric comorbidity. The high rate of psychiatric/neurodevelopmental comorbidities underscores the need for a full psychiatric/neurodevelopmental assessment at follow-up of males with AS.

Organizational models of emergency psychiatric intervention: state of the art.

PubMed

Barra, A; Daini, S; Tonioni, F; Bria, P

2007-01-01

Authors outline the differences between medical and psychiatric definition of emergency and analyze different organizational models of psychiatric intervention in Emergency Room. The historical evolution changed these models, and the relation with services for acute and subacute patients in hospital and community services. The Italian reform model is compared with the slow deinstitutionalization of psychiatry in other countries. Critical points in Italian emergency organization after the Psychiatric Reform are pointed out: low number of beds for acute patients, difficulties and delays in transfer from Emergency Room to GHPW (General Hospital Psychiatric Ward), waiting lists for voluntary treatments. To overcome some of these problems, the Authors propose that even in hospitals without psychiatric ward, a small unit of short psychiatric observation be implemented, for voluntary treatments, before transfer to other institutions.

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

Attitudes of college students toward mental illness stigma and the misuse of psychiatric medications.

PubMed

Stone, Amanda M; Merlo, Lisa J

2011-02-01

Mental illness stigma remains a significant barrier to treatment. However, the recent increase in the medical and nonmedical use of prescription psychiatric medications among college students seems to contradict this phenomenon. This study explored students' attitudes and experiences related to psychiatric medications, as well as correlates of psychiatric medication misuse (ie, attitudes toward mental illness and beliefs about the efficacy of psychiatric medications). Data were collected anonymously via self-report questionnaires from April 2008 to February 2009. Measures included the Michigan Alcoholism Screening Test, the Drug Abuse Screening Test, Day's Mental Illness Stigma Scale, the Attitudes Toward Psychiatric Medication scale, and the Psychiatric Medication Attitudes Scale. Participants included 383 university students (59.2% female), recruited on the campus of a large state university or through online classes offered through the same university. High rates of psychiatric medication misuse were shown (13.8%) when compared to rates of medical use (6.8%), and students with prescriptions for psychiatric drugs were also more likely to be misusers (χ(2) = 20.60, P < .001). Psychiatric medication misusers reported less stigmatized beliefs toward mental illness, including lower anxiety around the mentally ill (t = 3.26, P < .001) as well as more favorable attitudes toward psychiatric medications (t = 2.78, P < .01) and stronger beliefs in the potential for recovery from mental illness (t = -2.11, P < .05). Students with more stigmatized beliefs had greater concerns about psychiatric medications and less favorable beliefs regarding their effectiveness. Reasons for misuse varied by medication class, with 57.1% of stimulant misusers noting help with studying as their primary reason for use and 33.3% of benzodiazepine misusers noting attempts to get high or "party" as their primary reason for misuse. Results suggest the need for improved education regarding the nature of mental illness, the appropriate use of psychiatric medications, and the potential consequences associated with abuse of these potent drugs. © Copyright 2011 Physicians Postgraduate Press, Inc.

Making psychiatric semiology great again: A semiologic, not nosologic challenge.

PubMed

Micoulaud-Franchi, J-A; Quiles, C; Batail, J-M; Lancon, C; Masson, M; Dumas, G; Cermolacce, M

2018-06-06

This article analyzes whether psychiatric disorders can be considered different from non-psychiatric disorders on a nosologic or semiologic point of view. The supposed difference between psychiatric and non-psychiatric disorders relates to the fact that the individuation of psychiatric disorders seems more complex than for non-psychiatric disorders. This individuation process can be related to nosologic and semiologic considerations. The first part of the article analyzes whether the ways of constructing classifications of psychiatric disorders are different than for non-psychiatric disorders. The ways of establishing the boundaries between the normal and the pathologic, and of classifying the signs and symptoms in different categories of disorder, are analyzed. Rather than highlighting the specificity of psychiatric disorders, nosologic investigation reveals conceptual notions that apply to the entire field of medicine when we seek to establish the boundaries between the normal and the pathologic and between different disorders. Psychiatry is thus very important in medicine because it exemplifies the inherent problem of the construction of cognitive schemes imposed on clinical and scientific medical information to delineate a classification of disorders and increase its comprehensibility and utility. The second part of this article assesses whether the clinical manifestations of psychiatric disorders (semiology) are specific to the point that they are entities that are different from non-psychiatric disorders. The attribution of clinical manifestations in the different classifications (Research Diagnostic Criteria, Diagnostic Statistic Manual, Research Domain Criteria) is analyzed. Then the two principal models on signs and symptoms, i.e. the latent variable model and the causal network model, are assessed. Unlike nosologic investigation, semiologic analysis is able to reveal specific psychiatric features in a patient. The challenge, therefore, is to better define and classify signs and symptoms in psychiatry based on a dual and mutually interactive biological and psychological perspective, and to incorporate semiologic psychiatry into an integrative, multilevel and multisystem brain and cognitive approach. Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

28 CFR 551.114 - Medical, psychiatric and psychological.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Medical, psychiatric and psychological... MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.114 Medical, psychiatric and psychological. (a) Staff shall provide the pretrial inmate with the same level of basic medical (including dental), psychiatric, and...

28 CFR 551.114 - Medical, psychiatric and psychological.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Medical, psychiatric and psychological... MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.114 Medical, psychiatric and psychological. (a) Staff shall provide the pretrial inmate with the same level of basic medical (including dental), psychiatric, and...

28 CFR 551.114 - Medical, psychiatric and psychological.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Medical, psychiatric and psychological... MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.114 Medical, psychiatric and psychological. (a) Staff shall provide the pretrial inmate with the same level of basic medical (including dental), psychiatric, and...

42 CFR 441.151 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.151 General requirements. (a) Inpatient psychiatric services for individuals under age 21 must be: (1) Provided under the direction of a physician; (2) Provided by— (i) A psychiatric hospital that undergoes a...

32 CFR 1701.13 - Special procedures for medical/psychiatric/psychological records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Special procedures for medical/psychiatric... procedures for medical/psychiatric/psychological records. Current and former ODNI employees, including... access to their medical, psychiatric or psychological testing records by writing to: Information and...

42 CFR 441.181 - Maintenance of effort: Explanation of terms and requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... APPLICABLE TO SPECIFIC SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric... per capita non-Federal expenditures are expenditures for inpatient psychiatric services determined by... inpatient psychiatric services in the current quarter means— (i) The number of individuals receiving...

Suicide ideation and attempts in children with psychiatric disorders and typical development.

PubMed

Dickerson Mayes, Susan; Calhoun, Susan L; Baweja, Raman; Mahr, Fauzia

2015-01-01

Children and adolescents with psychiatric disorders are at increased risk for suicide behavior. This is the first study to compare frequencies of suicide ideation and attempts in children and adolescents with specific psychiatric disorders and typical children while controlling for comorbidity and demographics. Mothers rated the frequency of suicide ideation and attempts in 1,706 children and adolescents with psychiatric disorders and typical development, 6-18 years of age. For the typical group, 0.5% had suicide behavior (ideation or attempts), versus 24% across the psychiatric groups (bulimia 48%, depression or anxiety disorder 34%, oppositional defiant disorder 33%, ADHD-combined type 22%, anorexia 22%, autism 18%, intellectual disability 17%, and ADHD-inattentive type 8%). Most alarming, 29% of adolescents with bulimia often or very often had suicide attempts, compared with 0-4% of patients in the other psychiatric groups. It is important for professionals to routinely screen all children and adolescents who have psychiatric disorders for suicide ideation and attempts and to treat the underlying psychiatric disorders that increase suicide risk.

Military deployment to the Gulf War as a risk factor for psychiatric illness among US troops.

PubMed

Fiedler, Nancy; Ozakinci, Gozde; Hallman, William; Wartenberg, Daniel; Brewer, Noel T; Barrett, Drue H; Kipen, Howard M

2006-05-01

Several studies document an excess of psychiatric symptoms among veterans of the the 1991 Gulf War. However, little is known about the prevalence of psychiatric disorders in those who were deployed to that conflict. To compare the 12-month prevalence and associated risk factors for DSM Axis I psychiatric diagnoses between random samples of Gulf War-deployed veterans and veterans of the same era not deployed to the Persian Gulf (era veterans). Interview data from 967 Gulf War veterans and 784 era veterans were examined to determine current health status, medical conditions, symptoms and Axis I psychiatric disorders. Logistic regression models evaluated risk factors for psychiatric disorder. Gulf War veterans had a significantly higher prevalence of psychiatric diagnoses, with twice the prevalence of anxiety disorders and depression. Lower rank, female gender and divorced or single marital status were significant independent predictors of psychiatric disorder. Deployment to the Gulf War is associated with a range of mental health outcomes more than 10 years after deployment.

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.

Psychiatric service use and psychiatric disorders in adults with intellectual disability.

PubMed

Bhaumik, S; Tyrer, F C; McGrother, C; Ganghadaran, S K

2008-11-01

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 disorders in this population. A cross-sectional study was carried out on all adults with ID using specialist services in Leicestershire and Rutland, UK, between 2001 and 2006. Characteristics of individuals seen by psychiatric services and the nature and prevalence of psychiatric disorders were investigated. Of 2711 adults identified, 1244 (45.9%) accessed specialist psychiatric services at least once during the study period. Individuals attending psychiatric services were more likely to be older and to live in residential settings; they were less likely to be south Asian or to have mild/moderate ID. The prevalence of psychiatric disorders among the total study population was 33.8%; the most common disorders were behaviour disorder (19.8%) and autistic spectrum disorders (8.8%). Epilepsy was highly prevalent (60.8%) among those attending psychiatric services without a mental health diagnosis. Behaviour disorders and autistic spectrum disorders were more common in men and in adults with severe/profound ID, whereas schizophrenia and organic disorders were more common in women and in adults with mild/moderate ID. Depression was also more common in women with ID. Psychiatric disorders and specialist health problems are common among adults with ID and the profile of psychiatric disorders differs from that found in general psychiatry. Close collaboration between general and specialist service providers is needed if the current move towards use of general psychiatric services in this population is to be achieved. The measures should include a clear care pathway for people with ID and mental health problems to facilitate the smooth transfer of patients between specialist and generic mental health services and arrangements for joint working where input from both services is required. The commissioning framework for such processes should be in place with appropriate pooling of resources.

On the Moral Acceptability of Physician-Assisted Dying for Non-Autonomous Psychiatric Patients.

PubMed

Varelius, Jukka

2016-05-01

Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in current medical ethics and law, practices often referred to as 'passive euthanasia'. © 2015 John Wiley & Sons Ltd.

Multidisciplinary, Nurse-Led Psychiatric Consultation in Nursing Homes: A Pilot Study in Clinical Practice.

PubMed

Koekkoek, Bauke; van Baarsen, Carlijn; Steenbeek, Mirella

2016-07-01

To determine the effects of multidisciplinary, nurse-led psychiatric consultation on behavioral problems of nursing home residents. Residents often suffer from psychiatric symptoms, while staff psychiatric expertise varies. A pre-post study was conducted in seven homes using the Neuropsychiatric Inventory Nursing Home version (NPI-NH). In 71 consultations during 18 months, 56-75% of residents suffered from agitation/aggression, depression, anxiety, and disinhibition. Post-intervention (n = 54), frequency, and severity of psychiatric symptoms were significantly and clinically meaningfully reduced. Also, staff suffered from less work stress. Nurse-led psychiatric consultation is valuable to both nursing home residents and staff. © 2015 Wiley Periodicals, Inc.

Facing the challenges and building solutions in clinical psychiatric nursing in Iran: a qualitative study.

PubMed

Zarea, Kourosh; Nikbakht-Nasrabadi, Alireza; Abbaszadeh, Abbas; Mohammadpour, Ali

2012-10-01

Psychiatric nurses play an important role in the process of caring for mentally ill patients and are continually faced with the numerous challenges and complex issues related to this field. This study aimed to understand the perspectives of psychiatric nurses regarding the issues they face while providing care and examine the possible solutions for improvement of inpatient care in clinical settings. The study adopted a qualitative approach that utilized a content analysis of audio taped, semi-structured interviews that had been conducted with 24 nurses. Two main themes emerged from the data. The first, Challenges in Providing Care within Psychiatric Wards, had the following subthemes: Politics and Rules of Organization, Safety and Security Issues, Uncertainty about the Role, Lack of Trained Staff, and Sociocultural Issues. The second theme, Solutions for Improving Psychiatric Care, had the subthemes of Empowerment across four domains: Psychiatric Nurses, Mentally Ill Patients and their Families, The Psychiatric Mental Health System, and the Cultural Context. The results indicated that if nurses are expected to provide optimal nursing care within a psychiatric ward, then there is a need for a stable and responsible organizational structure, skilled psychiatric nurses, and community-based care along with an anti-stigma program.

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

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.

American Psychiatric Nurses Association-Transitions in Practice Certificate Program: Bridging the Knowledge Gap in Caring for Psychiatric Patients Within the General Nursing Workforce.

PubMed

Adams, Susie M; Black, Patricia

2016-01-01

The purpose of this article is to publicize an important new Web-based educational program. Recognizing the growing gap in psychiatric-mental health knowledge and the need to better prepare new graduates and nurses transitioning from other service lines into psychiatric inpatient nursing settings, the American Psychiatric Nurses Association developed a 15-hour, modularized curriculum to provide foundational psychiatric-mental health knowledge. This modularized curriculum, called American Psychiatric Nurses Association Transitions in Practice (ATP) focuses on the knowledge and skills to insure the success of nurses new to psychiatric-mental health nursing settings and to improve the overall care for persons with mental health and substance use disorders. The ATP program is also proving to be useful content for nurses in emergency departments, hospitals, and other health settings to improve their care of patients with psychiatric and mental health needs. A summary of the program modules and a toolkit with suggested measures for nurses, patients, and agency outcomes is described. Feedback from participants completing the ATP program within the first 6 months is overwhelmingly positive and holds promise for widespread application across a variety of health care settings.

Physical factors that influence patients' privacy perception toward a psychiatric behavioral monitoring system: a qualitative study.

PubMed

Zakaria, Nasriah; Ramli, Rusyaizila

2018-01-01

Psychiatric patients have privacy concerns when it comes to technology intervention in the hospital setting. In this paper, we present scenarios for psychiatric behavioral monitoring systems to be placed in psychiatric wards to understand patients' perception regarding privacy. Psychiatric behavioral monitoring refers to systems that are deemed useful in measuring clinical outcomes, but little research has been done on how these systems will impact patients' privacy. We conducted a case study in one teaching hospital in Malaysia. We investigated the physical factors that influence patients' perceived privacy with respect to a psychiatric monitoring system. The eight physical factors identified from the information system development privacy model, a comprehensive model for designing a privacy-sensitive information system, were adapted in this research. Scenario-based interviews were conducted with 25 patients in a psychiatric ward for 3 months. Psychiatric patients were able to share how physical factors influence their perception of privacy. Results show how patients responded to each of these dimensions in the context of a psychiatric behavioral monitoring system. Some subfactors under physical privacy are modified to reflect the data obtained in the interviews. We were able to capture the different physical factors that influence patient privacy.

Risk of suicide according to the level of psychiatric contact in the older people: Analysis of national health insurance databases in Taiwan.

PubMed

Yeh, Shin-Ting; Ng, Yee-Yung; Wu, Shiao-Chi

2017-04-01

Suicide in the older people is a serious problem worldwide; however the effect of psychiatric contact on the risk of suicide has not been fully explored. The aim of this study was to investigate the relationship between psychiatric contact and suicide in the older people in Taiwan. A population-based database was used in this national case-control study. Propensity score matching was used to match older people who did and did not commit suicide from 2010 to 2012 by calendar year, gender, age, and area of residence. The level of psychiatric contact in the preceding year was classified as "no psychiatric contact," "only outpatient psychiatric contact," "psychiatric emergency room contact," or "psychiatric hospital admission". Conditional logistic regression analysis was used to assess associations between variables and the risk of suicide. A total of 2528 older people committed suicide from 2010 to 2012, with a crude suicide mortality rate of 3.37/10,000. Compared to those who had no psychiatric contact in the preceding year, the adjusted odds ratios of suicide were 10.15 (95% CI=5.8-17.7) for those who had psychiatric emergency room contact, 6.57 (95% CI=3.7-11.6) for those who had psychiatric hospital admissions, and 3.64 (95% CI=3.0-4.4) for those with only outpatient psychiatric contact. The risk of suicide was higher in those who had depression (OR=3.49, 95% CI=2.2-5.4) and bipolar disorder (OR=1.98, 95% CI=1.1-3.6). Patients with cancer were associated with suicide (OR=8.96, 95% CI=5.6-14.4). The positive association with suicide and the level of psychiatric contact in the preceding year in older people indicated that the health personnel need to do a better job in determining possible risk for older people who had psychiatric contact, especially in emergency visit or psychiatric admission. A systematic approach to quality improvement in these settings is both available and necessary. Careful discharge planning and safe transitions of care to outpatient services are required for suicide prevention of high-risk patients after discharge. Copyright © 2017 Elsevier Inc. All rights reserved.

Psychiatric Correlates of Nonsuicidal Cutting Behaviors in an Adolescent Inpatient Sample

ERIC Educational Resources Information Center

Swenson, Lance P.; Spirito, Anthony; Dyl, Jennifer; Kittler, Jennifer; Hunt, Jeffrey I.

2008-01-01

This archival study of 288 adolescent psychiatric inpatients examined the psychiatric correlates of cutting behavior. Participants were categorized into Threshold cutters (n = 61), Subthreshold cutters (n = 43), and Noncutters (n = 184). Groups were compared on psychiatric diagnoses, suicidality, and self-reported impairment. Results demonstrated…

42 CFR 456.170 - 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... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric, and social evaluations. (a) Before admission to a mental hospital or before authorization for payment...

42 CFR 456.170 - 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... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric, and social evaluations. (a) Before admission to a mental hospital or before authorization for payment...

42 CFR 456.170 - 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... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric, and social evaluations. (a) Before admission to a mental hospital or before authorization for payment...

42 CFR 456.170 - 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... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric, and social evaluations. (a) Before admission to a mental hospital or before authorization for payment...

42 CFR 456.170 - Medical, psychiatric, and social evaluations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric, and social evaluations. (a) Before admission to a mental hospital or before authorization for payment...

Mental health literacy: knowledge of depression among undergraduate students in Hanoi, Vietnam.

PubMed

Nguyen Thai, Quynh Chi; Nguyen, Thanh Huong

2018-01-01

Mental health literacy (MHL) refers to an individuals' knowledge and beliefs about mental disorders that aid their recognition, management, and prevention. This study aims to investigate the MHL of depression among public health and sociology undergraduate students in Hanoi, Vietnam. A cross-sectional survey was carried out from May to September 2015. Data was collected using an anonymous, self-administered questionnaire distributed to 350 undergraduate students (213 public health majors; 137 sociology majors). Questions about MHL of depression were adapted from the Australian National Survey of Mental Health Literacy and Stigma. Question topics included recognition of depression, help-seeking intentions, first-aid support, and knowledge about interventions to help people with depression. Chi squared tests were conducted to compare proportional statistics across groups for multiple measures. With regard to recognition of mental disorders, 32.0% of the respondents used the accurate label "depression" for the vignette. Among those who correctly identified depression, 82.1% would seek help. The corresponding statistic was 81.1% from those who did not recognize depression. Both groups would seek help from counselor, psychologist, family members, and close friends. First-aid support suggested by the respondents in both groups were informal sources ( to listen to her problem in an understanding way, to encourage her to be more physically active , etc.). The interventions considered most helpful by the respondents were self-help strategies such as learning how to relax , getting physically active , doing exercise early in the morning , and reading a self - help book . Joining a group of individuals with similar problems was chosen to be a helpful intervention among those who did not recognize depression (p < 0.001), but those who correctly identify depression believed that people with depression should be admitted to hospital for psychiatric treatment (p < 0.05). There is a need for education about MHL of depression among undergraduate students in Vietnam. The training can focus on symptoms of depression, appropriate help-seeking intentions, and first-aid support relevant to the Vietnamese context.

Cushing Disease Presenting as Primary Psychiatric Illness: A Case Report and Literature Review.

PubMed

Rasmussen, Sean A; Rosebush, Patricia I; Smyth, Harley S; Mazurek, Michael F

2015-11-01

We report the case of a woman with long-standing refractory depression and psychotic features who was eventually diagnosed with Cushing disease. After surgical treatment of a pituitary adenoma, she experienced gradual psychiatric recovery and was eventually able to discontinue all psychotropic medication. We review the psychiatric components of Cushing disease, implications of psychiatric illnesses for the treatment and prognosis of Cushing disease, and potential pathophysiological mechanisms linking glucocorticoid excess to psychiatric illness.

Association between poverty and psychiatric disability among Chinese population aged 15-64 years.

PubMed

Li, Ning; Pang, Lihua; Du, Wei; Chen, Gong; Zheng, Xiaoying

2012-12-30

Psychiatric disability is an important public health problem in China, and poverty may be positively correlated with disability. Little study in the existing literatures has explored the contribution of poverty to the psychiatric disability among Chinese population. Using a nationally representative data, this paper aims to investigate the association between poverty and psychiatric disability in Chinese population aged 15-64 years. We used the second China National Sample Survey on Disability, comprising 1.8 million people aged 15-64 years. Identification and classification for psychiatric disability was based on consensus manuals. We used standard weighting procedures to construct sample weights considering the multistage stratified cluster sampling survey scheme. Population weighted numbers, weighted proportions, and the adjusted Odd Ratios (OR) were calculated. For people with psychiatric disability aged 15-64 years, more than 4 million were below the poverty level in China. After controlling for other demographic variables, poverty was found to be significantly associated with psychiatric disability (OR=2.25, 95% Confidence Interval (CI) 2.15-2.35). Given China is undergoing rapid social-economic transition and psychiatric diseases become a leading burden to the individuals, community, and health care systems, poverty reduction programs are warranted to prevent psychiatric disability and/or improve the lives for persons with psychiatric disability. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Psychiatric Symptoms in Patients with Cushing's Syndrome: Prevalence, Diagnosis and Management.

PubMed

Santos, Alicia; Resmini, Eugenia; Pascual, Juan Carlos; Crespo, Iris; Webb, Susan M

2017-05-01

Cushing's syndrome (CS) results from chronic exposure to cortisol excess, produced by the adrenal cortex. Hypercortisolism predisposes to psychiatric and neurocognitive disorders, mainly to depression and anxiety disorders. Screening tools to identify psychiatric symptoms are available for clinicians in their daily practice, although a specific diagnosis should be performed by specialists. Even if psychiatric symptoms improve after remission of hypercortisolism, complete recovery may not be achieved. Given the burden of these symptoms, psychiatric or psychological monitoring and treatment should be offered through all phases of CS, with a multidisciplinary approach. The aim of this article is to review data on the prevalence, diagnosis and management of psychiatric symptoms seen in patients with CS and to propose therapeutic approaches that may be followed in clinical practice. The prevalence of different psychiatric disorders has been described in both the active phase and after CS remission. Patients may not talk spontaneously about psychiatric symptoms they present, thus clinicians should ask directly about them. We recommend the use of screening tools in clinical practice to detect and treat these symptoms promptly. Even if reference endocrinologists cannot perform a definite psychiatric diagnosis, it will be important to ask patients directly about the presence of symptoms and refer if necessary to a psychiatrist. Additionally, patient information and educational programmes could be useful to manage psychiatric symptoms and to improve quality of life in patients with CS.

Psychiatric and neurological symptoms in patients with Niemann-Pick disease type C (NP-C): Findings from the International NPC Registry.

PubMed

Bonnot, Olivier; Gama, Clarissa S; Mengel, Eugen; Pineda, Mercè; Vanier, Marie T; Watson, Louise; Watissée, Marie; Schwierin, Barbara; Patterson, Marc C

2017-10-09

Niemann-Pick disease type C (NP-C) is a rare inherited neurovisceral disease that should be recognised by psychiatrists as a possible underlying cause of psychiatric abnormalities. This study describes NP-C patients who had psychiatric manifestations at enrolment in the international NPC Registry, a unique multicentre, prospective, observational disease registry. Treating physicians' data entries describing psychiatric manifestations in NPC patients were coded and grouped by expert psychiatrists. Out of 386 NP-C patients included in the registry as of October 2015, psychiatric abnormalities were reported to be present in 34% (94/280) of those with available data. Forty-four patients were confirmed to have identifiable psychiatric manifestations, with text describing these psychiatric manifestations. In these 44 patients, the median (range) age at onset of psychiatric manifestations was 17.9 years (2.5-67.9; n = 15), while the median (range) age at NP-C diagnosis was 23.7 years (0.2-69.8; n = 34). Almost all patients (43/44; 98%) had an occurrence of ≥1 neurological manifestation at enrolment. These data show that substantial delays in diagnosis of NP-C are long among patients with psychiatric symptoms and, moreover, patients presenting with psychiatric features and at least one of cognitive impairment, neurological manifestations, and/or visceral symptoms should be screened for NP-C.

Pegylated interferon-alpha2b plus ribavirin therapy in patients with hepatitis C and psychiatric disorders: results of a cohort study.

PubMed

Lang, Jean-Philippe; Melin, Pascal; Ouzan, Denis; Rotily, Michel; Fontanges, Thierry; Marcellin, Patrick; Chousterman, Michel; Cacoub, Patrice

2010-01-01

Hepatitis C antiviral therapies have significant psychiatric side effects. It is therefore believed that they might exacerbate mental illness in patients with pre-existing psychiatric disorders, resulting in poor adherence and response to antiviral treatment. We aimed to assess adherence to treatment, virological outcomes and mental safety in psychiatric patients, compared with non-psychiatric patients, treated for hepatitis C. A cohort study involved unselected hepatitis C patients on scheduled therapy with pegylated interferon-alpha2b and ribavirin, between 2002 and 2005 in France, and followed-up until 6 months after the end of treatment. Virological response was reported by the physician according to standard definitions and adverse events were monitored. Adherence to treatment was assessed by patient report. Among 1,860 patients, 403 (22%) had pre-existing psychiatric disorders, mostly depressive and anxiety disorders. Strict adherence was similar in psychiatric and non-psychiatric patients (35% versus 39%; P=0.20) as was the rate of sustained virological response (52% versus 51%; P=0.75). Conversely the rate of mental adverse events was higher in psychiatric patients (78% versus 57%; P<0.001). Baseline characteristics independently associated with the risk of later mental adverse events were history of depression, initial pegylated interferon-alpha2b dose and female gender. Antiviral therapy in hepatitis C patients with associated psychiatric disease appears as effective as in other patients but results in a higher rate of mental adverse events, emphasizing the need for close monitoring of these psychiatric patients.

Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke.

PubMed

Bongiorno, Diana M; Daumit, Gail L; Gottesman, Rebecca F; Faigle, Roland

2018-03-01

Intravenous thrombolysis (IVT) improves outcomes after acute ischemic stroke but is underused in certain patient populations. Mental illness is pervasive in the United States, and patients with comorbid psychiatric disease experience inequities in treatment for a range of conditions. We aimed to determine whether comorbid psychiatric disease is associated with differences in IVT use in acute ischemic stroke. Acute ischemic stroke admissions between 2007 and 2011 were identified in the Nationwide Inpatient Sample. Psychiatric disease was defined by International Classification of Diseases , Ninth Revision, Clinical Modification codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, depression, or anxiety. Using logistic regression, we tested the association between IVT and psychiatric disease, controlling for demographic, clinical, and hospital factors. Of the 325 009 ischemic stroke cases meeting inclusion criteria, 12.8% had any of the specified psychiatric comorbidities. IVT was used in 3.6% of those with, and 4.4% of those without, psychiatric disease ( P <0.001). Presence of any psychiatric disease was associated with lower odds of receiving IVT (adjusted odds ratio, 0.80; 95% confidence interval, 0.76-0.85). When psychiatric diagnoses were analyzed separately individuals with schizophrenia or other psychoses, anxiety, or depression each had significantly lower odds of IVT compared to individuals without psychiatric disease. Acute ischemic stroke patients with comorbid psychiatric disease have significantly lower odds of IVT. Understanding barriers to IVT use in such patients may help in developing interventions to increase access to evidence-based stroke care. © 2018 American Heart Association, Inc.

Prevalence and risk factors of psychiatric disorders in early adolescence: 2004 Pelotas (Brazil) birth cohort.

PubMed

La Maison, Carolina; Munhoz, Tiago N; Santos, Iná S; Anselmi, Luciana; Barros, Fernando C; Matijasevich, Alicia

2018-04-13

The present study aimed to evaluate the prevalence of psychiatric disorders in early adolescence, to examine the distribution of psychiatric disorders by maternal and child characteristics and to evaluate the occurrence of psychiatric comorbidities. This was a prospective cohort study of all live births in the city of Pelotas, Brazil, in 2004 (n = 4231). A total of 3562 subjects were evaluated at 11 years of age. Psychiatric disorders were assessed using the Development and Well-Being Assessment. Crude and adjusted logistic regression was used to investigate risk factors for any psychiatric disorder. According to DSM-5 criteria, the overall prevalence of psychiatric disorders was 13.2% (n = 471), 15.6% among the boys and 10.7% among the girls. The most common disorders were anxiety disorders (4.3%), any attention deficit/hyperactivity disorder (4.0%) and any conduct/oppositional disorder (2.8%). Low maternal education, smoking during pregnancy, the presence of moods symptoms during pregnancy or maternal chronic and severe depressive symptoms in the first years of the adolescent´s life, male gender, 5-min Apgar score < 7 at birth and preterm birth were associated with higher odds of any psychiatric disorder at age 11. Psychiatric comorbidities were observed in 107 subjects (22.7%), of whom 73, 24, and 10 had two, three, and four psychiatric diagnoses, respectively. Our results underscore the importance of psychiatric disorders as a prevalent condition in early adolescence, which has a direct impact on the planning of public policies and specific mental health care services in this age group.

[Psychiatric consultations for nursing-home residents: aspects and course of such consultations].

PubMed

Steenbeek, M; van Baarsen, C; Koekkoek, B

2012-01-01

Psychiatric symptoms occur frequently in nursing-home residents. The psychiatric expertise and support available to residents vary from one nursing home to another. International studies show that psychiatric consultations can be effective, but in the Netherlands very little research has been done on this topic. To list the types of psychiatric problems and symptoms for which consultations are requested and to determine whether a psychiatric consultation can have positive results for nursing-home residents and staff. The psychiatric consultations requested were tabulated and were analysed. Details of 71 psychiatric consultations were recorded. The percentage of women (average age 74 years) was slightly higher than the percentage of men. More than 75% of the patients suffered from agitation/aggression or irritability, 65% suffered from depression, 63% from anxiety and 56% from dysinhibition. A post-intervention assessment was performed in 54 patients (76%). In this group psychiatric symptoms were found to be greatly reduced, with regard to both frequency and severity. In addition, nursing staff seemed to suffer less of the stress and strain in their work. The patients for whom a consultation was requested seemed to suffer from serious psychiatric symptoms and were often aggressive. It was possible to achieve substantial progress as a result of a simple intervention. A possible explanation for this effect is probably the nature of the psychiatric consultation used; it was structured, multi-disciplinary and time-consuming. However, since no control group was involved, it is impossible to say with certainty that the reduction in symptoms can be attributed solely to the consultation.

Celiac Disease Is Associated with Childhood Psychiatric Disorders: A Population-Based Study.

PubMed

Butwicka, Agnieszka; Lichtenstein, Paul; Frisén, Louise; Almqvist, Catarina; Larsson, Henrik; Ludvigsson, Jonas F

2017-05-01

To determine the risk of future childhood psychiatric disorders in celiac disease, assess the association between previous psychiatric disorders and celiac disease in children, and investigate the risk of childhood psychiatric disorders in siblings of celiac disease probands. This was a nationwide registry-based matched cohort study in Sweden with 10 903 children (aged <18 years) with celiac disease and 12 710 of their siblings. We assessed the risk of childhood psychiatric disorders (any psychiatric disorder, psychotic disorder, mood disorder, anxiety disorder, eating disorder, psychoactive substance misuse, behavioral disorder, attention-deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], and intellectual disability). HRs of future psychiatric disorders in children with celiac disease and their siblings was estimated by Cox regression. The association between previous diagnosis of a psychiatric disorder and current celiac disease was assessed using logistic regression. Compared with the general population, children with celiac disease had a 1.4-fold greater risk of future psychiatric disorders. Childhood celiac disease was identified as a risk factor for mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD, and intellectual disability. In addition, a previous diagnosis of a mood, eating, or behavioral disorder was more common before the diagnosis of celiac disease. In contrast, siblings of celiac disease probands were at no increased risk of any of the investigated psychiatric disorders. Children with celiac disease are at increased risk for most psychiatric disorders, apparently owing to the biological and/or psychological effects of celiac disease. Copyright © 2017 Elsevier Inc. All rights reserved.

Unsupervised classification of major depression using functional connectivity MRI.

PubMed

Zeng, Ling-Li; Shen, Hui; Liu, Li; Hu, Dewen

2014-04-01

The current diagnosis of psychiatric disorders including major depressive disorder based largely on self-reported symptoms and clinical signs may be prone to patients' behaviors and psychiatrists' bias. This study aims at developing an unsupervised machine learning approach for the accurate identification of major depression based on single resting-state functional magnetic resonance imaging scans in the absence of clinical information. Twenty-four medication-naive patients with major depression and 29 demographically similar healthy individuals underwent resting-state functional magnetic resonance imaging. We first clustered the voxels within the perigenual cingulate cortex into two subregions, a subgenual region and a pregenual region, according to their distinct resting-state functional connectivity patterns and showed that a maximum margin clustering-based unsupervised machine learning approach extracted sufficient information from the subgenual cingulate functional connectivity map to differentiate depressed patients from healthy controls with a group-level clustering consistency of 92.5% and an individual-level classification consistency of 92.5%. It was also revealed that the subgenual cingulate functional connectivity network with the highest discriminative power primarily included the ventrolateral and ventromedial prefrontal cortex, superior temporal gyri and limbic areas, indicating that these connections may play critical roles in the pathophysiology of major depression. The current study suggests that subgenual cingulate functional connectivity network signatures may provide promising objective biomarkers for the diagnosis of major depression and that maximum margin clustering-based unsupervised machine learning approaches may have the potential to inform clinical practice and aid in research on psychiatric disorders. Copyright © 2013 Wiley Periodicals, Inc.

A latent class analysis of drug abuse in a national Swedish sample.

PubMed

Kendler, K S; Ohlsson, H; Sundquist, K; Sundquist, J

2013-10-01

Drug abuse (DA) is a clinically heterogeneous syndrome. Using medical, legal, death and pharmacy records covering the entire population of Sweden, could we uncover meaningful subtypes of DA? We performed a latent class analysis (LCA) on all individuals in Sweden born 1950–1993 who were registered with DA or its consequences (n=192,501) and then validated these classes using demographics, patterns of co-morbidity with alcohol use disorder (AUD), non-DA crime and psychiatric illness, and the pattern of aggregation and co-aggregation in sibling pairs. The best-fit LCA had six classes : (1) low-frequency pure criminal, (2) high-frequency medical criminal, (3) low-frequency pure medical, (4) high-frequency medical, (5) prescription and (6) death. Each class had a distinct pattern of demographic features and co-morbidity and aggregated within sibling pairs with at least moderate specificity. For example, class 2 was characterized by early age at registration, low educational attainment, high male preponderance, high rates of AUDs, strong resemblance within sibling pairs [odds ratio (OR) 12.6] and crime and the highest risk for DA in siblings (20.0%). By contrast, class 5 had a female preponderance, late age at registration, low rates of crime and AUDs, high rates of psychiatric illness, high familiality within sibling pairs (OR 14.7) but the lowest observed risk for DA in siblings (8.9%). DA as assessed by public records is a heterogeneous syndrome. Familial factors contribute substantially to this heterogeneity. Advances in our understanding of etiological processes leading to DA will be aided by a consideration of this heterogeneity.

Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit.

PubMed

Payne, Ann; Barry, Sandra; Creedon, Brian; Stone, Carol; Sweeney, Catherine; O' Brien, Tony; O' Sullivan, Kathleen

2007-04-01

The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. A prospective sample of consecutive admissions (n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9-97.0) but a lower specificity of 67.7% (95% CI 58.7-75.7). The false positive rate was 32.3% (95% CI 24.3-41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0-23.1). A subgroup analysis of individuals with a past experience of depressive illness, (n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16/29) compared to those with no background history of depression, 33.3% (22/66) (P = 0.045). The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness (P = 0.045).

Shelter-based palliative care for the homeless terminally ill.

PubMed

Podymow, Tiina; Turnbull, Jeffrey; Coyle, Doug

2006-03-01

The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed. 28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared. 28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described. The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.

Rapid response: email, immediacy, and medical humanitarianism in Aceh, Indonesia.

PubMed

Grayman, Jesse Hession

2014-11-01

After more than 20 years of sporadic separatist insurgency, the Free Aceh Movement and the Indonesian government signed an internationally brokered peace agreement in August 2005, just eight months after the Indian Ocean tsunami devastated Aceh's coastal communities. This article presents a medical humanitarian case study based on ethnographic data I collected while working for a large aid agency in post-conflict Aceh from 2005 to 2007. In December 2005, the agency faced the first test of its medical and negotiation capacities to provide psychiatric care to a recently amnestied political prisoner whose erratic behavior upon returning home led to his re-arrest and detention at a district police station. I juxtapose two methodological approaches-an ethnographic content analysis of the agency's email archive and field-based participant-observation-to recount contrasting narrative versions of the event. I use this contrast to illustrate and critique the immediacy of the humanitarian imperative that characterizes the industry. Immediacy is explored as both an urgent moral impulse to assist in a crisis and a form of mediation that seemingly projects neutral and transparent transmission of content. I argue that the sense of immediacy afforded by email enacts and amplifies the humanitarian imperative at the cost of abstracting elite humanitarian actors out of local and moral context. As a result, the management and mediation of this psychiatric case by email produced a bureaucratic model of care that failed to account for complex conditions of chronic political and medical instability on the ground. Copyright © 2014 Elsevier Ltd. All rights reserved.

Experience sampling methodology in mental health research: new insights and technical developments.

PubMed

Myin-Germeys, Inez; Kasanova, Zuzana; Vaessen, Thomas; Vachon, Hugo; Kirtley, Olivia; Viechtbauer, Wolfgang; Reininghaus, Ulrich

2018-06-01

In the mental health field, there is a growing awareness that the study of psychiatric symptoms in the context of everyday life, using experience sampling methodology (ESM), may provide a powerful and necessary addition to more conventional research approaches. ESM, a structured self-report diary technique, allows the investigation of experiences within, and in interaction with, the real-world context. This paper provides an overview of how zooming in on the micro-level of experience and behaviour using ESM adds new insights and additional perspectives to standard approaches. More specifically, it discusses how ESM: a) contributes to a deeper understanding of psychopathological phenomena, b) allows to capture variability over time, c) aids in identifying internal and situational determinants of variability in symptomatology, and d) enables a thorough investigation of the interaction between the person and his/her environment and of real-life social interactions. Next to improving assessment of psychopathology and its underlying mechanisms, ESM contributes to advancing and changing clinical practice by allowing a more fine-grained evaluation of treatment effects as well as by providing the opportunity for extending treatment beyond the clinical setting into real life with the development of ecological momentary interventions. Furthermore, this paper provides an overview of the technical details of setting up an ESM study in terms of design, questionnaire development and statistical approaches. Overall, although a number of considerations and challenges remain, ESM offers one of the best opportunities for personalized medicine in psychiatry, from both a research and a clinical perspective. © 2018 World Psychiatric Association.

A Comparison of Psychiatry and Internal Medicine: A Bibliometric Study

ERIC Educational Resources Information Center

Stone, Karina; Whitham, Elizabeth A.; Ghaemi, S. Nassir

2012-01-01

Objective: Psychiatric education needs to expose students to a broad range of topics. One resource for psychiatric education, both during initial training and in later continuing medical education, is the scientific literature, as published in psychiatric journals. The authors assessed current research trends in psychiatric journals, as compared…

Characteristics of a French African Caribbean Epidemiological Psychiatric Sample with a History of Suicide Attempt

ERIC Educational Resources Information Center

Slama, Frederic; Dehurtevent, Benedicte; Even, Jean-Daniel; Charles-Nicolas, Aime; Ballon, Nicolas; Slama, Remy

2008-01-01

Research on vulnerability factors among ethnic groups, independent of primary psychiatric diagnosis, may help to identify groups at risk of suicidal behavior. French African Caribbean general psychiatric patients (N = 362) were recruited consecutively and independently of the primary psychiatric diagnosis. Demographic and clinical characteristics…

Dissociative and Sexual Behaviors in Children and Adolescents with Sexual Abuse and Psychiatric Histories.

ERIC Educational Resources Information Center

Friedrich, William N.; Jaworski, Theresa M.; Huxsahl, John E.; Bengtson, Brad S.

1997-01-01

Evaluated children (N=350) to assess the degree to which dissociation and sexual behavior discriminated sexually abused children and adolescents from nonpsychiatric and psychiatric comparison groups. Results show that psychiatric and nonpsychiatric samples differed in their reports of sexual concerns and dissociation, whereas psychiatric abused…

42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... other than psychiatric hospitals. (a) Content of certification and recertification. Medicare Part A pays for inpatient hospital services of hospitals other than psychiatric hospitals only if a physician...

42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... psychiatric facilities. 424.14 Section 424.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Certification and Plan Requirements § 424.14 Requirements for inpatient services of inpatient psychiatric... requirements differ from those for other hospitals because the care furnished in psychiatric hospitals is often...

42 CFR 485.647 - Condition of participation: psychiatric and rehabilitation distinct part units.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: psychiatric and... Condition of participation: psychiatric and rehabilitation distinct part units. (a) Conditions. (1) If a CAH provides inpatient psychiatric services in a distinct part unit, the services furnished by the distinct...

College Student Utilization of a Comprehensive Psychiatric Emergency Program

ERIC Educational Resources Information Center

Mitchell, Sharon L.; Kader, Mahrin; Haggerty, Melinda Z.; Bakhai, Yogesh D.; Warren, Calvert G.

2013-01-01

The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatric hospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…

Pragmatism rules: the intervention and prevention strategies used by psychiatric nurses working with non-suicidal self-harming individuals.

PubMed

O'Donovan, A

2007-02-01

Self harm in the absence of expressed suicidal intent is an under explored area in psychiatric nursing research. This paper reports on findings of a study undertaken in two acute psychiatric inpatient units in Ireland. The purpose of the study was to gain an understanding of the practices of psychiatric nurses in relation to people who self harm, but who are not considered suicidal. Semi structured interviews were held with eight psychiatric nurses. Content analysis revealed several themes. For the purpose of this paper the prevention and intervention strategies psychiatric nurses engage in when working with non-suicidal self harming individuals are presented. Recommendations for further research are offered.

[Differences between patients in consultation psychiatry and psychiatric inpatients].

PubMed

Unterecker, Stefan; Maloney, Julia; Pfuhlmann, Bruno; Deckert, Jürgen; Warrings, Bodo

2014-05-01

To optimize psychiatric consultation service epidemiological information is needed. We compared data on gender, age and diagnoses of patients in the consultation service to psychiatric inpatients. In psychiatric consultation service patients are older (56.6 vs. 44.9 years, p < 0.05) and males are older than females (58.8 vs. 54.4 years, p < 0.05). For male patients, the psychiatric consultation service is contacted more often in cases of organic disorders, for females in adjustment disorders (p < 0.05). The diagnostic spectrum in psychiatric consultation service is different for males and females with relevance for diagnostic and therapeutic procedures. © Georg Thieme Verlag KG Stuttgart · New York.

Protective Effects of Psychological Strengths Against Psychiatric Disorders Among Soldiers.

PubMed

Shrestha, Alice; Cornum, B G Rhonda; Vie, Loryana L; Scheier, Lawrence M; Lester, M A J Paul B; Seligman, Martin E P

2018-03-01

This study prospectively examined psychological strengths targeted in U.S. Army training programs as predictors of psychiatric diagnosis in active duty soldiers. At baseline, the cohort (140,584 soldiers) was without psychiatric disorder. Soldiers were then followed for 2 yr and classified as healthy, or acquiring a psychiatric diagnosis (adjustment disorder, anxiety disorder, depression, or post-traumatic stress disorder), or being prescribed psychotropic medication without a psychiatric diagnosis. Soldiers who remained healthy reported significantly higher strengths scores at baseline, compared with soldiers who were diagnosed with a psychiatric disorder. In addition, soldiers in the worst strengths decile were twice as likely to develop a psychiatric disorder, compared with soldiers in the top 50% on baseline strengths. Strengths afforded the greatest protection against depression. Offering tailored resilience training programs could help the Army steel vulnerable soldiers against the challenges of life, military training, and combat.

Encopresis: a guide for psychiatric nurses.

PubMed

Hardy, Lyons T

2009-10-01

Encopresis is an elimination disorder that involves symptoms of fecal incontinence in children. It affects an estimated 1.5% to 7.5% of children ages 6 to 12 and accounts for approximately 3% to 6% of psychiatric referrals. The etiology of encopresis is thought to be related to physiologic problems such as constipation; however, it is also a psychiatric diagnosis and anecdotally may have some association with psychiatric problems. Publications on this association and publications directed toward psychiatric nurses are limited. Encopresis is typically treated with nutritional and medical management along with behavioral modification. Psychiatric nurses working with patients who have encopresis in inpatient settings will have unique concerns and challenges. This article gives an overview of published literature from the past 10 years on the etiology and treatment of encopresis. Specific suggestions for inpatient psychiatric nurses based on published literature and the author's professional experience are provided.

Psychiatric and autistic comorbidity in fragile X syndrome across ages.

PubMed

Gabis, Lidia V; Baruch, Yael Kesner; Jokel, Ariela; Raz, Raanan

2011-08-01

Fragile X syndrome is caused by CGG trinucleotide repeat expansion within the fragile X mental retardation 1 gene, when repeat number exceeds 200. The typical psychiatric profile of fragile X syndrome patients includes cognitive and behavioral deficits, psychiatric comorbidity, and autistic characteristics. Specific psychiatric features have not yet been clarified, specifically in relationship to age and genetic characteristics. The objective of this study was to characterize psychiatric comorbidities in subjects with fragile X syndrome at different ages. Subjects with fragile X syndrome and their unaffected siblings were recruited and their parents filled out functional-behavioral and psychiatric comorbidities questionnaires. Adolescents with fragile X syndrome showed decreased prevalence of functional-behavioral deficits. Incidence and severity of most psychiatric comorbidities were lower in older subjects. Incidence of generalized anxiety disorder increased with age in the fragile X syndrome group. The typical profile of patients with fragile X syndrome changes with age. Unaffected siblings exhibit anxiety and motor tics.

Microendophenotypes of psychiatric disorders: phenotypes of psychiatric disorders at the level of molecular dynamics, synapses, neurons, and neural circuits.

PubMed

Kida, S; Kato, T

2015-01-01

Psychiatric disorders are caused not only by genetic factors but also by complicated factors such as environmental ones. Moreover, environmental factors are rarely quantitated as biological and biochemical indicators, making it extremely difficult to understand the pathological conditions of psychiatric disorders as well as their underlying pathogenic mechanisms. Additionally, we have actually no other option but to perform biological studies on postmortem human brains that display features of psychiatric disorders, thereby resulting in a lack of experimental materials to characterize the basic biology of these disorders. From these backgrounds, animal, tissue, or cell models that can be used in basic research are indispensable to understand biologically the pathogenic mechanisms of psychiatric disorders. In this review, we discuss the importance of microendophenotypes of psychiatric disorders, i.e., phenotypes at the level of molecular dynamics, neurons, synapses, and neural circuits, as targets of basic research on these disorders.

Pituitary gland in psychiatric disorders: a review of neuroimaging findings.

PubMed

Atmaca, Murad

2014-08-01

In this paper, it was reviewed neuroimaging results of the pituitary gland in psychiatric disorders, particularly schizophrenia, mood disorders, anxiety disorders, and somatoform disorders. The author made internet search in detail by using PubMed database including the period between 1980 and 2012 October. It was included in the articles in English, Turkish and French languages on pituitary gland in psychiatric disorders through structural or functional neuroimaging results. After searching mentioned in the Methods section in detail, investigations were obtained on pituitary gland neuroimaging in a variety of psychiatric disorders. There have been so limited investigations on pituitary neuroimaging in psychiatric disorders including major psychiatric illnesses like schizophrenia and mood disorders. Current findings are so far from the generalizability of the results. For this reason, it is required to perform much more neuroimaging studies of pituitary gland in all psychiatric disorders to reach the diagnostic importance of measuring it.

Psychiatric Aspects of Dementia

PubMed Central

Onyike, Chiadi U.

2016-01-01

Purpose of Review: The psychiatric aspects of dementia are increasingly recognized as significant contributors to distress, disability, and care burden, and, thus, are of increasing interest to practicing neurologists. This article examines how psychiatric disorders are entwined with dementia and describes the predictive, diagnostic, and therapeutic implications of the psychiatric symptoms of dementia. Recent Findings: Psychiatric disorders, particularly depression and schizophrenia, are associated with higher risk for late-life dementia. Psychiatric phenomena also define phenotypes such as frontotemporal dementia and dementia with Lewy bodies, cause distress, and amplify dementia-related disabilities. Management requires a multidisciplinary team, a problem-solving stance, programs of care, and pharmacologic management. Recent innovations include model programs that provide structured problem-solving interventions and tailored in-home care. Summary: There is new appreciation of the complexity of the relationship between psychiatric disorders and dementia as well as the significance of this relationship for treatment, community services, and research. PMID:27042910

The effect of menstruation on psychiatric hospitalization.

PubMed

Weston, Jaclyn; Speroni, Karen Gabel; Ellis, Terri; Daniel, Marlon G

2012-07-01

This study evaluated the effect of menstruation on psychiatric hospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatric hospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatric hospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatric hospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission. Copyright 2012, SLACK Incorporated.

Hospitalization Risk Before and After Employment Among Adults With Schizophrenia, Bipolar Disorder, or Major Depression.

PubMed

Luciano, Alison; Metcalfe, Justin D; Bond, Gary R; Xie, Haiyi; Miller, Alexander L; Riley, Jarnee; O'Malley, A James; Drake, Robert E

2016-10-01

The influence of employment on subsequent psychiatric hospitalization for people with serious mental illness is unclear. This study examined whether unemployed people with serious mental illness were more or less likely to experience psychiatric hospitalization after gaining employment. A secondary analysis was conducted of data from the Mental Health Treatment Study. Two years of prospective employment and psychiatric hospital outcomes were examined for 2,055 adults with schizophrenia, bipolar disorder, or major depression. The analyses examined associations between employment and psychiatric hospitalization via multilevel regression by using time-lagged modeling. Employment was associated with a lower subsequent three-month risk of psychiatric hospitalization (odds ratio=.65, 95% confidence interval=.50-.84) after the analysis adjusted for baseline characteristics, including previous psychiatric hospitalizations and self-reported physical health. Unemployed outpatients with serious mental illness were less likely to experience psychiatric hospitalization after gaining employment.

Coping in Chest Pain Patients with and without Psychiatric Disorders.

ERIC Educational Resources Information Center

Vitaliano, Peter P.; And Others

1989-01-01

Examined relations between psychiatric disorder and coronary heart disease (CHD) in 77 patients with chest pain, and compared coping profiles of chest pain patients with and without psychiatric disorders and CHD. Psychiatric patients with no medical disease were also studied. Results are discussed in the context of illness behavior and…

Psychiatric Comorbidity and Functioning in a Clinically Referred Population of Adults with Autism Spectrum Disorders: A Comparative Study

ERIC Educational Resources Information Center

Joshi, Gagan; Wozniak, Janet; Petty, Carter; Martelon, Mary Kate; Fried, Ronna; Bolfek, Anela; Kotte, Amelia; Stevens, Jonathan; Furtak, Stephannie L.; Bourgeois, Michelle; Caruso, Janet; Caron, Ashley; Biederman, Joseph

2013-01-01

To systematically examine the patterns of psychiatric comorbidity and functioning in clinically referred adults with autism spectrum disorders (ASD). Psychiatrically referred adults with and without ASD were compared on measures assessing for psychiatric comorbidity and psychosocial functioning. Sixty-three adults with ASD participated in the…

Childhood-Onset Bipolar Disorder: Evidence for Increased Familial Loading of Psychiatric Illness

ERIC Educational Resources Information Center

Rende, Richard; Birmaher, Boris; Axelson, David; Strober, Michael; Gill, Mary Kay; Valeri, Sylvia; Chiappetta, Laurel; Ryan, Neal; Leonard, Henrietta; Hunt, Jeffrey; Iyengar, Satish; Keller, Martin

2007-01-01

Objective: To determine whether childhood-onset bipolar disorder (BP) is associated with an increased psychiatric family history compared with adolescent-onset BP. Method: Semistructured psychiatric interviews were conducted for 438 youth with BP spectrum disorders. To evaluate the effects of age at onset and psychiatric family history, the sample…

Primary prevention of psychiatric illness in special populations.

PubMed

Sajatovic, Martha; Sanders, Renata; Alexeenko, Lada; Madhusoodanan, Subramoniam

2010-11-01

Some populations appear to be particularly vulnerable to the development of psychiatric symptomatology related to life events and biologic or social/cultural factors. Such groups include individuals who have experienced traumatic events, military personnel, individuals with serious medical conditions, postpartum women, and immigrants. This study reviews the literature regarding primary prevention of psychiatric disorders in special populations and identifies a variety of universal, selective, and indicated prevention measures aimed at minimizing the psychiatric sequelae in these groups. The authors reviewed the literature regarding the prevention of psychiatric symptoms in trauma/abuse victims, individuals in the military, oncology patients, patients with diabetes, pregnant/postpartum women, and immigrants. The literature on primary prevention of psychiatric illness in the special populations identified is rather limited. Universal prevention may be beneficial in some instances through public awareness campaigns and disaster planning. In other instances, more specific and intensive interventions for individuals at high risk of psychiatric illness may improve outcomes, for example, crisis counseling for those who have experienced severe trauma. Primary prevention of psychiatric illness may be an attainable goal via implementation of specific universal, selected, and indicated primary prevention measures in special populations.

Regional supply of outreach service and length of stay in psychiatric hospital among patients with schizophrenia: National case mix data analysis in Japan.

PubMed

Niimura, Junko; Nakanishi, Miharu; Yamasaki, Syudo; Nishida, Atsushi

2017-12-01

Several clinical trials have demonstrated that linkage to an outreach service can prevent prolonged length of stay of patients at psychiatric hospitals. However, there has been no investigation of the association between length of stay in psychiatric hospital and regional supply of outreach services using national case mix data. The aim of this study was to clarify the relationship between length of stay in psychiatric hospital and regional supply of outreach services. We used data from the National Patient Survey in Japan, a nationally representative cross-sectional survey of inpatient care conducted every three years from 1996 to 2014. Data from 42,268 patients with schizophrenia who had been admitted to psychiatric hospitals were analyzed. After controlling for patient and regional characteristics, patients in regions with fewer number of visits for psychiatric nursing care at home had significantly longer length of stay in psychiatric hospitals. This finding implies that enhancement of the regional supply of outreach services would prevent prolonged length of stay in psychiatric hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

Suicidal Behavior in Juvenile Delinquents: The Role of ADHD and Other Comorbid Psychiatric Disorders.

PubMed

Ruchkin, Vladislav; Koposov, Roman A; Koyanagi, Ai; Stickley, Andrew

2017-10-01

This study evaluated the role of psychiatric morbidity in relation to a history of suicidal behavior, with a particular focus on attention-deficit/hyperactivity disorder (ADHD). Suicidality and psychiatric diagnoses were assessed in 370 incarcerated male juvenile delinquents from Northern Russia using the semi-structured K-SADS-PL psychiatric interview. A lifetime history of suicidal ideation only (24.7 %) and suicidal ideation with suicide attempts (15.7 %) was common. Binary logistic regression analysis was used to assess the role of ADHD and other psychiatric disorders in suicidal ideation and suicide attempts. A history of suicidal ideation and of suicide attempts were associated with higher rates of psychiatric morbidity and with the number of comorbid psychiatric disorders. An ADHD diagnosis was associated with an increased risk for both suicidal ideation and for suicide attempts. The comorbidity of ADHD with drug dependence further increased the risk for suicidal ideation, while ADHD and alcohol dependence comorbidity increased the risk for suicide attempts. Our findings highlight the importance of adequately detecting and treating psychiatric disorders in vulnerable youths, especially when they are comorbid with ADHD.

The recognition of diagnosable psychiatric disorders in suicide cases' last medical contacts.

PubMed

Pan, Yi-Ju; Lee, Ming-Been; Chiang, Hung-Chi; Liao, Shih-Cheng

2009-01-01

The objective of this study is to examine physicians' awareness of diagnosable psychiatric disorders in suicide cases' last medical contacts (MCs). The contact rates and proportions of both psychiatric and somatic diagnoses in a national cohort of suicide subjects (N=3468) in Taiwan seeking psychiatric or nonpsychiatric medical services within 1 month and 1 year preceding death were examined. The overall rates of MCs were 72.6% within 1 month and 89.2% within 1 year preceding suicide. While around 99.9% of the suicide subjects who contacted psychiatrists within 1 month preceding death were diagnosed as having psychiatric disorders, only 19.7% of those visiting nonpsychiatric physicians had psychiatric diagnoses. Suicide subjects, however, frequently complained of somatic symptoms, for example, gastrointestinal discomfort, headache/dizziness and back problem during their contacts with nonpsychiatric physicians within 1 month preceding death. Despite the high rates of MCs preceding suicide, the majority of suicide subjects were not diagnosed. Emphasizing psychosomatic manifestations of psychiatric disorders in physician education programs may help enhance the awareness of psychiatric disorders/suicide risk in clinical settings.

Psychiatric comorbidity in patients with spasmodic dysphonia: a controlled study

PubMed Central

Gündel, H; Busch, R; Ceballos‐Baumann, A; Seifert, E

2007-01-01

Objectives To study the prevalence of psychiatric comorbidity assessed by a structured clinical interview in patients with spasmodic dysphonia (SD) compared with patients suffering from vocal fold paralysis (VFP). Methods In 48 patients with SD and 27 patients with VFP, overall psychiatric comorbidity was studied prospectively using the Structured Clinical Interview for DSM‐IV Axis I disorders. Physical disability and psychometric variables were assessed with standardised self‐rating questionnaires. Results 41.7% of SD subjects and 19.5% of the control group met DSM‐IV clinical criteria for current psychiatric comorbidity (p<0.05). Significant predictors of psychiatric comorbidity in SD were severity of voice impairment and subjective assessment of “satisfaction with health”. As a limitation, the severity of voice impairment in patients with SD was nearly twice as high, and their illness had lasted nearly twice as long. Conclusions We found a high prevalence of psychiatric comorbidity in patients with SD. The significant correlation between current psychiatric comorbidity and the extent of voice pathology may point to an especially strong interaction between somatic and psychiatric complaints in SD. PMID:17615166

Psychiatric diagnoses after hospitalization with work-related burn injuries in Washington State.

PubMed

Anderson, Naomi J; Bonauto, David K; Adams, Darrin

2011-01-01

This study aims to describe workers who were hospitalized with work-related burn injuries and their psychiatric sequelae in Washington State. Psychiatric sequelae of interest were depression, posttraumatic stress disorder, and other anxiety disorders. Workers' compensation claims meeting a definition for a hospitalized burn patient from Washington State from January 2001 through April 2008 were analyzed. The resulting claims were searched for the presence of certain psychiatric diagnoses or treatment codes, and descriptive analyses performed. In Washington State during the time period, the prevalence of claims with psychiatric diagnoses after hospitalization with burn injury was 19%. Claims with psychiatric diagnoses had higher medical costs and more days of time loss than those without these diagnoses. Workers with electrical burns in the construction industry and in construction and extraction occupations had a higher proportion of psychiatric sequelae. Burns are devastating yet preventable injuries. Workers who were hospitalized with work-related burn injuries, particularly those in certain industries and occupations and those with electrical burns, are at high risk for developing serious psychiatric sequelae with major costs to both the individual and the society.

Assessing the evidence for shared genetic risks across psychiatric disorders and traits.

PubMed

Martin, Joanna; Taylor, Mark J; Lichtenstein, Paul

2017-12-04

Genetic influences play a significant role in risk for psychiatric disorders, prompting numerous endeavors to further understand their underlying genetic architecture. In this paper, we summarize and review evidence from traditional twin studies and more recent genome-wide molecular genetic analyses regarding two important issues that have proven particularly informative for psychiatric genetic research. First, emerging results are beginning to suggest that genetic risk factors for some (but not all) clinically diagnosed psychiatric disorders or extreme manifestations of psychiatric traits in the population share genetic risks with quantitative variation in milder traits of the same disorder throughout the general population. Second, there is now evidence for substantial sharing of genetic risks across different psychiatric disorders. This extends to the level of characteristic traits throughout the population, with which some clinical disorders also share genetic risks. In this review, we summarize and evaluate the evidence for these two issues, for a range of psychiatric disorders. We then critically appraise putative interpretations regarding the potential meaning of genetic correlation across psychiatric phenotypes. We highlight several new methods and studies which are already using these insights into the genetic architecture of psychiatric disorders to gain additional understanding regarding the underlying biology of these disorders. We conclude by outlining opportunities for future research in this area.

Physical factors that influence patients’ privacy perception toward a psychiatric behavioral monitoring system: a qualitative study

PubMed Central

Zakaria, Nasriah; Ramli, Rusyaizila

2018-01-01

Background Psychiatric patients have privacy concerns when it comes to technology intervention in the hospital setting. In this paper, we present scenarios for psychiatric behavioral monitoring systems to be placed in psychiatric wards to understand patients’ perception regarding privacy. Psychiatric behavioral monitoring refers to systems that are deemed useful in measuring clinical outcomes, but little research has been done on how these systems will impact patients’ privacy. Methods We conducted a case study in one teaching hospital in Malaysia. We investigated the physical factors that influence patients’ perceived privacy with respect to a psychiatric monitoring system. The eight physical factors identified from the information system development privacy model, a comprehensive model for designing a privacy-sensitive information system, were adapted in this research. Scenario-based interviews were conducted with 25 patients in a psychiatric ward for 3 months. Results Psychiatric patients were able to share how physical factors influence their perception of privacy. Results show how patients responded to each of these dimensions in the context of a psychiatric behavioral monitoring system. Conclusion Some subfactors under physical privacy are modified to reflect the data obtained in the interviews. We were able to capture the different physical factors that influence patient privacy. PMID:29343963

Current psychiatric disorders in patients with epilepsy are predicted by maltreatment experiences during childhood.

PubMed

Labudda, Kirsten; Illies, Dominik; Herzig, Cornelia; Schröder, Katharina; Bien, Christian G; Neuner, Frank

2017-09-01

Childhood maltreatment has been shown to be a risk factor for the development of psychiatric disorders. Although the prevalence of psychiatric disorders is high in epilepsy patients, it is unknown if childhood maltreatment experiences are elevated compared to the normal population and if early maltreatment is a risk factor for current psychiatric comorbidities in epilepsy patients. This is the main purpose of this study. Structured interviews were used to assess current Axis I diagnoses in 120 epilepsy patients from a tertiary Epilepsy Center (34 TLE patients, 86 non-TLE patients). Childhood maltreatment in the family and peer victimization were assessed with validated questionnaires. Patients' maltreatment scores were compared with those of a representative matched control group. Logistic regression analysis was conducted to assess the potential impact of childhood maltreatment on current psychiatric comorbidity in epilepsy patients. Compared to a matched control group, epilepsy patients had higher emotional and sexual maltreatment scores. Patients with a current psychiatric diagnosis reported more family and peer maltreatment than patients without a psychiatric disorder. Family maltreatment scores predicted the likelihood of a current psychiatric disorder. TLE patients did not differ from non-TLE patients according to maltreatment experiences and rates of current psychiatric disorders. Our findings suggest that in epilepsy patients emotional and sexual childhood maltreatment is experienced more often than in the normal population and that early maltreatment is a general risk factor for psychiatric comorbidities in this group. Copyright © 2017 Elsevier B.V. All rights reserved.

[The status of the psychiatric nurse as a guarantor in Taiwan: a case study].

PubMed

Huang, Hui-Man; Sun, Fan-Ko

2013-12-01

Psychiatric nurses have a special obligation and legal duty as guarantor against criminal negligence. The guarantor role and medical negligence in psychiatric nursing are topics that have been neglected in Taiwan. (1) Identify the status of psychiatric nurses as guarantors; (2) Understand the causal relationship in a legal context between this status and Non-Genuine Omission in the current case; (3) Understand the facts and the dispute in the current case. (4) Explore the reasons why the psychiatric nurse was convicted for criminal negligence in the current case. A literature review and case study were used to analyze the high court criminal judgment and sentence reconsideration of the first instance No. 122 (2005). (1) Psychiatric nurses hold two guarantor roles in Taiwan. One role is as legally protected interest guarantor and the other is as supervisors' dangerous source guarantor. (2) The three sources of guarantor status relevant to the current case are: nurses' voluntary commitments; medical contract; duty of care of supervisors. (3) In this case, the psychiatric nurse did not discharge her obligations as guarantor and failed to prevent the patient from committing suicide. Negligence resulted in patient death and the psychiatric nurse was found guilty. In order to prevent criminal acts, psychiatric nurses should gain a better understanding of their status as guarantor and the obligations entailed in this status. This article is intended to assist psychiatric nurses understand their responsibilities under current laws.

Profile of psychiatric symptoms in methamphetamine users in China: Greater risk of psychiatric symptoms with a longer duration of use.

PubMed

Ma, Jun; Sun, Xin-Jun; Wang, Ru-Jia; Wang, Tong-Yu; Su, Meng-Fan; Liu, Mo-Xuan; Li, Su-Xia; Han, Ying; Meng, Shi-Qiu; Wu, Ping; Shi, Jie; Bao, Yan-Ping; Lu, Lin

2018-04-01

Chronic methamphetamine (MA) use is associated with psychiatric symptoms. This study explored pattern of co-occurring psychiatric symptoms in MA users and their relationship to duration of MA use. A cross-sectional study was conducted among MA users at the Shenzhen Compulsory Drug Detoxification Center from April 2012 to October 2015. The Positive and Negative Syndrome Scale, Hamilton Anxiety Scale, and Beck Depression Inventory were used to assess psychiatric symptoms. Among 1277 MA users, 57.6% participants had any type of psychiatric symptoms including depressive, anxiety and psychotic symptoms. A dose-response relationship was found between duration of MA use and risk of psychiatric symptoms. The odds ratios (OR) of depressive symptoms increased with the duration of MA use (1-5 years vs. < 1 year: 1.74 [95% CI, 1.24-2.42]; ≥ 5 years vs. < 1 year: 2.07 [1.19-3.61]), so did the ORs of co-occurring anxiety and depressive symptoms (1-5 years: 1.74 [1.20-2.51]; ≥ 5 years: 3.09 [1.76-5.40]). Methamphetamine-dependent individuals were four-times more likely to experience any type of psychiatric symptoms than non-dependent users. The prevalence of psychiatric symptoms was high in chronic MA users and increased with MA use duration. Early prevention and treatment strategies targeting both MA use and associated psychiatric symptoms are needed. Copyright © 2018 Elsevier B.V. All rights reserved.

[The attitude of the general public towards (discharged) psychiatric patients: results from NEMESIS-2].

PubMed

Ten Have, M; van Weeghel, J; van Dorsselaer, S; Tuithof, M; de Graaf, R

2015-01-01

In the Netherlands there is no up-to-date information about the attitude of the public to (discharged) psychiatric patients. Also, very little is known about which population groups hold stigmatising views. To measure the public's attitudes to (discharged) psychiatric patients and to find out whether these attitudes differ according to the background characteristics (e.g. demographics, respondent's psychiatric history). In our study we used attitudes collected via the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological study of the adult general population (n = 6646; aged 18-64 years). The psychiatric history of the respondents was assessed by means of the Composite International Diagnostic Interview 3.0. More than 70% of the respondents stated that they had no objection to having a (discharged) psychiatric patient as a neighbour, friend or colleague. However, their ´willingness´ declined markedly, namely to less than 30%, when they were asked if they would be willing to have a (discharged) psychiatric patient as their son-in-law or baby-sitter. A comparison with other earlier Dutch studies indicates that since 1987 the willingness of members of the public to let (ex-)psychiatric patients participate in their private and/or family life has increased only very slightly. Nowadays, just as in past decades, most Dutch citizens are not opposed to living alongside (discharged) psychiatric patients, but they have reservations about letting such persons participate in their private and family life.

Anxiety-depressive disorders among irritable bowel syndrome patients in Guilan, Iran

PubMed Central

2012-01-01

Background Psychiatric disorders are common in irritable bowel syndrome (IBS) patients. The prevalence of psychiatric disorders in IBS patients varies in different cultures. We conducted this study to determine the prevalence of psychiatric disorders Methods In a cross-sectional study, 256 IBS patients were selected (using the criteria of Rome III) and evaluated for psychiatric disorders. In the first phase, subjects were screened using the General Health Questionnaire 28 (GHQ28). In the second phase, those who had scores ≥ 23 were assessed through semi-structured psychiatric interviews. Results Thirty out of 256 subjects had no significant psychiatric symptoms after performing GHQ28. In further psychiatric evaluation of the remaining subjects (226) who suffered from some degree of a psychiatric problem, 36 were diagnosed without Anxiety/Depressive disorder. Thus 66 subjects (25.8%) were known as a group without any significant psychiatric problem. A total of 190 subjects (74.2%) with anxiety-depressive problems were diagnosed; 89 were suffering from pure anxiety disorders, 41 were suffering from depressive disorders and 60 had co-morbid anxiety-depressive disorders. When comparing anxiety-depressive patients (n = 190) with normal subjects (n = 66), gender (P = 0.016), occupation (P = 0.002) and intensity of IBS (P < 0.001) showed statistically significant differences. Conclusion The high prevalence of anxiety-depressive disorders in this study indicates the necessity of psychiatric assessment, early diagnosis and treatment of the patients with IBS. It may improve management of the patients suffering from IBS. PMID:22353390

Anxiety-depressive disorders among irritable bowel syndrome patients in Guilan, Iran.

PubMed

Modabbernia, Mohamad-Jafar; Mansour-Ghanaei, Fariborz; Imani, Ali; Mirsafa-Moghaddam, Seyed-Alireza; Sedigh-Rahimabadi, Massih; Yousefi-Mashhour, Mahmoud; Joukar, Farahnaz; Atrkar-Roushan, Zahra; Bidel, Siamak

2012-02-21

Psychiatric disorders are common in irritable bowel syndrome (IBS) patients. The prevalence of psychiatric disorders in IBS patients varies in different cultures. We conducted this study to determine the prevalence of psychiatric disorders In a cross-sectional study, 256 IBS patients were selected (using the criteria of Rome III) and evaluated for psychiatric disorders. In the first phase, subjects were screened using the General Health Questionnaire 28 (GHQ28). In the second phase, those who had scores ≥ 23 were assessed through semi-structured psychiatric interviews. Thirty out of 256 subjects had no significant psychiatric symptoms after performing GHQ28. In further psychiatric evaluation of the remaining subjects (226) who suffered from some degree of a psychiatric problem, 36 were diagnosed without Anxiety/Depressive disorder. Thus 66 subjects (25.8%) were known as a group without any significant psychiatric problem. A total of 190 subjects (74.2%) with anxiety-depressive problems were diagnosed; 89 were suffering from pure anxiety disorders, 41 were suffering from depressive disorders and 60 had co-morbid anxiety-depressive disorders. When comparing anxiety-depressive patients (n = 190) with normal subjects (n = 66), gender (P = 0.016), occupation (P = 0.002) and intensity of IBS (P < 0.001) showed statistically significant differences. The high prevalence of anxiety-depressive disorders in this study indicates the necessity of psychiatric assessment, early diagnosis and treatment of the patients with IBS. It may improve management of the patients suffering from IBS.

Psychopathology in methamphetamine-dependent adults 3 years after treatment.

PubMed

Glasner-Edwards, Suzette; Mooney, Larissa J; Marinelli-Casey, Patricia; Hillhouse, Maureen; Ang, Alfonso; Rawson, Richard A

2010-01-01

Although psychiatric symptoms are frequently observed in methamphetamine (MA) users, little is known about the prevalence of psychiatric disorders in MA-dependent individuals. This is the first study to examine the association of psychiatric disorders with substance use and psychosocial functioning in a large sample of MA users 3 years after treatment. We predicted that psychiatric diagnoses and severity would be associated with substance use and poorer overall functioning over the 3 year post-treatment course. Participants (N = 526) received psychosocial treatment for MA dependence as part of the Methamphetamine Treatment Project and were reassessed for psychosocial functioning and substance use at a mean of 3 years after treatment initiation. DSM-IV psychiatric diagnoses were assessed at follow-up using the Mini-International Neuropsychiatric Interview. Psychosocial functioning was assessed using the Addiction Severity Index. Overall, 48.1% of the sample met criteria for a current or past psychiatric disorder other than a substance use disorder. Consistent with prior reports from clinical samples of cocaine users, this rate was largely accounted for by mood disorders, anxiety disorders and antisocial personality. Those with an Axis I psychiatric disorder evidenced increased MA use and greater functional impairment over time relative to those without a psychiatric disorder. This initial investigation of psychiatric diagnoses in MA users after treatment indicates elevated rates of Axis I and II disorders in this population and underscores the need for integrated psychiatric assessment and intervention in drug abuse treatment settings.

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan.

PubMed

Imai, Hirohisa; Nakao, Hiroyuki; Nakagi, Yoshihiko; Niwata, Satoko; Sugioka, Yoshihiko; Itoh, Toshihiro; Yoshida, Takahiko

2006-11-01

The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction". Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

Prevalence of psychiatric morbidity among cancer patients – hospital-based, cross-sectional survey

PubMed Central

Gopalan, Mohan Roy; Karunakaran, Vidhukumar; Prabhakaran, Anil; Jayakumar, Krishnannair Lalithamma

2016-01-01

Aim: To study the prevalence of Psychiatric disorders in cancer patients and to find out the factors associated with Psychiatric disorders in Cancer Patients. Settings and Design: Department of Radiotherapy, Medical College, Thiruvananthapuram, cross sectional survey design was used. Methods and Material: Adult patients (18 years of age and above), having a diagnosis of carcinoma were selected by consecutive sampling method.A questionnaire which included back ground data, socio economic variables, treatment variables like type of malignancy, exposure to radiation & chemotherapy prior to the evaluation and current treatment, co occurring medical illness & treatment and past & family history of psychiatric illness was used to collect data. Delirium rating scale and MINI International neuropsychiatric interview were used to assess Psychiatric disorders and delirium. Statistical Analysis Used: Chi square and logistics regression tests were used for analysis. Results: Of the 384 assessed, 160(41.7%) had psychiatric disorders. Adjustment disorders were seen in 22.6%. 10.9% of subjects had major depressive disorder. Thus a total of 33.5% of patients had a diagnosis of either anxiety or depressive disorder. Proportion of patients having delirium was 6.5%. Hypomania was seen in small (1.6%) of patients. Multivariate analysis for various parameters for psychiatric disorders showed that age, past history of chemotherapy, past history of radiotherapy, & surgical treatment of carcinomas are significant predictors of psychiatric disorders. Conclusions: Psychiatric disorders are seen in a significant proportion of Psychiatric patients. PMID:28066004

Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence

PubMed Central

Munk-Olsen, T; Maegbaek, M L; Johannsen, B M; Liu, X; Howard, L M; di Florio, A; Bergink, V; Meltzer-Brody, S

2016-01-01

Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes. PMID:27754485

Association of child and adolescent psychiatric disorders with somatic or biomedical diagnoses: do population-based utilization study results support the adverse childhood experiences study?

PubMed

Wilkes, T C R; Guyn, Lindsay; Li, Bing; Lu, Mingshan; Cawthorpe, David

2012-01-01

Few population-based studies have examined the relationship between psychiatric and somatic or biomedical disorders. We examined the effect of the presence or absence of any psychiatric disorder on somatic or biomedical diagnosis disorder costs. Guided by the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study, we examined our administrative data to test if psychiatric disorder is associated with a higher level of somatic disorder. A dataset containing registration data for 205,281 patients younger than age 18 years was randomly selected from administrative data based on these patients never having received any specialized, publicly funded ambulatory, emergency or inpatient admission for treatment of a psychiatric disorder. All physician billing records (8,724,714) from the 16 fiscal years April 1993 to March 2009 were collected and grouped on the basis of presence or absence of any International Classification of Diseases (ICD) psychiatric disorder. We compared 2 groups (with or without any psychiatric disorder: dependent variable) on the cumulative 16-year mean cost for somatic (biomedical, nonpsychiatric) ICD diagnoses (independent variable). Billing costs related to somatic and biomedical disorders (nonpsychiatric costs) were 1.8 times greater for those with psychiatric disorders than for those without psychiatric disorders. Somatic costs peaked before the age of 6 years and remained higher than the groupings without psychiatric disorders in each age range. In support of the ACE study, ICD psychiatric disorders (as an index of developmental adversity) are associated with substantially greater ICD somatic disorders. The findings have implications for health care practice.

First hundred cases of variant Creutzfeldt-Jakob disease: retrospective case note review of early psychiatric and neurological features

PubMed Central

Spencer, Michael D; Knight, Richard S G; Will, Robert G

2002-01-01

Objective To describe the early psychiatric and neurological features of variant Creutzfeldt-Jakob disease. Design Cohort study. Setting National surveillance system for Creutzfeldt-Jakob disease in the United Kingdom. Participants The first 100 cases of variant Creutzfeldt-Jakob disease identified in the United Kingdom. Main outcome measures The timing and nature of early psychiatric and neurological symptoms in variant Creutzfeldt-Jakob disease. Results The early stages of variant Creutzfeldt-Jakob disease are dominated by psychiatric symptoms, but neurological symptoms precede psychiatric symptoms in 15% of cases and are present in combination with psychiatric symptoms in 22% of cases from the onset of disease. Common early psychiatric features include dysphoria, withdrawal, anxiety, insomnia, and loss of interest. No common early neurological features exist, but a significant proportion of patients do exhibit neurological symptoms within 4 months of clinical onset, including poor memory, pain, sensory symptoms, unsteadiness of gait, and dysarthria. Conclusions Although the diagnosis of variant Creutzfeldt-Jakob disease may be impossible in the early stages of the illness, particular combinations of psychiatric and neurological features may allow early diagnosis in an appreciable proportion of patients. What is already known on this topicThe early stages of variant Creutzfeldt-Jakob disease are dominated by psychiatric symptomatologySome patients have early neurological features that might suggest the presence of an underlying neurological disorderWhat this study addsThis study provides a comprehensive description of the evolution of psychiatric and neurological features in variant Creutzfeldt-Jakob diseaseAn appreciable proportion of patients have early neurological symptomsA high proportion of patients have a combination of psychiatric and neurological features within four months of clinical onset that suggest the diagnosis of variant Creutzfeldt-Jakob disease PMID:12077031

Association between income trajectories in childhood and psychiatric disorder: a Swedish population-based study.

PubMed

Björkenstam, Emma; Cheng, Siwei; Burström, Bo; Pebley, Anne R; Björkenstam, Charlotte; Kosidou, Kyriaki

2017-07-01

Childhood family income variation is an understudied aspect of households' economic context that may have distinct consequences for children. We identified trajectories of childhood family income over a 12-year period, and examined associations between these trajectories and later psychiatric disorders, among individuals born in Sweden between 1987 and 1991 (n=534 294). We used annual income data between the ages of 3-14 years and identified 5 trajectories (2 high-income upward, 1 downward and 2 low-income upward trajectories). Psychiatric disorders in the follow-up period after age 15 were defined from International Classification of Disease (ICD)-codes in a nationwide patient register. Multiadjusted risks for all psychiatric disorders, as well as for specific psychiatric diagnoses, were calculated as HRs with 95% CIs. Of the 5 identified income trajectories, the constant low and the downward trajectories were particularly associated with later psychiatric disorder. Children with these trajectories had increased risks for psychiatric disorder, including mood, anxiety, psychotic disorders and attention deficit/hyperactivity disorder. The association remained, even after adjusting for important variables including parental psychiatric disorder. In contrast, the relationship was reversed for eating disorders, for which children in higher income trajectories had elevated risks. Findings show that children growing up in a household characterised by low or decreasing family income have an increased risk for psychiatric disorder. Continued work is needed to reduce socioeconomic inequalities in psychiatric disorders. Policies and interventions for psychiatric disorders should consider the socioeconomic background of the family as an important risk or protective factor. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups.

PubMed

Assari, Shervin

2017-11-13

In this study, we compared 10 ethnic groups for associations between psychiatric disorders and physical self-rated health (SRH) in the United States. Data came from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003. The study included 7587 non-Latino White, 4746 African American, 1442 Mexican, 1106 other Hispanic, 656 other Asian, 600 Chinese, 577 Cuban, 520 Vietnamese, 508 Filipino, and 495 Puerto Rican individuals. The Composite International Diagnostic Interview (CIDI) was used to measure psychiatric disorders, including major depressive disorder (MDD), general anxiety disorder (GAD), social phobia, panic disorder, post-traumatic stress disorder (PTSD), alcohol abuse, and binge eating disorders. A single-item measure was used to estimate physical SRH. Demographic (age and gender) and socioeconomic (education and income) factors were also measured. Unadjusted and adjusted correlations between psychiatric disorders and physical SRH were calculated. Major ethnic variations were found in the correlation between psychiatric disorders and physical SRH; as well as the role of demographic and socioeconomic status (SES) factors in explaining these associations. non-Hispanic Whites, Cubans, and African Americans showed more correlations between psychiatric disorders and physical SRH than other ethnic groups. In non-Hispanic Whites, the associations between psychiatric disorders and physical SRH were explained by demographic factors. In African Americans, the link between psychiatric disorders and poor physical SRH were explained by SES indicators. In conclusion , although single-item physical SRH measures are traditionally assumed to reflect the physical health needs of populations, they may also indicate psychiatric disorders in some ethnic groups, such as non-Hispanic Whites, Cubans, and African Americans. Demographic and socioeconomic factors also have differential roles in explaining the link between psychiatric disorders and physical SRH. Physical SRH does not exclusively reflect physical health, and it may be more biased by mental health across some ethnic groups.

Impact of a psychiatric unit's daily discharge rates on emergency department flow.

PubMed

Bastiampillai, Tarun; Schrader, Geoffrey; Dhillon, Rohan; Strobel, Jörg; Bidargaddi, Niranjan

2012-04-01

To investigate relationships between time spent in the emergency department (ED) in patients requiring admission to the psychiatric ward, the day of the week of presentation and the daily number of discharges from the psychiatric ward. Retrospective analysis of patient flow as a function of day of week, time of day (a.m., p.m.), number of patients requiring admission and number of ward discharges over a one-year period, for all mental health related presentations to the ED of the Queen Elizabeth Hospital in Adelaide, South Australia, before their admission to the psychiatric inpatient facility. The time spent by patients in the ED waiting for admission to the psychiatric ward was significantly greater on weekends. There were significantly fewer discharges from the psychiatric ward during weekends compared with weekdays. The average time spent by patients in the ED requiring admission to the psychiatric ward for those days when there were vacant beds was 17.9 hours (SD=14.5). More people presented to the ED with a psychiatric diagnosis in the afternoons. There was a significant inverse correlation between the time spent by patients in the ED requiring admission to the psychiatric ward per day and the number of discharges from the psychiatric ward per day. These findings demonstrate that patient flow is significantly slower on weekends because of fewer discharges from the ward, leading to longer times spent in the ED before ward transfer. Waiting times in the ED were very substantially greater than the proposed 4-hour target even when vacant beds were available, raising considerable doubt about that target being realistic for psychiatric patients.

Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness.

PubMed

Lavin, Kyle; Davydow, Dimitry S; Downey, Lois; Engelberg, Ruth A; Dunlap, Ben; Sibley, James; Lober, William B; Okimoto, Kelson; Khandelwal, Nita; Loggers, Elizabeth T; Teno, Joan M; Curtis, J Randall

2017-08-01

Little is known about psychiatric illness and utilization of end-of-life care. We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases-9 codes. We used International Classification of Diseases-9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities

PubMed Central

Takenoshita, Miho; Sato, Tomoko; Kato, Yuichi; Katagiri, Ayano; Yoshikawa, Tatsuya; Sato, Yusuke; Matsushima, Eisuke; Sasaki, Yoshiyuki; Toyofuku, Akira

2010-01-01

Background Burning mouth syndrome (BMS) and atypical odontalgia (AO) are two conditions involving chronic oral pain in the absence of any organic cause. Psychiatrically they can both be considered as “somatoform disorder”. From the dental point of view, however, the two disorders are quite distinct. BMS is a burning or stinging sensation in the mouth in association with a normal mucosa whereas AO is most frequently associated with a continuous pain in the teeth or in a tooth socket after extraction in the absence of any identifiable cause. Because of the absence of organic causes, BMS and AO are often regarded as psychogenic conditions, although the relationship between oral pain and psychologic factors is still unclear. Some studies have analyzed the psychiatric diagnoses of patients with chronic oral pain who have been referred from dental facilities to psychiatric facilities. No study to date has investigated patients referred from psychiatric facilities to dental facilities. Objective To analyze the psychiatric diagnoses of chronic oral pain patients, diagnosed with BMS and AO, and referred from psychiatric facilities to dental facilities. Study design Psychiatric diagnoses and disease conditions of BMS or AO were investigated in 162 patients by reviewing patients’ medical records and referral forms. Psychiatric diagnoses were categorized according to the International Statistical Classification of Disease and Related Health Problems, Tenth Revision. Results The proportion of F4 classification (neurotic, stress-related, and somatoform disorders) in AO patients was significantly higher than in BMS patients. BMS patients were more frequently given a F3 classification (mood/affective disorders). However, 50.8% of BMS patients and 33.3% of AO patients had no specific psychiatric diagnoses. Conclusion Although BMS and AO are both chronic pain disorders occurring in the absence of any organic cause, the psychiatric diagnoses of patients with BMS and AO differ substantially. PMID:21127687

Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients; a population-based register study.

PubMed

Brenner, Philip; Alexanderson, Kristina; Björkenstam, Charlotte; Hillert, Jan; Jokinen, Jussi; Mittendorfer-Rutz, Ellenor; Tinghög, Petter

2014-01-01

Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension. This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome. Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33). Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.

Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?

PubMed

Alfstad, Kristin Å; Torgersen, Halvor; Van Roy, Betty; Hessen, Erik; Hansen, Berit Hjelde; Henning, Oliver; Clench-Aas, Jocelyne; Mowinckel, Petter; Gjerstad, Leif; Lossius, Morten I

2016-03-01

Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors. The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded. Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders. Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

Psychiatric Disorders and Health-Related Quality of Life in Children With Type 1 Diabetes Mellitus.

PubMed

Butwicka, Agnieszka; Fendler, Wojciech; Zalepa, Adam; Szadkowska, Agnieszka; Zawodniak-Szalapska, Malgorzata; Gmitrowicz, Agnieszka; Mlynarski, Wojciech

2016-01-01

Type 1 diabetes mellitus (T1DM) is a chronic condition with major effect on health-related quality of life (HRQoL) and mental health. In 1990s, high rates of psychiatric disorders were reported among children with T1DM. Little is known, however, about current prevalence of psychiatric disorders in children with T1DM and the relation between psychiatric diagnosis and HRQoL. The aim of the study was to determine the prevalence of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) psychiatric disorders and the association between psychiatric comorbidity and HRQoL in the pediatric population with T1DM. We conducted a cross-sectional study of 207 children, aged 8-18 years, diagnosed with T1DM. The presence of psychiatric disorders has been assessed by the standard diagnostic interview according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria. HRQoL was measured by the general and diabetes mellitus-specific modules of the Paediatric Quality of Life Inventory. Of the evaluated patients, 26.6% (N = 55) met the criteria for psychiatric disorders at the time of evaluation. The most common diagnoses were anxiety (N = 32; 15.5%) and mood disorders (N = 8; 3.9%). One-third of the patients (N = 66, 31.9%) met the criteria for at least 1 psychiatric diagnosis in their lifetime. The presence of psychiatric disorders was related to an elevated hemoglobin A1c level (8.6% vs 7.6%) and a lowered HRQoL level in the general pediatric quality of life inventory. In the diabetes mellitus-specific pediatric quality of life inventory, children with psychiatric disorders revealed more symptoms of diabetes mellitus, treatment barriers, and lower adherence than children without psychiatric disorders. T1DM in children is associated with a very high prevalence of psychiatric comorbidity, which is related to elevated hemoglobin A1c and lower HRQoL levels. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Pre- and post-surgical psychiatric assessments and intervention by major epilepsy centers in Japan - Nationwide survey.

PubMed

Goji, Hiroko; Fukuchi, Toshihiko; Kanemoto, Kousuke

2017-05-01

Although psychiatric issues following epilepsy surgery are now widely recognized as a major problem, actual awareness of these issues by epilepsy centers remains to be elucidated. This is the first known report regarding the use of psychiatric assessments and interventions by epilepsy centers throughout Japan. At the beginning of 2016, we sent a questionnaire regarding psychiatric assessments performed before and after epilepsy surgery, psychiatric intervention after surgery, and future plans for dealing with psychiatric issues in relation to epilepsy surgery, which consisted of a total of 24 items, to all members of the Japan Epilepsy Center Association (JEPICA). Nearly all major epilepsy centers in Japan are included in JEPICA, which had 31 members in 2016. Twenty-four (77%) of the 31 centers responded to the questionnaire. Seventeen (70.8%) centers answered that a psychiatrist was incorporated as part of their epilepsy surgery unit. In addition, 17 (70.8%) noted that psychiatric assessments were obtained prior to surgery, which were performed by psychiatrists in 8 (33.3%) centers and psychologists in 11 (45.8%). In 23 (95.8%) of the centers, the risk of occurrence of psychiatric illness following surgery was routinely explained prior to surgery, at least to surgical candidates with high susceptibility. In total, cases of psychiatric illness following surgery had been experienced in 16 (66.7%) centers, with depression as the most commonly encountered (41.7%), followed by anxiety (33.3%), psychosis (25.0%), and psychogenic non-epileptic seizures (8.3%). Strong points of epilepsy centers in Japan include serious concern regarding post-surgical psychiatric illness by nearly all members of JEPICA and explanation of the risk of psychiatric adverse events provided beforehand to their patients. On the other hand, the small size of some epilepsy centers, along with lack of a standardized method for evaluation of psychiatric symptoms as well as dependence on the individual willingness of psychiatrists assigned as members of the epilepsy units, seem to have led to significant diagnostic and therapeutic gaps among epilepsy centers regarding psychiatric issues related to epilepsy surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

[Experience of liaison psychiatry in Morocco: transversal study over 24 months].

PubMed

Barrimi, M; Elghazouani, F; Aarab, C; Tliji, A; Rharrabti, S; Lahlou, F; Rammouz, I; Aalouane, R

2014-10-01

Liaison psychiatry is a discipline caring for psychiatric disorders in patients of general hospitals. It involves clinical, educational, and research aspects. The liaison psychiatry supports patients hospitalized for full-time in medical and surgical departments, patients admitted in day-hospital and patients treated in the emergency department. In this transversal study, we assessed the liaison psychiatry impact that is still in development stage in Morocco. This study lasted 24 months, and was conducted at the University Hospital in Fez, Morocco. The goal of this work was to evaluate the prevalence of psychiatric disorders managed by liaison psychiatry, identify those requiring medical and surgical departments of such psychiatric support, and classify the motivations involved in their needs. This transversal study was initiated in January 2010 and has lasted 24 months. The study recruited 180 patients requiring psychiatric consultation from different medical and surgical departments at the University Hospital in Fes, Morocco. The psychiatric assessment was based on a psychiatric interview using the MINI. The data were collected by a certified psychiatrist using a questionnaire containing 24 items. After initial psychiatric assessment, the follow-up was proposed to the patient in the psychiatric department. During this study, 22 medical and surgical departments of our University Hospital had requested a psychiatric assessment for their patients. Most demands were respectively emitted by the Department of Dermatology (16%) and Nephrology (11%). The most common motivations for psychiatric consultations were respectively psychomotor agitation (17%) and an evaluation of suicide attempts (17%). Depressive and psychotic disorders were the most diagnosed disorders with 47% and 11% respectively. The psychiatric support was based on pharmacological treatment in 60% of cases. Finally, the outcome was favourable in 80% of followed cases. Hospitalized patients in different medical and surgical departments of the University Hospital of Fez have demonstrated a high prevalence of psychiatric disorders. This constitutes a very strong motivation to setup a department of liaison psychiatry. This would allow a better psychiatric support and follow-up of patients. Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Parting at the crossroads: the emergence of education for psychiatric nursing in three Canadian provinces, 1909-1955.

PubMed

Tipliski, Veryl Margaret

2004-01-01

Early in the 20th century, nursing emerged as an essential part of psychiatry's attempt to provide scientific care for insanity. Throughout Canada psychiatric nursing is a specialty of general or registered nursing. In Western Canada, however, it is also a separate and distinct profession known as registered psychiatric nursing (RPN). To further the study of nursing history, this paper examines the emergence and early development of mental hospital nursing in Canada, tracing the changing patterns of nurse training from 1909, when Ontario's asylum training school movement was established, to 1955, when education for psychiatric nursing split along the Manitoba-Ontario border into two models. Through case studies in three provinces (Ontario, Manitoba and Saskatchewan), this study examines the question of how Canadian psychiatric nursing developed into two entirely different models. During the 20th century, and interplay of social, political and economic factors emerged which shaped the development of psychiatric nursing and influenced the evolution of the two models. In addition, there were forces within nursing itself, including the effects of specific strategic decisions taken by nursing's leaders and the continuing role of nurses' resistance to the authority expressed by those within the medical profession. The development of psychiatric nursing is best understood by focusing on the point where psychiatry's authority intersected with the gendered limitations of nursing's leaders. This struggle represented a contest for control over education for mental hospital nursing. This paper argues that the turning point in the battle for control of Canadian education for psychiatric nursing occurred when nurse leaders refused to allow the specialty of psychiatric nursing to be taken over by an expanding psychiatric monopoly. The distinct psychiatric-controlled Western Canadian-style apprenticeship training was halted at the Manitoba-Ontario border. That nursing leaders persevered in the struggle to gain authority for psychiatric nursing education was a significant contribution to the development of Canadian nursing education and the psychiatric nursing specialty. Remnants of the themes found in the study endure to the present as organized nursing continues to struggle with issues around autonomy and authority over education and practice.

Psychiatric disorders and traumatic brain injury

PubMed Central

Schwarzbold, Marcelo; Diaz, Alexandre; Martins, Evandro Tostes; Rufino, Armanda; Amante, Lúcia Nazareth; Thais, Maria Emília; Quevedo, João; Hohl, Alexandre; Linhares, Marcelo Neves; Walz, Roger

2008-01-01

Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients’ care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed. PMID:19043523

Critical Behaviors in Psychiatric-Mental Health Nursing. Volume 2: Behavior of Nurses.

ERIC Educational Resources Information Center

Jacobs, Angeline Marchese; And Others

Part of a three-volume document, this volume is concerned with providing source data about the activities of mental health nursing personnel as these activities relate to patient care, and contains abstracts of more than 4,000 critical behaviors of psychiatric nurses in 50 psychiatric hospitals, general hospitals with psychiatric units, and…

Critical Behaviors in Psychiatric-Mental Health Nursing. Volume 3: Behavior of Attendants.

ERIC Educational Resources Information Center

Jacobs, Angeline Marchese; And Others

Part of a three-volume document, this volume is concerned with providing source data about the activities of mental health nursing personnel as the activities relate to patient care and contains abstracts of more than 4,000 critical behaviors of psychiatric attendants in 50 psychiatric hospitals, general hospitals with psychiatric units, and…

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…

Psychosocial and Psychiatric Factors Associated with Adolescent Suicide: A Case-Control Psychological Autopsy Study

ERIC Educational Resources Information Center

Portzky, Gwendolyn; Audenaert, Kurt; van Heeringen, Kees

2009-01-01

This study aimed at the investigation of psychosocial and psychiatric risk factors of adolescent suicide by means of a case-control psychological autopsy study. Relatives and other informants of 19 suicide victims and 19 matched psychiatric controls were interviewed by means of a semi-structured interview schedule. Psychiatric controls included…

Psychiatric Disorders in Adolescents and Adults with Autism and Intellectual Disability: A Representative Study in One County in Norway

ERIC Educational Resources Information Center

Bakken, Trine L.; Helverschou, Sissel B; Eilertsen, Dag E.; Heggelund, Trond; Myrbakk, Even; Martinsen, Harald

2010-01-01

Few studies assess psychiatric disorders in representative samples of individuals with autism and ID. Symptoms of autism and psychiatric disorders have been confounded. PAC, a conceptually analysed and validated screening instrument, was used. Aims: Assess prevalence of psychiatric disorders in individuals with intellectual disability only…

Utility of the Brief Symptom Inventory (BSI) in Psychiatric Outpatients with Intellectual Disabilities

ERIC Educational Resources Information Center

Wieland, J.; Wardenaar, K. J.; Fontein, E.; Zitman, F. G.

2012-01-01

Background: Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this…

Comorbidity of Psychiatric Disorders and Nicotine Dependence among Adolescents: Findings from a Prospective, Longitudinal Study

ERIC Educational Resources Information Center

Griesler, Pamela C.; Hu, Mei-Chen; Schaffram, Christine; Kandel, Denise B.

2008-01-01

The relationship between nicotine dependence and DSM-IV psychiatric disorders in 1,039 adolescents is examined. Findings revealed that psychiatric disorders most usually predicted the onset of the first basis of nicotine dependence while nicotine dependence does not appear to have an influence on the onset of psychiatric disorders. Other…

Organic brain syndrome. The psychiatric imposter.

PubMed

Dubin, W R; Weiss, K J; Zeccardi, J A

1983-01-07

Rapid differentiation of organic brain syndrome (OBS) from functional psychiatric illness can be difficult when patients come to an emergency department with predominantly psychiatric symptoms. Using four screening criteria-disorientation, abnormal vital signs, clouded consciousness, and patients older than 40 years with no previous psychiatric history-we detected 38 cases of OBS from 1,140 medically cleared patients. Twelve of these patients were subsequently admitted to a medical unit. Despite the presence of striking behavioral aberration, an increased awareness of the clinical manifestations of OBS will enhance the physician's ability to discriminate OBS from other psychiatric illness.

The lived experience of long-term psychiatric hospitalization of four women in Brazil.

PubMed

Pereira, Maria Alice Ornellas; Furegato, Antonia Regina F; Pereira, Alfredo

2005-01-01

What is the experience from long-term psychiatric hospitalization? How can psychiatric nursing contribute to reduce the emotional suffering and the feeling of social exclusion related to this process? This study was conducted on four women committed to long periods of psychiatric hospitalization in Brazil. Data were collected through open interviews and drawings made by the patients, and interpreted according to the theory of social representations. Reports on the patients refer to a process of social exclusion, emotional suffering, and inadequate treatment in the hospital, leading to no other option but recurrent hospitalization. Negative experiences related to long-term hospitalization could possibly be minimized through adequate assistance provided by psychiatric nursing in open services, as proposed in the recent Brazilian psychiatric reform.

Time and the psychiatric interview: the negotiation of temporal criteria of the depressive disorder.

PubMed

Ziólkowska, Justyna

2014-03-01

In this article, I am concerned with doctors' negotiations of the temporal dimension of the diagnostic criteria of depressive disorders during the first psychiatric interview. The data come from 16 initial psychiatric interviews recorded by doctors in three psychiatric hospitals in Poland. Taking a constructionist view of discourse and psychiatric practices, I shall argue that the discursive practice related to temporal information about patients' illnesses serves in gaining information, which is useful in the medical model of psychiatric diagnosis. The doctors positioned the patients' experiences on the timeline when the illness history was taken and temporal information authenticated the information. Conversely, the patients' current conditions were constructed in a limitless present, which allowed the psychiatrists to remove the relativity.

[Recognition of psychiatric disorders with a religious content by members of the clergy of different denominations in the Netherlands].

PubMed

Noort, A; Braam, A W; van Gool, A R; Verhagen, P J; Beekman, A T F

2012-01-01

Clergy members (CMS) frequently provide support and counselling for people with psychological and psychiatric disorders. There is evidence in the literature that CMS consider themselves to be inadequately trained to recognise psychiatric disorders. To investigate to what extent CMS are able to recognise psychiatric symptoms. CMS were recruited in the south-west of the Netherlands among various denominations (Roman Catholic, strict (orthodox) Protestant, moderate Protestant and Evangelical; n = 143) by means of a regional sampling method. The participating CMS (n = 143) and a control group consisting of mental health care professionals MPHS; n = 73) evaluated four vignettes of psychiatric problems with a religious content: two were about a psychiatric disorder (a psychotic state and a psychotic depression/melancholic state), and two concerned non-psychiatric states (a spiritual/religious experience and a mourning reaction with a religious dilemma). For each vignette the respondents scored the suitability of psychiatric medication, the desirability of mental health care, the severity of the disorder and whether there was a religious or spiritual aetiology. Some CMS were able to recognise psychiatric problems almost as well as the MHPS, but among the CMS the degree of recognition varied according to the denomination. Recognition was relatively poor among Evangelical CMS, but was best among the strict Protestant CMS. Evangelical pastors and strict Protestant CMS tended to interpret the non-psychiatric states as pathological. The findings of this study emphasise the need for collaboration between MHPS and CMS and stress the importance of consultation.

Comorbidity of autoimmune thyroid disorders and psychiatric disorders during the postpartum period: a Danish nationwide register-based cohort study.

PubMed

Bergink, V; Pop, V J M; Nielsen, P R; Agerbo, E; Munk-Olsen, T; Liu, X

2018-06-01

The postpartum period is well-known risk period for the first onset of autoimmune thyroid disorders (AITDs) as well as first onset of psychiatric disorders. These two disorders are some of the most prevalent medical conditions postpartum, often misdiagnosed and disabling if left untreated. Our study was designed to explore the possible bidirectional association between AITDs and psychiatric disorders during the postpartum period. A population-based cohort study through linkage of Danish national registers, which comprised 312 779 women who gave birth to their first child during 1997-2010. We conducted Poisson regression analysis to estimate the incidence rate ratio (IRR) of psychiatric disorders among women with first-onset AITDs, the IRR of AITDs among women with first-onset psychiatric disorders as well as the overlap between these disorders using a comorbidity index. Women with first-onset AITDs postpartum were more likely to have first-onset psychiatric disorders than women who did not have postpartum AITDs (IRR = 1.88, 95% confidence interval (CI): 1.25-2.81). Women with first-onset postpartum psychiatric disorders had a higher risk of AITDs than women with no psychiatric disorders (IRR = 2.16, 95% CI: 1.45-3.20). The comorbidity index 2 years after delivery was 2.26 (95% CI: 1.61-2.90), indicating a comorbidity between first-onset AITDs and psychiatric disorders. First-onset AITDs and psychiatric disorders co-occur in the postpartum period, which has relevance to further studies on the etiologies of these disorders and why childbirth in particular triggers the onset.

Prevalence and comorbidity of psychiatric disorders among 6-year-old children: 2004 Pelotas Birth Cohort.

PubMed

Petresco, Sandra; Anselmi, Luciana; Santos, Iná S; Barros, Aluísio J D; Fleitlich-Bilyk, Bacy; Barros, Fernando C; Matijasevich, Alicia

2014-06-01

Most studies published on the prevalence of psychiatric disorders in children were conducted in high-income countries despite the fact that nearly 90 % of the world's population aged under 18 live in low- and middle-income countries. The study aimed to assess the prevalence of psychiatric disorders among children of 6 years of age, to examine the distribution of psychiatric disorders by gender and socioeconomic status and to evaluate the occurrence of psychiatric comorbidities. The 2004 Pelotas Birth Cohort originally comprised 4,231 live births from Pelotas, southern Brazil. A total of 3,585 (84.7 % of 4,231 births) children aged 6 years were assessed using the Development and Well-Being Assessment (DAWBA). Nearly 13 % of the children presented a psychiatric diagnosis according to DSM-IV, being more prevalent among males than females (14.7 and 11.7 %, respectively, p = 0.009). Anxiety disorders were the most prevalent of all disorders (8.8 %) and specific phobias (5.4 %) and separation anxiety disorder (3.2 %) were the most common subtypes. Attention deficit hyperactivity disorder (2.6 %), oppositional defiant disorder/conduct disorder (2.6 %), and depression (1.3 %) were also diagnosed. More than one psychiatric disorder was presented by 17 % of children. Socioeconomically disadvantaged children had a higher prevalence of psychiatric disorders. Our findings underline the early onset of psychiatric disorders among children and the frequent occurrence of psychiatric comorbidity. Early prevention is needed in the field of mental health in Brazil and should start during infancy.

Perceived discrimination among people with self-reported emotional, psychological, or psychiatric conditions in a population-based sample of Canadians reporting a disability.

PubMed

Kassam, Aliya; Williams, Jeanne; Patten, Scott

2012-02-01

The prevalence of perceived discrimination among people reporting an emotional, psychological, or psychiatric condition in a population of people with a disability has not been studied. Our study evaluated a model that integrated having an emotional, psychological, or psychiatric condition while accounting for age, sex, education, employment, marital status, immigration status, and type of community to estimate the prevalence of perceived discrimination in the population of people with a disability. We hypothesized that higher levels of perceived discrimination would occur in people reporting an emotional, psychological, or psychiatric condition. The Participation and Activity Limitation Survey (PALS) by Statistics Canada is a postcensual survey of community residents reporting health-related impairments. PALS was used to evaluate the interaction between self-reported emotional, psychological, or psychiatric conditions and demographic variables and the odds of experiencing discrimination. In the overall sample, 14.5% perceived discrimination and 18.2% reported having an emotional, psychological, or psychiatric condition. Thirty-five per cent of people with such conditions perceived discrimination. When adjusting for covariates, people reporting an emotional, psychological, or psychiatric condition were 3 times more likely to perceive having been discriminated against than people without such conditions. Across medical conditions, perceived discrimination was higher in people who also reported an emotional, psychological, or psychiatric condition. The results demonstrate that perceived discrimination and the presence of an emotional, psychological, or psychiatric condition frequently co-occur in people with a disability and therefore programs aimed at reducing the discrimination of emotional, psychological, or psychiatric conditions should take this into account.

Psychiatric Evaluation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychiatric Evaluation Workgroup

PubMed Central

Stowell, Keith R; Florence, Peter; Harman, Herbert J; Glick, Rachel L

2012-01-01

It is difficult to fully assess an agitated patient, and the complete psychiatric evaluation usually cannot be completed until the patient is calm enough to participate in a psychiatric interview. Nonetheless, emergency clinicians must perform an initial mental status screening to begin this process as soon as the agitated patient presents to an emergency setting. For this reason, the psychiatric evaluation of the agitated patient can be thought of as a 2-step process. First, a brief evaluation must be aimed at determining the most likely cause of agitation, so as to guide preliminary interventions to calm the patient. Once the patient is calmed, more extensive psychiatric assessment can be completed. The goal of the emergency assessment of the psychiatric patient is not necessarily to obtain a definitive diagnosis. Rather, ascertaining a differential diagnosis, determining safety, and developing an appropriate treatment and disposition plan are the goals of the assessment. This article will summarize what components of the psychiatric assessment can and should be done at the time the agitated patient presents to the emergency setting. The complete psychiatric evaluation of the patient whose agitation has been treated successfully is beyond the scope of this article and Project BETA (Best practices in Evaluation and Treatment of Agitation), but will be outlined briefly to give the reader an understanding of what a full psychiatric assessment would entail. Other issues related to the assessment of the agitated patient in the emergency setting will also be discussed. PMID:22461916

Psychiatric inpatient services in general hospitals.

PubMed

HUME, P B; RUDIN, E

1960-10-01

Traditional asylum care of psychiatric patients leads to the isolation, confinement, and restraint of the patients, and to isolation of psychiatric practice from the rest of medicine. Modern psychiatric advances have demonstrated the disadvantages to both patients and their families of such isolation, confinement and restraint. It is in the best interests of patients and professional workers that inpatient psychiatric services be continuous with, and contiguous to, other medical services and to rehabilitation services of all kinds. Examination of currently available information reveals a shortage of psychiatric beds in California, particularly for diagnosis and brief treatment. Thus, not only is there a need to develop psychiatric inpatient facilities, but also an opportunity to develop them along several different lines. Since both the Hill-Burton Act (federal) and the Short-Doyle Act (state) give financial assistance to only those psychiatric services established in general hospitals or affiliated with general hospitals, this requirement calls for examination in the light of experience with services so operated. At first, the Short-Doyle Act was perceived as a panacea for the psychiatric ills of the state. Now it is beginning to be recognized as one method of providing additional mental health resources, rather than the exclusive method. As more short-term cases are treated in local, tax-supported, psychiatric units in general hospitals, an impact can be expected on the state hospital program. In its administration of the Short-Doyle Act, the Department of Mental Hygiene attempts to respond to community needs as locally determined. It tries to insure local option and encourage local responsibility while furthering high standards of staffing and of service.

Psychiatric morbidity and subsequent divorce: a couple-level register-based study in Finland.

PubMed

Metsä-Simola, Niina; Martikainen, Pekka; Monden, Christiaan W

2018-05-02

Studies that assess the role of mental health for the risk of divorce are scarce and mostly rely on individual-level data, although divorce is a couple-level phenomenon. Using data on couples, we examine the effects of both spouses' psychiatric morbidity on the risk of divorce, and whether socio-demographic factors affect these associations. We followed 96,222 Finnish married couples for 6 years using register-based data on both spouses and their household. New incidence of psychiatric morbidity and subsequent divorce was identified from dates of prescription medication purchases and hospital admissions, and dates of registered divorce. Socio-demographic factors were measured annually for both spouses and their household. The effect of incident psychiatric morbidity on divorce risk was analyzed using Cox regression. Psychiatric morbidity in men increased the age-adjusted risk of divorce more than twofold and in women nearly twofold. The risk of divorce was particularly pronounced immediately after new incidence of psychiatric morbidity, before settling to a persistently high level. Psychiatric morbidity in both spouses increased the risk of divorce almost threefold. Adjustment for socio-economic factors had little effect on these associations. Psychiatric morbidity is a persistent risk factor of divorce. The risk is larger when both spouses experience psychiatric morbidity compared to only one spouse. The findings are consistent with the idea that poor relationship quality and dissatisfaction in couples suffering from mental health problems have long-term consequences for marital stability. Treatment of psychiatric morbidity should not focus only on the individual but on couple-level dynamics.

The lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution.

PubMed

Bimenyimana, E; Poggenpoel, M; Myburgh, C; van Niekerk, V

2009-09-01

Caring for good people is difficult enough; to care for people who are either aggressive or violent is even more difficult. This is what psychiatric nurses working in the psychiatric institution in which research was done are exposed to on a daily basis. The aim of the research was to explore and describe the lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution. A qualitative, explorative, descriptive, and contextual study design was utilised. Data was collected by means of semi-structured interviews and naïve sketches. Tesch 's (Creswell, 2004: 256) method of open coding and an independent coder were utilised for data analysis. This study shed some light on the lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution. The findings show that the level of violence and aggression to which psychiatric nurses are exposed is overwhelming and the consequences are alarming. The contributing factors to this violence and aggression are: the mental status and the conditions in which patients are admitted; the staff shortage; the lack of support among the members of the multidisciplinary team (MDT); and the lack of structured and comprehensive orientation among newly appointed staff members. As a result, psychiatric nurses are emotionally, psychologically, and physically affected. They then respond with the following emotions and behaviour: fear, anger, frustration, despair, hopelessness and helplessness, substance abuse, absenteeism, retaliation and the development of an "I don't care" attitude.

Characteristics of unrecognised bipolar disorder in patients treated for major depressive disorder in China: general versus psychiatric hospitals.

PubMed

Chen, F Z; Xiang, Y T; Lu, Z; Wang, G; Hu, C; Kilbourne, A M; Ungvari, G S; Fang, Y R; Si, T M; Yang, H C; Lai, K Yc; Hu, J; Chen, Z Y; Huang, Y; Sun, J; Wang, X P; Li, H C; Zhang, J B; Zhang, X Y; Chiu, H F K

2013-12-01

Bipolar disorder is often misdiagnosed as major depressive disorder. Such misdiagnosis partly depends on the type of treatment setting. This study compared general hospital psychiatric units with psychiatric hospitals in China with respect to basic demographic and clinical characteristics of patients with unrecognised bipolar disorder who are treated for major depressive disorder. Patients treated for major depressive disorder were consecutively examined in 13 health centres (6 general hospital psychiatric units and 7 psychiatric hospitals) in China. Their socio-demographic and clinical features were recorded using a standardised protocol and data collection procedure. The DSM-IV diagnoses were established using the Mini-International Neuropsychiatric Interview. Of the 1487 patients included in the study, 309 (20.8%) were diagnosed with bipolar disorder. There was no significant difference between general hospital psychiatric units and psychiatric hospitals in the ratio of all types of unrecognised bipolar disorders (χ2 = 0.008, degrees of freedom = 1, p = 0.9) and bipolar II disorders (χ2 = 3.1, degrees of freedom = 1, p = 0.08). The proportions of unrecognised bipolar I disorders (χ2 = 4.1, degrees of freedom = 1, p = 0.04) differed significantly between the 2 types of study site. Multivariate analyses showed that patients with bipolar I disorders with more seasonal depressive episodes were more likely to receive treatment in general hospital psychiatric units (odds ratio = 3.3, 95% confidence interval = 1.1-9.8). Patients with bipolar I disorders receiving treatment in general hospital psychiatric units had different clinical characteristics compared to their counterparts treated in psychiatric hospitals in China.

Which skills boost service provider confidence when managing people presenting with psychiatric emergencies?

PubMed

Poremski, Daniel; Lim, Xin Ya; Kunjithapatham, Ganesh; Koh, Doris; Alexander, Mark; Cheng, Lee

2016-12-01

The way service seekers interact with the staff at emergency services has been shown to influence the standard of care, especially in the case of certain psychiatric manifestations. Staff reactions to psychiatric complaints have been linked to their comfort dealing with these types of service users as well as their competencies understanding the illness. It is therefore vital to understand which skills increase confidence in treating psychiatric emergencies. Twenty-six open-ended convergent interviews were conducted with staff working in a psychiatric emergency department. Thematic analysis was used to analyze the data. Participants reported several non-technical skills which developed from exclusively serving people with psychiatric emergencies: 1) Vigilance allowed staff to be sensitive to minor changes in behavior which precede psychiatric emergencies. 2) The ability to negotiate and find tangible solutions was particularly important when dealing with psychiatric complaints which may not have tangible resolutions. 3) The ability to appraise social support networks allowed staff to plan follow-up actions and ensure continuity of care when support was available. 4) The ability to self-reflect allowed participants to learn from their experience and avoid burnout, frustration, and fatigue. Participants also reported several other clinical skills which they gained during training, including teamwork, de-escalating techniques and risk assessment. Tentatively speaking, these skills improve staff's confidence when treating psychiatric emergencies. Certain skills may be generalized to staff working in medical emergency departments who frequently encounter psychiatric complaints. © 2016 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.

ABO blood groups and psychiatric disorders: a Croatian study.

PubMed

Pisk, Sandra Vuk; Vuk, Tomislav; Ivezić, Ena; Jukić, Irena; Bingulac-Popović, Jasna; Filipčić, Igor

2018-02-15

The prevalence of ABO alleles is different in different populations, and many studies have shown a correlation between the occurrences of some diseases and different genotypes of ABO blood groups. The aim of this study was to determine whether there is a significant association between psychiatric syndromes and ABO blood groups. This case-control study involved 156 psychiatric patients and 303 healthy, unrelated, voluntary blood donors. Genomic DNA was isolated from blood on a QIAcube device using a QIAamp DNA Blood mini QIAcube kit. ABO genotyping on five basic ABO alleles was performed using allele-specific polymerase chain reaction analysis. Compared with healthy subjects, a significantly higher proportion of psychiatric patients had AB blood group (χ 2 =9.359, df=3, p=0.025) and, accordingly, a significantly higher incidence of A1B genotype (χ 2 =8.226, df=3, p=0.042). The odds ratio showed that psychiatric disorders occur almost three times more frequently in carriers of AB group compared to other blood groups. However, no statistically significant difference was found in the distribution of ABO blood groups among patients with different psychiatric diagnoses. Likewise, no correlations were found between ABO blood groups and other characteristics of the psychiatric patients (sex, psychiatric heredity, somatic comorbidity, suicidality). The results of this study support the hypothesis of an association between psychiatric disorders and ABO blood groups. The probability is that psychiatric disorders will occur almost three times more frequently in carriers of AB group compared to other ABO blood groups in the Croatian population.

Altschul's legacy in mediating British and American psychiatric nursing discourses: common sense and the 'absence' of the accountable practitioner.

PubMed

Tilley, S

1999-08-01

This paper contributes to an archaeology of knowledge in the field of psychiatric and mental health nursing. It focuses on a principal concern of contributors to literature on British psychiatric nursing: the problem of defining psychiatric nursing. Early British writers describing psychiatric nursing accomplished the 'presence' of psychiatric nursing as a discursive object, by discursively constructing the 'absence' of the psychiatric nurse doing, and being accountable for, 'appropriate' work. Altschul's (1972) Patient-nurse Interaction was the key text in this tradition, mediating British and American discourses, setting the methodological and substantive agenda for an important body of subsequent British psychiatric nursing research. The paper examines a number of topics in the American and British discourses mediated by Altschul: the privileging of nurses' presence and language in communication with patients; lay versus professional knowledge, and interaction as gossip; 'common sense' as a topic; common sense as different from 'identifiable perspective'; the problem of accountability and the hierarchy of credibility; accountability, the 'absent' nurse, and issues of method. Altschul's later work keeps in tension two potentially conflicting claims--on the one hand, that the practice of psychiatric nursing depends on the 'kind of person' the nurse is, and on the other, that specialist discourses have priority in determining the basis for practice. Altschul played a crucial role in establishing the role of research in British psychiatric nursing discipline: locating the accountable individual practitioner, and devising remedies for 'absence'. In doing so, she anticipated current discourses on nurses' accountability, particularly their inability to demonstrate 'evidence' of their 'effectiveness'.

Family functioning in the families of psychiatric patients: a comparison with nonclinical families.

PubMed

Trangkasombat, Umaporn

2006-11-01

To examine family functioning in the families of psychiatric patients. Families of psychiatric patients and nonclinical families were compared. There were 60 families in each group. The instrument included a semistructured interview of family functioning and the Chulalongkorn Family Inventory (CFI), a self-report questionnaire designed to assess the perception of one's family. From the assessment by semistructured interview, 83.3% of psychiatric families and 45.0% of nonclinical families were found to be dysfunctional in at least one dimension. The difference was statistically significant (p < 0.001). The average number of dysfunctional dimensions in the psychiatric families was significantly higher than in the nonclinical control group, 3.5 +/- 1.9 and 0.98 +/- 1.5 respectively, p < 0.0001. The CFI scores of the psychiatric families were significantly lower than the control group, reflecting poor family functioning. The dysfunctions were mostly in the following dimensions: problem-solving, communication, affective responsiveness, affective involvement, and behavior control. Psychiatric families faced more psychosocial stressors and the average number of stressors was higher than the control families, 88.3% vs. 56.7% and 4.2 +/- 2.7 vs. 1.3 +/- 1.47 stressors respectively, p < 0.0001. Family functioning of psychiatric patients was less healthy than the nonclinical control. The present study underlined the significance of family assessment and family intervention in the comprehensive care of psychiatric patients.

The interaction of parental history of suicidal behavior and exposure to adoptive parents' psychiatric disorders on adoptee suicide attempt hospitalizations.

PubMed

Wilcox, Holly C; Kuramoto, S Janet; Brent, David; Runeson, Bo

2012-03-01

The authors examined the risk of suicide attempt or other psychiatric hospitalization among adoptees whose biological parents died from or were hospitalized for suicidal behavior (BPSB) relative to adoptees whose biological parents had a psychiatric hospitalization but never for suicide attempt (BPPH). The authors examined whether risk was moderated by having an adoptive parent who had a psychiatric hospitalization during the adoptee's childhood or adolescence. This retrospective cohort study used national longitudinal population-based Swedish registry data from 1973 to 2003 to identify 2,516 adoptees with BPSB and 5,875 adoptees with BPPH. Cox regression models compared the risk for suicide attempt and other psychiatric hospitalization in the two groups. The interaction of BPSB with adoptive mothers' psychiatric hospitalization while the adoptee was younger than 18 years old increased the risk for an adoptee's suicide attempt. Neither BPSB nor psychiatric hospitalization among adoptive mothers alone placed adoptees at greater risk for suicide attempt hospitalizations. The interaction results were specific to adoptee suicide attempt. Exposure to the hospitalization of an adoptive mother because of a psychiatric disorder amplified an adoptee's risk for suicide attempt hospitalization among those adoptees at high genetic risk of suicide or suicide attempt. These results imply that suicide attempts among those at biological risk might be prevented with the early recognition and care of parental psychiatric illness.

Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial.

PubMed

Kidorf, Michael; Brooner, Robert K; Gandotra, Neeraj; Antoine, Denis; King, Van L; Peirce, Jessica; Ghazarian, Sharon

2013-11-01

The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program. Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks. ROIC participants attended more overall psychiatric sessions at month 1 (M=7.53 vs. 3.97, p<.001), month 2 (M=6.31 vs. 2.81, p<.001), and month 3 (M=5.71 vs. 2.44, p<.001). Both conditions evidenced reductions in psychiatric distress (p<.001) and similar rates of drug-positive urine samples. No differences in study retention were observed. These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Psychiatric Residents' Self-Assessment of Teaching Knowledge and Skills following a Brief "Psychiatric Residents-as-Teachers" Course: A Pilot Study

ERIC Educational Resources Information Center

Grady-Weliky, Tana A.; Chaudron, Linda H.; DiGiovanni, Sue K.

2010-01-01

Objective: Resident physicians have an important role in medical student teaching. There has been limited curriculum development in this area for general psychiatric residents. A 4-hour workshop for PGY-2 psychiatric residents was designed and implemented to improve residents' self-assessment of their knowledge of the medical student curriculum…

[Graduation from nursing: learning about the Brazilian psychiatric reform].

PubMed

Olschowsky, A; Barros, S

1999-12-01

This paper aims at identifying the changes that became part of the teaching of psychiatric nursing. The study points out the concern regarding teaching updating in this area in which the teacher's transformation, participation and the creation of a new concept about psychiatric knowledge and practice make it possible to have new ways to learn how to learn the brazilian psychiatric reform.

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.

Reliability and Validity of the "Children's Interview for Psychiatric Syndromes-Parent Version" in Autism Spectrum Disorders

ERIC Educational Resources Information Center

Witwer, Andrea N.; Lecavalier, Luc; Norris, Megan

2012-01-01

The "Children's Interview for Psychiatric Syndromes-Parent Version" (P-ChIPS) is a structured psychiatric interview designed to assess the presence of psychiatric disorders in children and adolescents. This study examined the reliability and validity of the P-ChIPS in 61 youngsters (6- to 17-years-old) with Autism Spectrum Disorders. Reliability…

Psychiatric Symptoms in Youth with a History of Autism and Optimal Outcome

ERIC Educational Resources Information Center

Orinstein, Alyssa; Tyson, Katherine E.; Suh, Joyce; Troyb, Eva; Helt, Molly; Rosenthal, Michael; Barton, Marianne L.; Eigsti, Inge-Marie; Kelley, Elizabeth; Naigles, Letitia; Schultz, Robert T.; Stevens, Michael C.; Fein, Deborah A.

2015-01-01

Since autism spectrum disorder (ASD) is often comorbid with psychiatric disorders, children who no longer meet criteria for ASD (optimal outcome; OO) may still be at risk for psychiatric disorders. A parent interview for DSM-IV psychiatric disorders (K-SADS-PL) for 33 OO, 42 high-functioning autism (HFA) and 34 typically developing (TD) youth,…

Differences in job stress experienced by female and male Japanese psychiatric nurses.

PubMed

Yada, Hironori; Abe, Hiroshi; Omori, Hisamitsu; Matsuo, Hisae; Masaki, Otsubo; Ishida, Yasushi; Katoh, Takahiko

2014-10-01

In psychiatric nursing, female nurses tend to spend more time building rapport with patients and developing cooperative working relationships with colleagues; they encounter more sexual harassment by patients. In contrast, male nurses respond to aggressive patients and tend to resist physically caring for female patients; they encounter more physical and verbal assault from patients. These gender differences might result in differences in job-related stress. We quantitatively examined gender differences in psychiatric nurses' job stress. The Psychiatric Nurse Job Stressor Scale and the Stress Reaction Scale of the Brief Job Stress Questionnaire were administered to 159 female and 85 male Japanese psychiatric nurses. The results indicated that female nurses had significantly higher stress levels than males related to psychiatric nursing ability, attitude towards nursing, and stress reactions of fatigue and anxiety. Moreover, the factors affecting stress reactions differed somewhat between sexes. In particular, male nurses reported that greater irritability was affected by patients' attitudes. Their anxiety and somatic symptoms were affected by their attitude towards nursing, and depressed mood was affected by psychiatric nursing ability. Knowledge of these differences can lead to better mental health-care interventions for psychiatric nurses. © 2014 Australian College of Mental Health Nurses Inc.

Job satisfaction and intent to leave among psychiatric nurses: closed versus open wards.

PubMed

Baum, Alexander; Kagan, Ilya

2015-08-01

The aim of this study was to investigate: (a) the association between socio-demographic variables, job satisfaction and intent to leave among hospital psychiatric nurses, and (b) the differences in the above between psychiatric nurses working on closed and open wards. After receiving ethical approval, a convenience sample of 52 (70% of total nursing staff) was drawn from psychiatric nurses in a large Israeli psychiatric hospital (95% response rate). The sample completed anonymously a self-administered structured questionnaire. A negative correlation was found between job satisfaction and intent to leave and between age, all categories of seniority, and intent to leave. Closed-ward nurses reported a higher intent to leave psychiatric nursing. Nurses under 35 reported a significantly higher intent to leave psychiatric nursing than nurses over 35. Job satisfaction was significantly higher among full-time nurses than part-time. Psychiatric hospitals need to pay attention to all factors associated with workers' readiness to leave. Given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, and the particular stresses that closed-ward nurses work under. Copyright © 2015 Elsevier Inc. All rights reserved.

Understanding migraine and psychiatric comorbidity.

PubMed

Seng, Elizabeth K; Seng, Cynthia D

2016-06-01

This article describes recent trends in our understanding of the role of psychiatric disorders in the experience and treatment of migraine, and the role of migraine in the experience and treatment of psychiatric disorders. Although the majority of studies evaluating psychiatric comorbidity in migraine have focused on depression, anxiety, and bipolar disorders are highly associated with migraine and relevant for prognosis and treatment planning. Comorbid psychiatric disorders may be associated with poorer treatment response for some acute pharmacotherapies; however, people with comorbid migraine and mood or anxiety disorders can achieve large responses to preventive pharmacologic and behavioral therapies. Emerging research is developing and evaluating behavioral treatments designed to manage cooccurring migraine and mood or anxiety disorders. Stigma related to psychiatric disorders has been well characterized, and could exacerbate extant migraine-related stigma. Anxiety and mood disorders are prevalent in people with migraine, although not ubiquitous. Psychiatric comorbidity is associated with greater migraine symptoms and disability; however, people with comorbid depression or anxiety are amenable to preventive migraine treatment. Research regarding migraine treatment strategies optimized for people with comorbid psychiatric disorders is critical to advancing care and reducing stigma for this important subpopulation of people with migraine.

Substance abuse treatment and psychiatric comorbidity: do benefits spill over? analysis of data from a prospective trial among cocaine-dependent homeless persons

PubMed Central

Kertesz, Stefan G; Madan, Alok; Wallace, Dennis; Schumacher, Joseph E; Milby, Jesse B

2006-01-01

Background Comorbid psychiatric illness can undermine outcomes among homeless persons undergoing addiction treatment, and psychiatric specialty care is not always readily available. The prognosis for nonsubstance abuse psychiatric diagnoses among homeless persons receiving behaviorally-based addiction treatment, however, is little studied. Results Data from an addiction treatment trial for 95 cocaine-dependent homeless persons (1996–1998) were used to profile psychiatric diagnoses at baseline and 6 months, including mood-related disorders (e.g. depression) and anxiety-related disorders (e.g. post-traumatic stress disorder). Treatment interventions, including systematic reinforcement for goal attainment, were behavioral in orientation. There was a 32% reduction in the prevalence of comorbid non-addiction psychiatric disorder from baseline to 6 months, with similar reductions in the prevalence of mood (-32%) and anxiety-related disorders (-20%) (p = 0.12). Conclusion Among cocaine-dependent homeless persons with psychiatric comorbidity undergoing behavioral addiction treatment, a reduction in comorbid psychiatric disorder prevalence was observed over 6 months. Not all participants improved, suggesting that even evidence-based addiction treatment will prove insufficient for a meaningful proportion of the dually diagnosed homeless population. PMID:16965639

Advances in Psychiatric Diagnosis: Past, Present, and Future.

PubMed

North, Carol S; Surís, Alina M

2017-04-26

This editorial examines controversies identified by the articles in this special issue, which explore psychopathology in the broad history of the classification of selected psychiatric disorders and syndromes over time through current American criteria. Psychiatric diagnosis has a long history of scientific investigation and application, with periods of rapid change, instability, and heated controversy associated with it. The articles in this issue examine the history of psychiatric nomenclature and explore current and future directions in psychiatric diagnosis through the various versions of accepted diagnostic criteria and accompanying research literature addressing the criteria. The articles seek to guide readers in appreciating the complexities of psychiatric diagnosis as the field of psychiatry pushes forward toward future advancements in diagnosis. Despite efforts of many scientists to advance a diagnostic classification system that incorporates neuroscience and genetics, it has been argued that it may be premature to attempt to move to a biologically-based classification system, because psychiatric disorders cannot yet be fully distinguished by any specific biological markers. For now, the symptom-based criteria that the field has been using continue to serve many essential purposes, including selection of the most effective treatment, communication about disease with colleagues, education about psychiatric illness, and support for ongoing research.

HIV RELATED ADMISSIONS IN A PSYCHIATRIC HOSPITAL A FIVE YEAR PROFILE

PubMed Central

Chandra, P.S.; Krishna, V.A.S.; Ravi, V.; Desai, A.; Puttaram, S.

1999-01-01

Recent reports have indicated an increasing prevalence of HIV infection in the mentally ill. Reports have also emphasised the etiological role of HIV infection in psychiatric illness. The aim of this study was to assess the clinical and risk profile of psychiatric inpatients found seropositive for HIV infection. All psychiatric inpatients from a psychiatric hospital who tested positive for HI V infection over a five year period were assessed. The assessments included a detailed clinical history, psychiatric assessment and risk behaviour evaluation. Of the 2283 psychiatric patients tested, 51 were found to be seropositive. 43 patients were included in the study. 30 (69.7%) had a diagnosis of alcohol dependence, of which, 11 patients had comorbid psychiatnc diagnosis in the form of affective disorders (23%) and psychosis (14%). Personality disorders were seen in 9 patients. In 19% the clinical manifestation was considered to be etiologically related to HIV infection. The predominant risk behaviour was in the form of multiple partner heterosexual contacts. In several patients the risk behaviour had occurred during an episode of mental illness or under the influence of alcohol. The study demonstrates the importance of detecting and describing HIV infection and its manifestation among psychiatric patients. PMID:21430804

Substance abuse treatment and psychiatric comorbidity: do benefits spill over? Analysis of data from a prospective trial among cocaine-dependent homeless persons.

PubMed

Kertesz, Stefan G; Madan, Alok; Wallace, Dennis; Schumacher, Joseph E; Milby, Jesse B

2006-09-11

Comorbid psychiatric illness can undermine outcomes among homeless persons undergoing addiction treatment, and psychiatric specialty care is not always readily available. The prognosis for nonsubstance abuse psychiatric diagnoses among homeless persons receiving behaviorally-based addiction treatment, however, is little studied. Data from an addiction treatment trial for 95 cocaine-dependent homeless persons (1996-1998) were used to profile psychiatric diagnoses at baseline and 6 months, including mood-related disorders (e.g. depression) and anxiety-related disorders (e.g. post-traumatic stress disorder). Treatment interventions, including systematic reinforcement for goal attainment, were behavioral in orientation. There was a 32% reduction in the prevalence of comorbid non-addiction psychiatric disorder from baseline to 6 months, with similar reductions in the prevalence of mood (-32%) and anxiety-related disorders (-20%) (p = 0.12). Among cocaine-dependent homeless persons with psychiatric comorbidity undergoing behavioral addiction treatment, a reduction in comorbid psychiatric disorder prevalence was observed over 6 months. Not all participants improved, suggesting that even evidence-based addiction treatment will prove insufficient for a meaningful proportion of the dually diagnosed homeless population.

CNS Drug Development: Lessons Learned Part 3: Psychiatric and Central Nervous System Drugs Developed Over the Last Decade-Implications for the Field.

PubMed

Preskorn, Sheldon H

2017-09-01

This column reviews the divergence between the approach to drug development in infectious disease, oncology, and immunology versus psychiatry. Between 2009 and 2016, 254 new drugs were approved. Of those, only 9 were for a psychiatric indication; another 5 were labeled to treat central nervous system disorders that are not considered psychiatric per se but are frequently found in individuals with psychiatric illnesses (eg, substantial weight gain). There were 2 additional new products for psychiatric indications that involved either a combination product (Contrave) or a prodrug for the production of aripiprazole (Aristada). The column discusses the reasons behind these different rates of development of psychiatric and/or central nervous system drugs compared with drugs in the areas of infectious disease, oncology, and immunology, and it predicts that this situation will change over the next century as we develop an improved understanding of the neurobiology underlying specific psychiatric illnesses.

Psychiatric Symptoms and Barriers to Care in HIV-Infected Individuals Who Are Lost to Care.

PubMed

McLean, Carmen P; Gay, Natalie G; Metzger, David A; Foa, Edna B

Past studies of barriers to HIV care have not comprehensively assessed psychiatric symptoms, and few have assessed barriers to care among people living with HIV (PLWH) who are lost to care (LTC). We examined psychiatric symptoms, barriers to HIV care, and immune functioning in PLWH who were retained in care (RIC; n = 21) or LTC (n = 21). Participants completed diagnostic interviews for posttraumatic stress disorder (PTSD) and other psychiatric disorders, self-report measures of HIV risk behaviors and psychiatric symptoms, and a blood draw to assess viral load. Compared to RIC participants, LTC participants met criteria for a greater number of psychiatric disorders and reported greater depressive symptoms and more barriers to HIV care. There were no group differences in PTSD severity, risk behaviors, or viral load, suggesting that LTC individuals experience greater psychiatric problems and perceive more barriers to care than RIC participants, but are not less likely to have achieved viral suppression.

The role of comorbid psychiatric conditions in health status in epilepsy.

PubMed

Zeber, John E; Copeland, Laurel A; Amuan, Megan; Cramer, Joyce A; Pugh, Mary Jo V

2007-06-01

Comorbid psychiatric conditions are highly prevalent in patients with epilepsy, yet the long-term implications across multiple mental health conditions are poorly understood. We examined the association between psychiatric diagnoses and self-reported health status in veterans with epilepsy. ANCOVA models were used to derive adjusted SF-36V scores for individuals with epilepsy alone (N=7379) or with additional psychiatric conditions (N=6320): depression, schizophrenia, bipolar disorder, anxiety disorder, substance abuse, and posttraumatic stress disorder (PTSD). Compared with patients with epilepsy alone, scores of veterans with comorbid psychiatric diagnoses averaged 21% lower across all domains. Role Limitation scales exhibited the greatest decrement across domains. A PTSD diagnosis consistently corresponded to lower scores, followed by depression. Schizophrenia contributed the least detriment to perceived health status. Comorbid psychiatric conditions impart significant emotional and physical burdens, requiring timely recognition and treatment of these disorders. Patients with epilepsy are uniquely at risk for high physical-psychiatric comorbidity profiles, with concomitant losses in perceived health status.

Conditions of life and death of psychiatric patients in France during World War II: euthanasia or collateral casualties?

PubMed

Lemoine, Patrick; Stahl, Stephen M

2018-04-01

Between 1940 and 1944, an estimated 48,588 patients resident in French psychiatric hospitals died of starvation. Standard prisons, while facing similar problems, did not experience the same number of deaths by starvation, partly due to their ability to develop a black market for food and rations. Patients in psychiatric hospitals, on the other hand, were completely at the mercy of their doctors and the personnel in charge. At Hôpital du Vinatier, a psychiatric facility in Lyon, the mortality rate increased sharply from 1940 to 1944. In 1942, the worst year, 42% of patients died of hunger and exposure. In the end, more than 2,000 patients died at Vinatier. Was this due to a supposed lack of rations, or was it something more sinister? In Germany at the same time, tens of thousands of psychiatric patients died of purposeful starvation in psychiatric hospitals as part of the Nazi program of psychiatric euthanasia. Was the same thing occurring in Lyon?

Who Seeks Treatment When Medicine Opens the Door to Pathological Gambling Patients-Psychiatric Comorbidity and Heavy Predominance of Online Gambling.

PubMed

Håkansson, Anders; Mårdhed, Emma; Zaar, Mats

2017-01-01

Few studies have assessed treatment-seeking behavior and patient characteristics in pathological gambling focusing on psychiatric comorbidity, particularly in a setting of heavy exposure to online gambling. This study aimed to address patient characteristics in a novel health care-based treatment modality for pathological gambling, including potential associations between gambling types, psychiatric comorbidity, and gender. All patients undergoing structured assessment between January 2016 and April 2017 were included ( N  = 106), and patient records were reviewed for cooccurring psychiatric disorders and types of problem games. Eighty percent were men, and 58% received a psychiatric disorder apart from pathological gambling. Problematic gambling on online casino and online sports betting represented 84% of patients. Non-substance-related psychiatric comorbidity was significantly associated with female gender. Online gambling is more clearly predominating in this setting than in studies from other countries. High rates of comorbidity call for structured psychiatric assessment in problem gambling, with a particular focus on female patients with pathological gambling.

Psychiatric disorders associated with Cushing's syndrome.

PubMed

Bratek, Agnieszka; Koźmin-Burzyńska, Agnieszka; Górniak, Eliza; Krysta, Krzysztof

2015-09-01

Cushing's syndrome is the term used to describe a set of symptoms associated with hypercortisolism, which in most cases is caused by hypophysial microadenoma over-secreting adrenocorticotropic hormone. This endocrine disorder is often associated with psychiatric comorbidities. The most important include mood disorders, psychotic disorders, cognitive dysfunctions and anxiety disorders. The aim of this article was to review the prevalence, symptoms and consequences of psychiatric disorders in the course of Cushing's syndrome. We therefore performed a literature search using the following keywords: Cushing's syndrome and psychosis, Cushing's syndrome and mental disorders, Cushing's syndrome and depression, Cushing's syndrome and anxiety. The most prevalent psychiatric comorbidity of Cushing's syndrome is depression. Psychiatric manifestations can precede the onset of full-blown Cushing's syndrome and therefore be misdiagnosed. Despite the fact that treatment of the underlying endocrine disease in most cases alleviates psychiatric symptoms, the loss of brain volume persists. It is important to be alert to the symptoms of hypercortisolism in psychiatric patients to avoid misdiagnosis and enable them receiving adequate treatment.

Use of the delusions-symptoms-states inventory to detect psychiatric symptoms in a sample of homeless men.

PubMed Central

Shanks, N J; Priest, R G; Bedford, A; Garbett, S

1995-01-01

BACKGROUND. Previous research, often using the symptom-sign inventory, had demonstrated a high prevalence of psychiatric disorder among homeless people. The delusions-symptoms-states inventory detects the presence or absence of four classes of psychiatric illness--delusions of disintegration, integrated delusions, neurotic symptoms and dysthymic states. AIM. A study was undertaken to determine the utility of the delusions-symptoms-states inventory in a sample of homeless men, and the prevalence of psychiatric symptoms in this group. METHOD. The inventory was administered to 55 homeless men in a reception centre in Sheffield. RESULTS. Nearly half of the men obtained scores on the inventory suggesting that they had psychiatric symptoms. There was an overlap of syndromes, particularly among those with severe psychiatric illness. For example, seven men had all four classes of psychiatric illness. CONCLUSION. Use of the questionnaire proved satisfactory. The findings support the contention that reception centres and similar accommodation are repositories for homeless mentally ill people. PMID:7612322

Occupational stress, coping strategies, and psychological-related outcomes of nurses working in psychiatric hospitals.

PubMed

Hasan, Abd Alhadi; Elsayed, Sonia; Tumah, Hussein

2018-02-25

Psychiatric nurses experience a wide range of stressful events, evolving from the care of violent, aggressive patients, recurrent relapse, and poor prognosis of mental disorders. The aim of the study was to assess workplace stress, coping strategies, and levels of depression among psychiatric nurses. A descriptive correlation design was conducted on psychiatric nurses working in mental health settings Port-Said, Egypt. Data were collected from 70 nurses at a mental health hospital. The results revealed that psychiatric nurses had moderate levels of work-related stress and depression, and exhibiting different coping strategies. Stress and depression are prevalent among psychiatric nurses. Implementing programs aimed at teaching them how to deal with stress at work and improving their coping strategies and problem-solving skills are recommended. © 2018 Wiley Periodicals, Inc.

Psychiatric outcomes after pediatric sports-related concussion.

PubMed

Ellis, Michael J; Ritchie, Lesley J; Koltek, Mark; Hosain, Shahid; Cordingley, Dean; Chu, Stephanie; Selci, Erin; Leiter, Jeff; Russell, Kelly

2015-12-01

The objectives of this study were twofold: (1) to examine the prevalence of emotional symptoms among children and adolescents with a sports-related concussion (SRC) who were referred to a multidisciplinary pediatric concussion program and (2) to examine the prevalence, clinical features, risk factors, and management of postinjury psychiatric outcomes among those in this clinical population. The authors conducted a retrospective chart review of all patients with SRC referred to a multidisciplinary pediatric concussion program between September 2013 and October 2014. Clinical assessments carried out by a single neurosurgeon included clinical history, physical examination, and Post-Concussion Symptom Scale (PCSS) scoring. Postinjury psychiatric outcomes were defined as a subjective worsening of symptoms of a preinjury psychiatric disorder or new and isolated suicidal ideation or diagnosis of a novel psychiatric disorder (NPD). An NPD was defined as a newly diagnosed psychiatric disorder that occurred in a patient with or without a lifetime preinjury psychiatric disorder after a concussion. Clinical resources, therapeutic interventions, and clinical and return-to-play outcomes are summarized. One hundred seventy-four patients (mean age 14.2 years, 61.5% male) were included in the study. At least 1 emotional symptom was reported in 49.4% of the patients, and the median emotional PCSS subscore was 4 (interquartile range 1-8) among those who reported at least 1 emotional symptom. Overall, 20 (11.5%) of the patients met the study criteria for a postinjury psychiatric outcome, including 14 patients with an NPD, 2 patients with isolated suicidal ideation, and 4 patients with worsening symptoms of a preinjury psychiatric disorder. Female sex, a higher initial PCSS score, a higher emotional PCSS subscore, presence of a preinjury psychiatric history, and presence of a family history of psychiatric illness were significantly associated with postinjury psychiatric outcomes. Interventions for patients with postinjury psychiatric outcomes included pharmacological therapy alone in 2 patients (10%), cognitive behavioral therapy alone in 4 (20%), multimodal therapy in 9 (45%), and no treatment in 5 (25%). Overall, 5 (25%) of the patients with postinjury psychiatric disorders were medically cleared to return to full sports participation, whereas 5 (25%) were lost to follow-up and 9 (45%) remained in treatment by the multidisciplinary concussion program at the end of the study period. One patient who was asymptomatic at the time of initial consultation committed suicide. Emotional symptoms were commonly reported among pediatric patients with SRC referred to a multidisciplinary pediatric concussion program. In some cases, these symptoms contributed to the development of an NPD, isolated suicidal ideation, and worsening symptoms of a preexisting psychiatric disorder. Future research is needed to clarify the prevalence, pathophysiology, risk factors, and evidence-based management of postinjury psychiatric outcomes after pediatric SRC. Successful management of these patients requires prompt recognition and multidisciplinary care by experts with clinical training and experience in concussion and psychiatry.

Towards a second-person neuropsychiatry

PubMed Central

Schilbach, Leonhard

2016-01-01

Psychiatric disorders can affect our ability to successfully and enjoyably interact with others. Conversely, having difficulties in social relations is known to increase the risk of developing a psychiatric disorder. In this article, the assumption that psychiatric disorders can be construed as disorders of social interaction is reviewed from a clinical point of view. Furthermore, it is argued that a psychiatrically motivated focus on the dynamics of social interaction may help to provide new perspectives for the field of social neuroscience. Such progress may be crucial to realize social neuroscience's translational potential and to advance the transdiagnostic investigation of the neurobiology of psychiatric disorders. PMID:26644599

Psychiatric/mental health nursing.

PubMed

DeSalvo Rankin, E A

1986-09-01

From a historical perspective, psychiatric/mental health nursing as a specialized area of practice is in its early developmental stages. Within the discipline of nursing and on the interdisciplinary scene, the range and scope of actions of the psychiatric/mental health specialists is still being debated. Professional roles and responsibilities are somewhat blurred. But the role is expanding. Contemporary psychiatric nursing practice has moved to a position of collegial support among the disciplines with shared responsibility. The attitudes of society, of the nursing profession, and of the health care providers will continue to influence the maturation process of the psychiatric/mental health nursing specialty.

Psychiatric DRGs: more risk for hospitals?

PubMed

Ehrman, C M; Funk, G; Cavanaugh, J

1989-09-01

The diagnosis related group (DRG) system, which replaced the cost-plus system of reimbursement, was implemented in 1983 by Medicare to cover medical expenses on a prospective basis. To date, the DRG system has not been applied to psychiatric illness. The authors compare the likelihood of cost overruns in psychiatric illness with that of cost overruns in medical illness. The data analysis demonstrates that a prospective payment system would have a high likelihood of failure in psychiatric illness. Possible reasons for failure include wide variations in treatments, diagnostics, and other related costs. Also, the number of DRG classifications for psychiatric illness is inadequate.

42 CFR 441.152 - Certification of need for services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs...) Proper treatment of the recipient's psychiatric condition requires services on an inpatient basis under...

Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment.

PubMed

Bogart, L M; Kelly, J A; Catz, S L; Sosman, J M

2000-04-15

To examine influences of medical factors (e.g., viral load) and nonmedical factors (e.g., patient characteristics) on treatment decisions for highly active antiretroviral therapy (HAART), we sent a survey to a random sample of 995 infectious disease physicians who treat patients with HIV/AIDS in the United States in August, 1998. The response rate was 53%. Respondents were asked to report their current practices with respect to antiretroviral treatment and the extent to which each of three medical and 17 nonmedical factors would influence them for or against prescribing HAART to a hypothetical HIV-positive patient. Most reported initiating HAART with findings of low CD4+ cell counts and high viral loads, and weighing CD4+ cell counts, viral load, and opportunistic infection heavily in their decisions to prescribe HAART. Patients' prior history of poor adherence was weighed very much against initiating HAART. Patient homelessness, heavy alcohol use, injection drug use, and prior psychiatric hospitalization were cited by most physicians as weighing against HAART initiation. Thus, most physicians in this sample follow guidelines for the use of HAART, and nonmedical factors related to patients' life situations are weighed as heavily as disease severity in treatment decisions. As HIV increasingly becomes a disease associated with economic disadvantage and other social health problems, it will be essential to develop interventions and care support systems to enable patients experiencing these problems to benefit from HIV treatment advances.

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…

Predictors of Psychiatric Disorders in Combat Veterans

DTIC Science & Technology

2013-05-07

Naval Health Research Center Predictors of Psychiatric Disorders in Combat Veterans Stephanie Booth-Kewley Emily A. Schmied Robin M...ARTICLE Open Access Predictors of psychiatric disorders in combat veterans Stephanie Booth-Kewley1*, Emily A Schmied1, Robyn M Highfill-McRoy1, Gerald E...examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders

Psychiatric severity and HIV-risk sexual behaviors among persons with substance use disorders.

PubMed

Majer, John M; Komer, Anne C; Jason, Leonard A

2015-01-01

The relationship between mental illness and human-immunodeficiency virus (HIV)-risk sexual behavior among persons with substance use disorders is not well-established because of differences in assessing psychiatric factors (types, symptoms, severity), substance use (diagnosis, survey responses, past substance use), and HIV-risk sexual behaviors (individual measures, combination of sex/drug use risk behaviors) across studies. This study utilized a more global and dimensional aspect of psychiatric issues (problem severity) to examine the relationship with HIV-risk sexual behaviors and substance use among persons with substance use disorders. Participants included 224 men and 46 women, with a mean age of 40.4 years (SD = 9.5). The most common substances were heroin/opiates, with 41.4% reporting use of these substances (n = 110), while 27.8% reported using cocaine (n = 74) and 12.8% reported using alcohol (n = 34). Of all participants, 39 (14.4%) were identified as having high psychiatric severity (defined using the psychiatric severity score from the Addiction Severity Index), which was used as an indication of probable comorbid psychiatric and substance use disorders. Among these participants likely to have comorbid disorders, hierarchical linear regression was conducted to examine HIV-risk sexual behaviors (number of partners and unprotected sexual behaviors in the past 30 days) in relation to psychiatric severity, substance use, and gender. Gender (women) and psychiatric severity (higher) were significantly related to greater HIV-risk sexual behaviors. After entering gender and substance use into the regression model, psychiatric severity accounted for another 21.9% of the variance in number of partners and 14.1% of the variance in unprotected sexual behaviors. Overall, the models accounted for 55.5% and 15.6% of the variance, respectively. A significant interaction was found for number of partners (but not frequency of unprotected behavior), such that those higher in psychiatric severity and higher in substance use had a greater number of sexual partners. The model including this interaction term accounted for 63.4% of the variance in number of partners. Findings suggest psychiatric severity is an underlying risk factor for HIV-risk sexual behavior among persons with substance use disorders who have various psychiatric comorbidities.

Association of Psychiatric Illness or Psychotropic Medication Usage with Calcaneus Fracture.

PubMed

Janney, Cory F; Goodrum, Jason T; Jupiter, Daniel; Wigg, Cindy L; Carmichael, Kelly

2017-12-21

Background There is a noticeable lack of studies examining the connection between psychiatric illness and orthopaedic injury. The goal of this study is to determine if a relationship exists between calcaneus fracture and psychiatric illness or use of psychotropic medication.  Methods A retrospective review was undertaken of calcaneus fracture patients at our institution from January 2011 through January 2014, and those with a diagnosis of psychiatric illness or history of psychotropic medication usage were identified. Medication records were analyzed along with medical histories taken during the initial encounter. If the patient was admitted, hospital notes for the hospitalization were reviewed to determine if any information was missed during the initial encounter. The date of injury, age, sex, insurance status at the time of initial encounter, psychiatric diagnoses or psychotropic medication use, and mechanism of injury were recorded. Any specific psychiatric diagnoses were collected from the patient charts, as was the presence of any specific prescribed psychotropic medications. After completion of the data collection, an attending psychiatrist verified the recorded data to ensure an accurate psychiatric assessment. Results A total of 85 calcaneus fractures met the inclusion criteria. In the population, there were 71 males and 14 females. The average age of the patients was 41.74 years, with 24% of patients having a diagnosis of psychiatric illness at the time of injury. The relative risk of a psychiatric illness in males compared to females was 0.31 (p = 0.009) while the relative risk of using psychotropic medication in males compared to females was 0.17 (p = 0.0007). Males were less likely to undergo operative intervention than females (p = 0.0001). The average age of a patient who either had a diagnosis or took medication for a psychiatric illness was 48.4 years, as compared to 39.7 years in those who did not (p = 0.014). Conclusion Males were less likely to have a psychiatric illness or be currently treated with psychotropic medications. A dedicated review of psychiatric history and prior medication may be useful during preoperative, perioperative, and postoperative treatment planning.  Level of Clinical Evidence: 4.

Effects of mandatory screening labs in directing the disposition of the apparently healthy psychiatric patient in the emergency department.

PubMed

Kagel, Karyn E; Smith, Meghan; Latyshenko, Ilya V; Mitchell, Christopher; Kagel, Andrew

2017-01-01

To determine whether mandatory psychiatric admission laboratory tests yield results that change the disposition of a patient with primary psychiatric complaint from admission to a psychiatric service to admission to a medical service. This was a single center retrospective cohort chart review study approved by the facility Institutional Review Board in which we used a records database maintained by the emergency department's social workers to access the records of every patient that presented to our emergency department with a psychiatric chief complaint between the dates of December 1, 2011, and December 1, 2013. We focused on those that were admitted to either a psychiatric service or a medical service after a thorough evaluation by the department of social work and an emergency provider. We applied our inclusion and exclusion criteria and reviewed the results of the mandatory psychiatric laboratory tests (complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, acetaminophen, aspirin, blood alcohol level, urinalysis, urine pregnancy test, urine drug screen) required for admission. Our independent variables were the compulsory psychiatric admission laboratory tests and our dependent variable was the admission to a medical service. Of 5,606 laboratory tests that were ordered and produced results for the 682 patients enrolled in our study, 51 results were considered clinically significant abnormal results, or results requiring treatment prior to psychiatric service admission, by the 2 reviewing emergency physicians. Only one of 682 psychiatric patients received a final disposition to a medical service based upon abnormal laboratory studies. That patient presented without any medical complaints but a chief complaint of "suicidal ideation," and was found to have diabetic ketoacidosis. Based on our data, the probability that an abnormal laboratory test will result in a change in disposition is 1/682=0.1% (95% CI: 0.0% to 0.9%). Patients presenting to the emergency department with a psychiatric chief complaint and no physical complaints, abnormal vital signs, or abnormal physical exam findings have less than 1% probability that an abnormal laboratory study will change their disposition from a psychiatric admission to a medical admission.

Association of Psychiatric Illness or Psychotropic Medication Usage with Calcaneus Fracture

PubMed Central

Goodrum, Jason T; Jupiter, Daniel; Wigg, Cindy L; Carmichael, Kelly

2017-01-01

Background There is a noticeable lack of studies examining the connection between psychiatric illness and orthopaedic injury. The goal of this study is to determine if a relationship exists between calcaneus fracture and psychiatric illness or use of psychotropic medication.  Methods A retrospective review was undertaken of calcaneus fracture patients at our institution from January 2011 through January 2014, and those with a diagnosis of psychiatric illness or history of psychotropic medication usage were identified. Medication records were analyzed along with medical histories taken during the initial encounter. If the patient was admitted, hospital notes for the hospitalization were reviewed to determine if any information was missed during the initial encounter. The date of injury, age, sex, insurance status at the time of initial encounter, psychiatric diagnoses or psychotropic medication use, and mechanism of injury were recorded. Any specific psychiatric diagnoses were collected from the patient charts, as was the presence of any specific prescribed psychotropic medications. After completion of the data collection, an attending psychiatrist verified the recorded data to ensure an accurate psychiatric assessment. Results A total of 85 calcaneus fractures met the inclusion criteria. In the population, there were 71 males and 14 females. The average age of the patients was 41.74 years, with 24% of patients having a diagnosis of psychiatric illness at the time of injury. The relative risk of a psychiatric illness in males compared to females was 0.31 (p = 0.009) while the relative risk of using psychotropic medication in males compared to females was 0.17 (p = 0.0007). Males were less likely to undergo operative intervention than females (p = 0.0001). The average age of a patient who either had a diagnosis or took medication for a psychiatric illness was 48.4 years, as compared to 39.7 years in those who did not (p = 0.014). Conclusion Males were less likely to have a psychiatric illness or be currently treated with psychotropic medications. A dedicated review of psychiatric history and prior medication may be useful during preoperative, perioperative, and postoperative treatment planning.  Level of Clinical Evidence: 4 PMID:29492366

Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study

PubMed Central

Agerbo, Esben; Ingstrup, Katja G; Musliner, Katherine; Meltzer-Brody, Samantha; Bergink, Veerle; Munk-Olsen, Trine

2017-01-01

Objective To investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders. Design Population based cohort study. Setting Danish national registers. Participants 905 383 liveborn singletons born during 1998-2012 in Denmark and followed from birth until July 2014, death, emigration, or date of first psychiatric diagnosis, whichever came first. The children were followed for a maximum of 16.5 years and contributed 8.1×106 person years at risk. Exposures for observational studies Children were categorised into four groups according to maternal antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy), and new user (use only during pregnancy). Main outcome measure First psychiatric diagnosis in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models. Results Overall, psychiatric disorders were diagnosed in 32 400 children. The adjusted 15 year cumulative incidence of psychiatric disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group. The antidepressant continuation group had an increased risk of psychiatric disorders (hazard ratio 1.27, 1.17 to 1.38), compared with the discontinuation group. Conclusions In utero exposure to antidepressants was associated with increased risk of psychiatric disorders. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. The findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive. PMID:28877907

Psychiatric disorders in children at one year after the tsunami disaster in Thailand.

PubMed

Piyasil, Vinadda; Ketumarn, Panom; Prubrukarn, Ratanotai; Pacharakaew, Siripapa; Dumrongphol, Hattaya; Rungsri, Sarinee; Sitdhiraksa, Nantawat; Pitthayaratsathien, Nattorn; Prasertvit, Jiraporn; Sudto, Korapin; Theerawongseree, Siriporn; Aowjinda, Sumitra; Thaeramanophab, Somchit; Jotipanu, Vajiraporn; Chatchavalitsakul, Wilairatana

2008-10-01

The tsunami that struck Thailand on 26th December 2004 was the greatest natural disaster in the country's history. It left in its wake unprecedented damage and destruction. Children suffered the loss of parents or guardians, and survivors were left to cope with psychological trauma of the disaster To assess the psychiatric disorders in tsunami victim children at one year after the event. A cross sectional study was done. One thousand three hundred and sixty-four students from 2 schools were enrolled. Three tests were used according to the students' grades, pediatric symptoms checklist, Childhood Depressive Inventory and the Revised Child Impact of Events scale (CRIES). Psychiatric disorders were diagnosed by child and adolescent psychiatrists, using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV). Analysis data by using SPSS version 10.0 and Chi-square test. The results were presented as percentage and p-value. Psychiatric disorders were found in 142 students or 10.4 percents of all students at one year after the tsunami disaster. Not all the students who had psychiatric disorders developed them as the result of the tsunami disaster However, ninety students or 6.3 percent of all the students did have psychiatric disorders resulting from the tsunami disaster The most common psychiatric problem was post traumatic stress disorder Ten percent of grade 4-6 students and 11 percent of grade 7-9 students had psychiatric disorders. The prevalence was lower in kindergarten and grade 1-3 students of which the percentage was 2.3 and 3.8 respectively. The prevalence of psychiatric disorders at 1 year after the tsunami disaster was 10.4 percent of all the students or 33.1 percent of victims. The prevalence of psychiatric disorders in grade 4-6 and 7-9 students was higher than in kindergarten and grade 1-3 students. The most common psychiatric problem is post traumatic stress disorder.

Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups

PubMed Central

2017-01-01

In this study, we compared 10 ethnic groups for associations between psychiatric disorders and physical self-rated health (SRH) in the United States. Data came from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. The study included 7587 non-Latino White, 4746 African American, 1442 Mexican, 1106 other Hispanic, 656 other Asian, 600 Chinese, 577 Cuban, 520 Vietnamese, 508 Filipino, and 495 Puerto Rican individuals. The Composite International Diagnostic Interview (CIDI) was used to measure psychiatric disorders, including major depressive disorder (MDD), general anxiety disorder (GAD), social phobia, panic disorder, post-traumatic stress disorder (PTSD), alcohol abuse, and binge eating disorders. A single-item measure was used to estimate physical SRH. Demographic (age and gender) and socioeconomic (education and income) factors were also measured. Unadjusted and adjusted correlations between psychiatric disorders and physical SRH were calculated. Major ethnic variations were found in the correlation between psychiatric disorders and physical SRH; as well as the role of demographic and socioeconomic status (SES) factors in explaining these associations. non-Hispanic Whites, Cubans, and African Americans showed more correlations between psychiatric disorders and physical SRH than other ethnic groups. In non-Hispanic Whites, the associations between psychiatric disorders and physical SRH were explained by demographic factors. In African Americans, the link between psychiatric disorders and poor physical SRH were explained by SES indicators. In conclusion, although single-item physical SRH measures are traditionally assumed to reflect the physical health needs of populations, they may also indicate psychiatric disorders in some ethnic groups, such as non-Hispanic Whites, Cubans, and African Americans. Demographic and socioeconomic factors also have differential roles in explaining the link between psychiatric disorders and physical SRH. Physical SRH does not exclusively reflect physical health, and it may be more biased by mental health across some ethnic groups. PMID:29137173

77 FR 2067 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-13

... and Seclusion in Psychiatric Residential Treatment Facilities Providing Psychiatric Services to Individuals Under Age 21 and Supporting Regulations at 42 CFR 483.350-483.376; Use: Psychiatric Residential...

[Shift of usage of medical psychiatric and psychosocial services in Upper Austria (whole territory of Austria) in the period 1965-2005].

PubMed

Hofmann, Gustav; Schöny, Werner; Donabauer, Rita; Rachbnauer, Christian

2005-06-01

Psychiatric reforms in Upper Austria have considerably improved the quality of life of psychiatric patients. Modernizing the status of acute psychiatric departments based on a bio- psycho-, social concept implemented multidimensional approach in diagnostics and therapeutic methods applied by multiprofessional teams. Prophylactic procedures and rehabilitation programs have minimized chronification of psychiatric diseases. By "late rehabilitation programs" increased autonomy, more individualized planning of life processes could be achieved even with "chronic" patients. We do not see any need to confine "chronic" psychiatric patients in psychiatric hospitals. These patients are cared for, socially integrated by special rehabilitation measures and professional rehabilitation in community-based services and units of Pro Mente Upper Austria--a non-profit organization. Problems decreased the duration of stay in psychiatric hospitals, and increased admission rates when the number of beds in psychiatric departments was considerably decreased in the course of psychiatric reforms in Austria. In our province--Upper Austria--these problems are of lesser importance because private non-profit organizations like Pro Mente Upper Austria have provided a variety of community-based services (mental health centres, day clinics, housing facilities and special services for drug addicts and geriatric patients) in ever increasing numbers. Still there is the need for further development of community-based services provided by specially trained professionals. These services are financed mainly by the state, the provincial government, the labour market services and to a small degree by funds of the European Union. In these days of reduced social budgets of the state and social departments of provincial governments it is not easy to keep our standards and meet the increased needs of our clients.

Adverse life events increase risk for postpartum psychiatric episodes: A population-based epidemiologic study.

PubMed

Meltzer-Brody, S; Larsen, J T; Petersen, L; Guintivano, J; Florio, A Di; Miller, W C; Sullivan, P F; Munk-Olsen, T

2018-02-01

Trauma histories may increase risk of perinatal psychiatric episodes. We designed an epidemiological population-based cohort study to explore if adverse childhood experiences (ACE) in girls increases risk of later postpartum psychiatric episodes. Using Danish registers, we identified women born in Denmark between January 1980 and December 1998 (129,439 childbirths). Exposure variables were ACE between ages 0 and 15 including: (1) family disruption, (2) parental somatic illness, (3) parental labor market exclusion, (4) parental criminality, (5) parental death, (6) placement in out-of-home care, (7) parental psychopathology excluding substance use, and (8) parental substance use disorder. Primary outcome was first occurrence of in- or outpatient contact 0-6 months postpartum at a psychiatric treatment facility with any psychiatric diagnoses, ICD-10, F00-F99 (N = 651). We conducted survival analyses using Cox proportional hazard regressions of postpartum psychiatric episodes. Approximately 52% of the sample experienced ACE, significantly increasing risk of any postpartum psychiatric diagnosis. Highest risks were observed among women who experienced out-of-home placement, hazard ratio (HR) 2.57 (95% CI: 1.90-3.48). Women experiencing two adverse life events had higher risks of postpartum psychiatric diagnosis HR: 1.88 (95% CI: 1.51-2.36), compared to those with one ACE, HR: 1.24 (95% CI: 1.03-49) and no ACE, HR: 1.00 (reference group). ACE primarily due to parental psychopathology and disability contributes to increased risk of postpartum psychiatric episodes; and greater numbers of ACE increases risk for postpartum psychiatric illness with an observed dose-response effect. Future work should explore genetic and environmental factors that increase risk and/or confer resilience. © 2017 Wiley Periodicals, Inc.

The impact of prior psychiatric medical treatment on return to work after a diagnosis of breast cancer: A registry based study.

PubMed

Jensen, Laura Schärfe; Overgaard, Charlotte; Garne, Jens Peter; Bøggild, Henrik; Fonager, Kirsten

2017-08-01

Breast cancer and psychiatric disorders negatively impact work life, both positively associated with unemployment and early retirement. Our purpose was to assess whether being prescribed psychiatric medication, 2-4 yrs prior to a diagnosis of breast cancer, could impact the likelihood of returning to work after cancer therapy. 16,868 self-supporting women, diagnosed with breast cancer in Denmark from 2000 to 2012, were identified from a population-based clinical database, then cross-referenced to data held for psychiatric medication usage, sociodemographics, and labour-market participation. The association between historic psychiatric medication and return to work was estimated using a modified Poisson regression model. 'Return to work' was defined as being self-supporting one year after diagnosis of breast cancer. 16% of our cohort had used psychiatric medical treatment 2-4 years before their diagnosis. Sixty-three per cent of these individuals had returned to work one year later, compared to 69% of the patient group with no prior history of using psychiatric medication treatments. In the fully adjusted model, prior use of psychiatric medication diminished the likelihood of returning to work one year after cancer diagnosis (RR = 0.91 (0.87-0.94)). High income and older age were positively associated with returning to work; negative correlates included those related to disease severity. Historic use of psychiatric medication provoked a minor, although statistically significant reduction in the resumption of working life one year after a diagnosis of breast cancer. Although historic use of psychiatric medication may incur a minor effect on working life, further research is needed on the long-term social consequences for sub-groups.

Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations.

PubMed

Gold, Jessica A; Sher, Yelizaveta; Maldonado, José R

2016-01-01

Frontal lobe epilepsy (FLE) can masquerade as a primary psychiatric condition, be misdiagnosed in-lieu of a true psychiatric disorder, or may be comorbid with psychiatric illness. To (1) qualitatively review psychiatric manifestations of FLE and (2) to systematically review the cases/case series of psychiatric manifestations of FLE presented in the literature to date. A systematic review of the literature was performed following the PRISMA guidelines and using PubMed/Medline, PsychInfo, and Cochrane database of systematic reviews to identify cases and case series of psychiatric manifestations of FLE. A total of 35 separate articles were identified. Further, 17 patients primarily presented with psychosis, 33 with affective symptoms, and 16 with personality changes. Also, 62% of cases were males and 38% were females. Ages ranged from 2-83 years with the average age of 32.7. Prior psychiatric history was reported in 27.3% of cases. Causes of seizure were known in 53%, with the most common causes being dysplasia and tumor. Only 6 cases (<10%) did not have electroencephalographic correlations. Psychiatric manifestations were primarily ictal in 74.3% of the cases. Associated manifestations included motor (63.6%), cognitive (34.8%), and medical (9.0%) findings. Surgery was required in 31.8% of the cases, whereas others were treated with medications alone. All, but 3, patients were seizure free and saw an improvement in symptoms with treatment. Given the complexity and multifunctionality of the frontal lobes, FLE can present with complex, psychiatric manifestations, with associated motor, cognitive, and medical changes; thus, psychiatrists should keep FLE on the differential diagnosis of complex neuropsychiatric cases. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

A general practice-based study of the relationship between indicators of mental illness and challenging behaviour among adults with intellectual disabilities.

PubMed

Felce, D; Kerr, M; Hastings, R P

2009-03-01

Existing studies tend to show a positive association between mental illness and challenging behaviour among adults with intellectual disabilities (ID). However, whether the association is direct or artefactual is less clear. The purpose was to explore the association between psychiatric status and level of challenging behaviour, while controlling for adaptive behaviour and occurrence of autistic spectrum disorders. Data were collected on the age, gender, adaptive and challenging behaviour, social impairment and psychiatric status of 312 adults with ID. Participants were divided according to psychiatric status, group equivalence in adaptive behaviour and the presence of autistic spectrum disorders achieved, and differences in challenging behaviour explored. In addition, multiple regression was used to examine the association between psychiatric status and challenging behaviour after controlling for other participant characteristics and to test whether the interaction between psychiatric status and adaptive behaviour added significantly to explanation. Challenging behaviour was higher among participants meeting threshold levels on the psychiatric screen. The regression analysis confirmed the association and demonstrated an interaction between total score on the psychiatric screen and level of adaptive behaviour. This moderated effect showed the relationship between psychiatric status and challenging behaviour to be stronger at lower adaptive behaviour. This study reinforces previous findings that psychiatric morbidity among people with ID is associated with higher levels of challenging behaviour and supports predictions that this association is more pronounced for people with severe ID. The precise nature and causal direction of the association requires further clarification. However, the understanding of how psychiatric problems might contribute to challenging behaviour needs to be part of the clinical appreciation of such behaviour.

Treating psychiatric emergencies in incarcerated minors in the emergency department: what is the cost and what is their disposition?

PubMed

Wood, David Brian; Donofrio, Joy Joelle; Santillanes, Genevieve; Lam, Chun Nok; Claudius, Ilene

2014-06-01

Although mental health disorders are common among incarcerated minors, psychiatric urgencies and emergencies often cannot be treated in juvenile detention facilities, necessitating emergency department (ED) transfers. The cost of this ED care has not been well studied. This study aimed to provide information on disposition and cost related to ED visits by juvenile hall patients transported for urgent psychiatric evaluation. A retrospective cross-sectional descriptive study of patients presenting to 1 ED from juvenile detention centers for consideration of psychiatric holds was conducted. Eligible patients were identified by a search of the International Classification of Diseases, Ninth Revision, discharge diagnosis codes and chart review. We collected information on patient demographics and disposition and calculated costs of ED visits, screening laboratories performed, inpatient stays on a medical ward, sitter and parole officer salaries, and ambulance transfers. One hundred eight patients accounting for 196 visits were transported from juvenile hall for urgent psychiatric evaluation. Of the 196 visits, 131 (67%) resulted in an involuntary psychiatric hold. More than half of the patients on hold (75 patients) were admitted to a medical ward for boarding because of lack of psychiatric inpatient beds. Included charges for the 196 visits during the 18-month period totaled US $1,357,884, with most of the costs due to boarding on the medical ward. We describe the magnitude and cost associated with addressing psychiatric emergencies in a juvenile correctional system relying on transport of patients to an ED for acute psychiatric evaluation and treatment. Further research is needed to determine if costs could be decreased by increasing psychiatric resources in juvenile detention centers.

Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness.

PubMed

Lahmann, Claas; Henningsen, Peter; Brandt, Thomas; Strupp, Michael; Jahn, Klaus; Dieterich, Marianne; Eckhardt-Henn, Annegret; Feuerecker, Regina; Dinkel, Andreas; Schmid, Gabriele

2015-03-01

Vertigo and dizziness are often not fully explained by an organic illness, but instead are related to psychiatric disorders. This study aimed to evaluate psychiatric comorbidity and assess psychosocial impairment in a large sample of patients with a wide range of unselected organic and non-organic (ie, medically unexplained) vertigo/dizziness syndromes. This cross-sectional study involved a sample of 547 patients recruited from a specialised interdisciplinary treatment centre for vertigo/dizziness. Diagnostic evaluation included standardised neurological examinations, structured clinical interview for major mental disorders (SCID-I) and self-report questionnaires regarding dizziness, depression, anxiety, somatisation and quality of life. Neurological diagnostic workup revealed organic and non-organic vertigo/dizziness in 80.8% and 19.2% of patients, respectively. In 48.8% of patients, SCID-I led to the diagnosis of a current psychiatric disorder, most frequently anxiety/phobic, somatoform and affective disorders. In the organic vertigo/dizziness group, 42.5% of patients, particularly those with vestibular paroxysmia or vestibular migraine, had a current psychiatric comorbidity. Patients with psychiatric comorbidity reported more vertigo-related handicaps, more depressive, anxiety and somatisation symptoms, and lower psychological quality of life compared with patients without psychiatric comorbidity. Almost half of patients with vertigo/dizziness suffer from a psychiatric comorbidity. These patients show more severe psychosocial impairment compared with patients without psychiatric disorders. The worst combination, in terms of vertigo-related handicaps, is having non-organic vertigo/dizziness and psychiatric comorbidity. This phenomenon should be considered when diagnosing and treating vertigo/dizziness in the early stages of the disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The correlation between occupational stress, coping strategies, and the levels of psychological distress among nurses working in mental health hospital in Jordan.

PubMed

Hasan, Abd Alhadi; Tumah, Hussein

2018-05-21

Psychiatric nurses encounter variety of demanding and stressful events such as dealing with aggressive patients, and hostile. This study purposed to assess workplace stress, coping strategies, and psychiatric distress among psychiatric nurses. A descriptive explanatory design was employed. One hundred and nineteen psychiatric nurses were recruited in the study and data were collected in the period between June and September 2017. The results showed that participants experienced moderate level of occupational stress and psychiatric distress. In addition, they utilized different coping mechanism. Stress management techniques program is very effective in helping psychiatric nurse to deal with occupational stress which might influence their wellbeing. Moreover, this program assists them to use more effective coping strategies as problem solving. © 2018 Wiley Periodicals, Inc.

Provision of mental health care in general practice in Italy.

PubMed Central

Tansella, M; Bellantuono, C

1991-01-01

The main features of the psychiatric system and of the general practice system in Italy since the psychiatric reform and the introduction of a national health service are briefly described. Research conducted in Italy confirms that a large proportion of patients seen by general practitioners have psychological disorders and that only some of those patients whose psychological problems are identified by general practitioners are referred to specialist psychiatric care. Thus, the need to identify the best model of collaboration between psychiatric services and general practice services is becoming increasingly urgent. The chances of improving links between the two services and of developing a satisfactory liaison model are probably greater in countries such as Italy where psychiatric services are highly decentralized and community-based, than in countries where the psychiatric services are hospital-based. PMID:1807308

[The new law on strengthening the rights of victims of sexual abuse and its implications for the forensic-psychiatric assessment of sexual offenders].

PubMed

Bumb, Jan Malte; Foerster, Klaus; Dressing, Harald

2014-07-01

Highlighting practical implications and research aspects of forensic-psychiatric assessments in the context of the new law on strengthening the rights of victims of sexual abuse. Based on a clinical case we report implications for the forensic-psychiatric assessment. The new law now requires an expert to evaluate the necessity and the subject's motivation to receive a given treatment. Up to now, the majority of sexual offenders were assumed to be responsible for their actions and in most cases a forensic-psychiatric assessment was not required. For this reason, guidelines for forensic-psychiatric assessments are urgently needed. The number of forensic-psychiatric assessments is likely to increase substantially and a relevant-case law is still lacking. © Georg Thieme Verlag KG Stuttgart · New York.

Suicidal ideation and self-harm following K2 use.

PubMed

Thomas, Shannon; Bliss, Sarah; Malik, Mohammed

2012-11-01

There is emerging evidence of adverse effects associated with K2 and similar synthetic cannabinoid compounds marketed as herbal alternatives to marijuana. Few studies were identified regarding the psychiatric effects of K2, including suicidal ideation, and to our knowledge none have been written related to self-harm following use of K2. A healthy 20-year-old single Caucasian male with no previous psychiatric diagnoses or treatment was brought by police to the ED with acute agitation, confusion, suicidal ideation, and self-inflicted trauma after smoking K2. Evaluation in the ED was notable for agitation, significant abrasions, respiratory rate of 30, negative UDS, and sinus tachycardia on EKG. Once medically stabilized, he was transferred to the inpatient psychiatric unit for continued monitoring. Upon evaluation on the psychiatric unit the following day, his symptoms had completely resolved, he continued to deny any previous psychiatric history, and was discharged home. K2 and other synthetic cannabinoids have been shown to have significant medical and psychiatric adverse effects and they are still readily available for purchase. Evidence is limited regarding the psychiatric effects; however, synthetic cannabinoid products may potentially lead to suicidal ideation and self-harm behaviors amongst many other psychiatric symptoms.The long-term risks are still unclear, but some studies suggest the possibility of inducing chronic psychotic symptoms and worsening underlying psychiatric illness. Continued research is needed regarding the effects of these substances as well as an increase in public awareness of the risks.

The Dubai Community Psychiatric Survey. IV. Life events, chronic difficulties and psychiatric morbidity.

PubMed

Bebbington, P; Hamdi, E; Ghubash, R

1998-10-01

The relationship between life events, chronic social difficulties and psychiatric morbidity was investigated in 297 women selected at random as part of the Dubai Community Psychiatric Survey. The PSE-ID-CATEGO system was used to identify psychiatric cases, based on an Index of Definition level of 5 or more. Life events in the 6-month period prior to illness or interview were elicited through the Life Events and Difficulties Schedule. Chronic difficulties were explored through direct questioning based on a list of possible problems. The study demonstrates a significant excess of marked and moderately threatening life events in acute cases of psychiatric disorder (50%) compared to chronic cases (16.7%) and non-cases (27.9%). The association was particularly marked for events in the 3-month period before the onset. Around 33% of psychiatric morbidity may be attributed to marked and moderately threatening life events. Rates for mild events were similar in the three groups of subjects. Subjects experiencing chronic social difficulties included a significantly higher proportion of cases (33.3%) than those who did not experience such difficulties (9.1%). The effect of chronic social difficulties was more pronounced than, and independent of, the effects of life events. There were no interactions between life events and vulnerability factors in their effect on psychiatric morbidity, although numbers were small. The results suggest that the overall influence of life events and chronic difficulties on psychiatric morbidity is commensurate with that in Western societies, despite the different coping traditions of Islam.

A study to compare the differences between genders in psychiatric comorbidities in individuals with psychoses.

PubMed

Das, Praveen; Sreedaran, Priya; Mv, Ashok

2018-02-01

Psychiatric comorbidities worsen the outcome and increase severity of suffering in psychotic disorders. Gender differences have also been found to impact the severity and outcome in psychoses. In this background, this study attempted to compare psychiatric comorbidity between genders. The aim was to compare psychiatric co-morbidity between men and women with psychotic disorders. A descriptive cross sectional study design was used. Data was collected through clinical interviews using standardized tools as well as the current case records. We used the MINI neuropsychiatric interview 5.0 to generate an ICD 10 diagnosis for primary psychotic illness and psychiatric comorbidity. PANSS was used to assess severity. Calgary Depression Scale for Schizophrenia, Hamilton Anxiety rating scale, Yale Brown Obsessive Compulsive Scale, Alcohol Use Disorders Identification Test and Fagerstrom Nicotine Tolerance Questionnaire were used to study comorbidity. 100 patients were included in the study. 61% of the population had a psychiatric comorbidity. 42% of the men had significantly more multiple psychiatric comorbidities as compared to 7% among women. Men had significantly more substance use than women. Age of onset of psychosis was not found to be different between men and women. In this study men had more psychiatric comorbidity than women, owing to greater levels of substance use disorders and anxiety disorders. This could be one of the possible reasons for differing outcomes between men and women with psychotic disorders thus indicating need for systematic future researching in psychiatric comorbidities in psychoses. Copyright © 2017 Elsevier B.V. All rights reserved.

Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

PubMed

Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael

2012-01-01

Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Clinical correlates of childhood trauma and dissociative phenomena in patients with severe psychiatric disorders.

PubMed

Bozkurt Zincir, Selma; Yanartaş, Omer; Zincir, Serkan; Semiz, Umit Başar

2014-12-01

In this present study, we aim to investigate the possibility of a link between psychotic disorders and traumatic experiences in a group of female patients diagnosed with psychotic disorders by comparing childhood trauma exposure with a group of non-psychotic psychiatric disorder attending the same pschiatric clinic. Secondary purpose of this study is to examine the clinical correlates of trauma exposure, dissociative phenomena and psychiatric symptomatology between these two group of patients. Two psychiatric sample groups, those with psychotic disorders-mostly schizophrenic-(n = 54), and those with a non-psychotic severe psychiatric disorders (n = 24), were recruited. Data were collected for demographic, psychiatric and trauma histories and psychiatric symptomatology for all patients. In this study, high prevalance rates of childhood traumatic experiences and dissociative phenomena were found in both groups. Total scores of childhood trauma questionnaire in favor of the non-psychotic group were found to be close to significance (p = 0.052). DES scores of non-psychotic group were also higher although not statistically significant. 54.2 % of nonpsychotic cases had DES scores >20 on the other hand, that percentage of psychotic cases were found to be as 38.9 %. Furthermore, psychiatric patients who have suffered childhood traumatic experiences are far more likely to try to kill themselves than psychiatric patients who have not experienced such abuse. The high rates of childhood traumatic events in our present samples of both schizophrenia-spectrum patients and nonpsychotic patients confirm the need for clinicans to take trauma histories routinely.

Association Between Allergies and Psychiatric Disorders in Patients Undergoing Invasive Procedures.

PubMed

Aberle, Dwight; Wu, Stephanie E; Oklu, Rahmi; Erinjeri, Joseph; Deipolyi, Amy R

Associations between allergies and psychiatric disorders have been reported in the context of depression and suicide; psychiatric disorders may affect pain perception. To investigate the relationship of allergies with psychiatric disorders and pain perception in the context of invasive procedures, specifically during tunneled hemodialysis catheter placement. We identified 89 patients (51 men, 38 women), mean age 66 years (range: 23-96), who underwent tunneled hemodialysis catheter placement (1/2014-2/2015), recording numeric rating scale pain scores, medications, psychiatric history, allergies, and smoking status. Of 89 patients, 47 patients had no allergies, and 42 had ≥1 allergy. Patients with allergies were more likely to have a pre-existing psychiatric disorder compared to those without allergies, odds ratio 2.6 (95% CI: 1.0-6.8). Having allergies did not affect procedural sedation or postprocedural pain scores. Multiple logistic regression with age, sex, smoking, presence of allergies, psychiatric history, inpatient/outpatient status, procedure time, and procedural sedation administration as inputs and postprocedural pain as the outcome showed that the only independent predictor was receiving procedural sedation (P = 0.005). Findings corroborate anecdotal reports of allergies as a marker for psychiatric history. However, having allergies was not associated with increased pain or need for more sedation. Further studies could prospectively assess whether allergies and psychiatric disorders affect patient/doctor perceptions beyond pain during invasive procedures. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Platform for systems medicine research and diagnostic applications in psychotic disorders-The METSY project.

PubMed

Frank, Elisabeth; Maier, Dieter; Pajula, Juha; Suvitaival, Tommi; Borgan, Faith; Butz-Ostendorf, Markus; Fischer, Alexander; Hietala, Jarmo; Howes, Oliver; Hyötyläinen, Tuulia; Janssen, Joost; Laurikainen, Heikki; Moreno, Carmen; Suvisaari, Jaana; Van Gils, Mark; Orešič, Matej

2018-04-01

Psychotic disorders are associated with metabolic abnormalities including alterations in glucose and lipid metabolism. A major challenge in the treatment of psychosis is to identify patients with vulnerable metabolic profiles who may be at risk of developing cardiometabolic co-morbidities. It is established that both central and peripheral metabolic organs use lipids to control energy balance and regulate peripheral insulin sensitivity. The endocannabinoid system, implicated in the regulation of glucose and lipid metabolism, has been shown to be dysregulated in psychosis. It is currently unclear how these endocannabinoid abnormalities relate to metabolic changes in psychosis. Here we review recent research in the field of metabolic co-morbidities in psychotic disorders as well as the methods to study them and potential links to the endocannabinoid system. We also describe the bioinformatics platforms developed in the EU project METSY for the investigations of the biological etiology in patients at risk of psychosis and in first episode psychosis patients. The METSY project was established with the aim to identify and evaluate multi-modal peripheral and neuroimaging markers that may be able to predict the onset and prognosis of psychiatric and metabolic symptoms in patients at risk of developing psychosis and first episode psychosis patients. Given the intrinsic complexity and widespread role of lipid metabolism, a systems biology approach which combines molecular, structural and functional neuroimaging methods with detailed metabolic characterisation and multi-variate network analysis is essential in order to identify how lipid dysregulation may contribute to psychotic disorders. A decision support system, integrating clinical, neuropsychological and neuroimaging data, was also developed in order to aid clinical decision making in psychosis. Knowledge of common and specific mechanisms may aid the etiopathogenic understanding of psychotic and metabolic disorders, facilitate early disease detection, aid treatment selection and elucidate new targets for pharmacological treatments. Copyright © 2017. Published by Elsevier Masson SAS.

Onset of Maternal Psychiatric Disorders after the Birth of a Child with Autism Spectrum Disorder: A Retrospective Cohort Study

ERIC Educational Resources Information Center

Fairthorne, Jenny; Jacoby, Peter; Bourke, Jenny; de Klerk, Nick; Leonard, Helen

2016-01-01

Background: Mothers of a child with autism spectrum disorder have more psychiatric disorders after the birth of their child. This might be because they have more psychiatric disorders before the birth, or the increase could be related to the burden of caring for their child. Aims: We aimed to calculate the incidence of a psychiatric diagnosis in…

Psychopathology and Borderline Personality Pathology Associated with Lifetime Self-Injurious Behavior in Adolescent Psychiatric Inpatients and Detainees.

PubMed

Koenig, Julian; Brunner, Romuald; Schmidt, Johannes Michael; Parzer, Peter; Resch, Franz; Kaess, Michael

2017-11-01

Self-injurious behavior (SIB) is a widespread phenomenon among adolescent psychiatric inpatients. It is also reported among delinquent adolescents detained in correctional facilities. While previous studies have addressed different functions of SIB within offender populations, here we investigate particular patterns of borderline personality pathology and psychopathology underlying SIB in both adolescent psychiatric inpatients and detainees. Adolescent psychiatric inpatients and detainees were recruited consecutively. Participants completed self-reports on SIB, suicidal thoughts and behavior, borderline personality pathology, and general psychopathology. Predictors of lifetime SIB by group were analyzed. Psychiatric inpatients (n = 77) and detainees (n = 50) did not differ with respect to lifetime SIB (57.14 % versus 54.00 %), whereas SIB within the past year did (67.53 % versus 14 %; χ2 (1) = 6.158, p = .013). Psychiatric inpatients reported greater emotional problems (t (125) = 5.109, p < .0001) and greater borderline personality pathology. Those with lifetime SIB were characterized by greater emotional problems and borderline personality pathology, independent of their group. Results from regression analyses suggest no group-specific predictors of lifetime SIB. Although psychiatric inpatients endorse greater psychopathological distress, lifetime SIB among adolescent psychiatric inpatients and detainees is associated with similar patterns of psychopathology and borderline personality pathology.

Psychiatric leisure rehabilitation: conceptualization and illustration.

PubMed

Rudnick, Abraham

2005-01-01

Leisure or recreational rehabilitation is not much developed in psychiatric rehabilitation. I present some definitions and a (very) brief history of the notion of leisure, as well as the role of leisure in health. I then describe a novel classification of leisure activities relevant to people with psychiatric disabilities. Following that, I conceptualize the process of psychiatric leisure rehabilitation, illustrated by a case study. I conclude with the benefits of psychiatric leisure rehabilitation and with suggestions for further study and development in this field. Leisure or recreational activities are central in modern life. Not so for persons who have serious and disabling mental disorders. This is manifest even in psychiatric rehabilitation, which mostly addresses vocational and residential--rather than leisure--environments (Anthony, Cohen, Farkas & Gagne, 2002; Corrigan, 2003). Yet leisure is important for persons with psychiatric disabilities, perhaps especially so for those who are not successful or satisfied in vocational environments. This paper outlines a conceptual framework for psychiatric leisure rehabilitation, based on a novel classification of leisure activities, and illustrates this with a case vignette. But first, some definitions and a (very) brief history of the notion of leisure is in order, as well as a presentation of facts about the role of leisure in health (physical and mental).

Sex differences and the influence of social factors in a Chilean urban psychiatric hospital population.

PubMed

Roselló Peñaloza, Miguel; Gómez Fuentealba, Pablo; Castillo Gallardo, Patricia

2018-03-01

The epidemiological literature has reported differences by sex in the prevalence of psychiatric diagnoses. However, we know little about how other socio-demographic factors participate in these differences. To identify the socio-demographic factors that correlate with prevalent psychiatric diagnoses in women and men in a Chilean urban psychiatric hospital population. Socio-demographic information (age, educational level, marital status, family group and work status), psychiatric diagnoses and sex of the population were collected for 3,920 patients of a tertiary care hospital during a period of 8 years (2007-2014). The data were subjected to bivariate and multivariate analyses comparing the results by sex. Among the most prevalent psychiatric diagnoses, those significantly correlated with sex were eating disorders and major depression (women) and schizophrenia (men). Socio-demographic factors behave differently in men and women regarding those diagnoses. Among the differences, working and being married correlated directly with the diagnosis of depression only among women. Living alone correlated directly with the diagnosis of schizophrenia among men, but correlated inversely among women. Dissimilar associations between sex, psychiatric diagnosis and socio-demographic factors found in this Latin American sample invite us to reflect on how social conditions crosscut the relation between sex and psychopathology and to include gender perspectives in psychiatric practices.

Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study.

PubMed

Molebatsi, Keneilwe; Ndetei, David M; Opondo, Phillip R

2017-09-01

To determine levels and correlates of caregiver burden among caregivers of children and adolescents with psychiatric morbidity. Over a period of four months, a total of 252 caregivers of children and adolescents with psychiatric morbidity were recruited. Data on socio-demographic factors, psychiatric morbidity among caregivers, and level of caregiver burden was collected using a researcher-designed socio-demographic questionnaire, Mini International Neuropsychiatric Interview, and Zarit burden interview, respectively. Data was analysed using statistical package for social sciences (SPSS) version 21. Females (n = 211, 83.7%) and mothers (n = 182, 72.2%) accounted for the majority of the study participants. The majority of caregivers reported moderate to severe caregiver burden; (n = 100, 39.7%). Being single or separated (B = -6.91, p = 0.001, β = -0.18) and presence of psychiatric morbidity (B = 7.44, p = 0.009, β = 0.22) in the caregiver significantly contributed to the high levels of caregiver burden. Caregivers of children and adolescents with psychiatric morbidity suffer high levels of caregiver burden. A multidisciplinary approach to management of children with psychiatric morbidity to address challenges faced by the caregivers may alleviate the burden; thereby improving clinical outcomes of children and adolescents with psychiatric morbidity.

The relationship between psychiatric morbidity and quality of life: interview study of Norwegian tsunami survivors 2 and 6 years post-disaster.

PubMed

Hussain, Ajmal; Nygaard, Egil; Siqveland, Johan; Heir, Trond

2016-05-31

The study investigated the impact of psychiatric disorders on Quality of Life (QOL) cross-sectionally and longitudinally in a group of Norwegian tourists severely exposed to the 2004 tsunami. Sixty-two adult Norwegian tsunami survivors were interviewed face to face 2 years post-tsunami (T1) and 58 were interviewed again by telephone 6 years post-tsunami (T2). The majority (81 %) reported direct exposure to the waves, and 14 participants (23 %) lost a close family member in the tsunami. Psychiatric morbidity was measured by structured clinical interviews and QOL was assessed with WHO's Quality of Life-Bref scale. Multiple linear regression analyses were performed to assess the independent effects of psychiatric disorders on QOL 2 and 6 years after the tsunami. Psychiatric disorders, especially depression, but also PTSD and other anxiety disorders, were associated with reduced QOL. Psychiatric disorders were more strongly related to QOL at 6 years after the tsunami than at 2 years. Psychiatric disorders, and especially depression, is related to reduced QOL in a disaster exposed population. Post-disaster psychiatric disorders, such as PTSD and especially depression, should be addressed properly in the aftermath of disasters.

Communication of Psychiatric Risk in 22q11.2 Deletion Syndrome: A Pilot Project.

PubMed

Hart, Sarah J; Schoch, Kelly; Shashi, Vandana; Callanan, Nancy

2016-02-01

Individuals with 22q11.2 deletion syndrome (22q11.2DS) have an increased chance of developing a psychiatric disorder. While parents of children affected by 22q11.2DS typically receive counseling about risk for non-psychiatric health concerns, genetic counselors may be reluctant to discuss psychiatric risk. Further education of genetic counselors may be necessary to encourage discussion of psychiatric risk with these families. The goal of this project was to develop recommendations for genetic counselors to provide psychiatric risk information to families affected by 22q11.2DS. The recommendations were developed by synthesizing resources in the literature about risk communication. These recommendations were refined following an online focus group meeting with five health care professionals who were recruited for participation from 22q11.2DS clinics across the U.S.A. The focus group data revealed three themes related to discussion of psychiatric risk: 1) Stepwise approach, 2) Discussing treatment options and reducing risks, and 3) Addressing stigma. These recommendations may be used as a foundation for a future clinical protocol to encourage discussion about the risk for psychiatric illness at an earlier point in the diagnostic process for 22q11.2DS and to provide improved information, support and resources to affected families.

Attention Deficit Hyperactivity Disorder in Childhood: Healthcare Use in a Danish Birth Cohort during the First 12 Years of Life.

PubMed

Laugesen, Britt; Mohr-Jensen, Christina; Boldsen, Søren Kjærgaard; Jørgensen, Rikke; Sørensen, Erik Elgaard; Grønkjær, Mette; Rasmussen, Philippa; Lauritsen, Marlene Briciet

2018-06-01

To compare the mean number of medical and psychiatric hospital-based services in children with and without attention deficit hyperactivity disorder (ADHD) and to assess the effect of ADHD on hospital-based service use, including child-, parental-, and socioeconomic-related risk factors. A Danish birth cohort was followed through 12 years, and children with ADHD were identified using Danish nationwide registries. Poisson regression analyses were used to assess the association of ADHD with service use and to adjust for a comprehensive set of explanatory variables. Children diagnosed with ADHD used more medical and psychiatric hospital-based healthcare than those without ADHD. In children with ADHD, intellectual disability and parental psychiatric disorder were associated with increased medical and psychiatric service use. Low birth weight and low gestational age were associated with increased medical service use. Psychiatric comorbidity and having a divorced or single parent were associated with increased psychiatric service use. ADHD independently affected medical and psychiatric hospital-based service use even when adjusting for a comprehensive set of explanatory variables. However, the pattern of medical and psychiatric hospital-based service use is complex and cannot exclusively be explained by the child-, parental-, and socioeconomic-related variables examined in this study. Copyright © 2018 Elsevier Inc. All rights reserved.

The psychoactive effects of psychiatric medication: the elephant in the room.

PubMed

Moncrieff, Joanna; 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.

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

Attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments.

PubMed

Shaoling, Zhong; Jun, Wang; Graham, Mellsop; Chen, Chen; Simei, Zhang; Qiguang, Li; Qun, Wang; Jiansong, Zhou; Xiaoping, Wang

2017-12-01

The aim of this study was to investigate the attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. A questionnaire designed to record attitudes toward the current forensic psychiatric assessment procedures and the disposal of mentally ill offenders was developed and distributed via a mobile App. A total of 134 community members and 132 psychiatrists voluntarily completed the questionnaire. Most of responders agreed that the department of public-security has the right to apply for a forensic psychiatric assessment but should not be held solely by that department. Community members were less significantly confident in the validation of forensic psychiatric opinions than were the psychiatrists. A significantly higher proportion of community members than psychiatrists considered that offenders judged Not Criminally Responsible on Account of Mental Disorder (NCRMD) should be punished as would be sane people. In addition, only a minority of responders supported that NCRMD should not be held criminally responsible. Our results indicate that both groups have comments on the current distribution of right of startup of forensic psychiatric assessments. Compared to psychiatrists, community members have lower confidence in the validation of forensic psychiatric assessment and have stricter attitudes toward the disposal of offenders with psychiatric disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit.

PubMed

Staal, Jason A; Sacks, Amanda; Matheis, Robert; Collier, Lesley; Calia, Tina; Hanif, Henry; Kofman, Eugene S

2007-01-01

A randomized, controlled, single-blinded, between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit. All participants received pharmacological therapy, occupational therapy, structured hospital environment, and were randomized to receive multi sensory behavior therapy (MSBT) or a structured activity session. Greater independence in activities of daily living (ADLs) was observed for the group treated with MSBT and standard psychiatric inpatient care on the Katz Index of Activities of Daily Living (KI-ADL; P = 0.05) than standard psychiatric inpatient care alone. The combination treatment of MSBT and standard psychiatric care also reduced agitation and apathy greater than standard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer's Disease (P = 0.05). Multiple regression analysis predicted that within the multi-sensory group, activities of daily living (KI-ADL) increased as apathy and agitation reduced (R2 = 0.42; p = 0.03). These data suggest that utilizing MSBT with standard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than standard care alone.

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. Copyright © 2015 Elsevier Inc. All rights reserved.

Utilization of psychiatric care and antidepressants among people with different severity of depression: a population-based cohort study in Stockholm, Sweden.

PubMed

Sun, Yuying; Möller, Jette; Lundin, Andreas; Wong, Samuel Y S; Yip, Benjamin H K; Forsell, Yvonne

2018-06-01

To identify how severity of depression predicts future utilization of psychiatric care and antidepressants. Data derived from a longitudinal population-based study in Stockholm, Sweden, include 10443 participants aged 20-64 years. Depression was assessed by Major Depression Inventory and divided into subsyndromal, mild, moderate and severe depression. Outcomes were the first time of hospitalization, specialized outpatient care and prescribed drugs obtained from national register records. The association between severity of depression and outcomes was tested by Cox regression analysis, after adjusting for gender, psychiatric treatment history and socio-environmental factors. The cumulative incidences of hospitalizations, outpatient care and antidepressants were 4.0, 11.2, and 21.9% respectively. Compared to the non-depressed group, people with different severity of depression (subsyndromal, mild, moderate and severe depression) all had significantly higher risk of all three psychiatric services (all log-rank test P < 0.001). Use of psychiatric care and antidepressants increased by rising severity of depression. Although the associations between severity of depression and psychiatric services were significant, the dose relationship was not present in people with previous psychiatric history or after adjusting for gender and other factors. People with subsyndromal to severe depression all have increased future psychiatric service utilization compared to non-depressed people.

PSYCHIATRIC DISORDERS AND LEUKOCYTE TELOMERE LENGTH: UNDERLYING MECHANISMS LINKING MENTAL ILLNESS WITH CELLULAR AGING

PubMed Central

Lindqvist, Daniel; Epel, Elissa S.; Mellon, Synthia H.; Penninx, Brenda W.; Révész, Dóra; Verhoeven, Josine E.; Reus, Victor I.; Lin, Jue; Mahan, Laura; Hough, Christina M.; Rosser, Rebecca; Bersani, F. Saverio; Blackburn, Elizabeth H.; Wolkowitz, Owen M.

2015-01-01

Many psychiatric illnesses are associated with early mortality and with an increased risk of developing physical diseases that are more typically seen in the elderly. Moreover, certain psychiatric illnesses may be associated with accelerated cellular aging, evidenced by shortened leukocyte telomere length (LTL), which could underlie this association. Shortened LTL reflects a cell’s mitotic history and cumulative exposure to inflammation and oxidation as well as the availability of telomerase, a telomere-lengthening enzyme. Critically short telomeres can cause cells to undergo senescence, apoptosis or genomic instability, and shorter LTL correlates with poorer health and predicts mortality. Emerging data suggest that LTL may be reduced in certain psychiatric illnesses, perhaps in proportion to exposure to the psychiatric illnesses, although conflicting data exist. Telomerase has been less well characterized in psychiatric illnesses, but a role in depression and in antidepressant and neurotrophic effects has been suggested by preclinical and clinical studies. In this article, studies on LTL and telomerase activity in psychiatric illnesses are critically reviewed, potential mediators are discussed, and future directions are suggested. A deeper understanding of cellular aging in psychiatric illnesses could lead to re-conceptualizing them as systemic illnesses with manifestations inside and outside the brain and could identify new treatment targets. PMID:25999120

‘Often there is a Good Deal to be Done, But Socially Rather Than Medically’: The Psychiatric Social Worker as Social Therapist, 1945–70

PubMed Central

LONG, VICKY

2011-01-01

Seeking to align psychiatric practice with general medicine following the inauguration of the National Health Service, psychiatric hospitals in post-war Britain deployed new treatments designed to induce somatic change, such as ECT, leucotomy and sedatives. Advocates of these treatments, often grouped together under the term ‘physical therapies’, expressed relief that the social problems encountered by patients could now be interpreted as symptomatic of underlying biological malfunction rather than as a cause of disorder that required treatment. Drawing on the British Journal of Psychiatric Social Work, this article analyses the critique articulated by psychiatric social workers based within hospitals who sought to facilitate the social reintegration of patients following treatment. It explores the development of ‘psychiatric social treatment’, an approach devised by psychiatric social workers to meet the needs of people with enduring mental health problems in hospital and community settings that sought to alleviate distress and improve social functioning by changing an individual’s social environment and interpersonal relationships. ‘Physical’ and ‘social’ models of psychiatric treatment, this article argues, contested not only the aetiology of mental illness but also the nature of care, treatment and cure. PMID:21461311

Predictive Psychiatric Genetic Testing in Minors: An Exploration of the Non-Medical Benefits.

PubMed

Manzini, Arianna; Vears, Danya F

2018-03-01

Predictive genetic testing for susceptibility to psychiatric conditions is likely to become part of standard practice. Because the onset of most psychiatric diseases is in late adolescence or early adulthood, testing minors could lead to early identification that may prevent or delay the development of these disorders. However, due to their complex aetiology, psychiatric genetic testing does not provide the immediate medical benefits that current guidelines require for testing minors. While several authors have argued non-medical benefits may play a crucial role in favour of predictive testing for other conditions, little research has explored such a role in psychiatric disorders. This paper outlines the potential non-medical benefits and harms of psychiatric genetic testing in minors in order to consider whether the non-medical benefits could ever make such testing appropriate. Five non-medical themes arise in the literature: psychological impacts, autonomy/self-determination, implications of the biomedical approach, use of financial and intellectual resources, and discrimination. Non-medical benefits were prominent in all of them, suggesting that psychiatric genetic testing in minors may be appropriate in some circumstances. Further research needs to empirically assess these potential non-medical benefits, incorporate minors in the debate, and include normative reflection to evaluate the very purposes and motivations of psychiatric genetic testing in minors.

Mental health/psychiatric issues in elder abuse and neglect.

PubMed

Cooper, Claudia; Livingston, Gill

2014-11-01

Elder abuse may be defined as a violation of a vulnerable older person's human and civil rights. Psychiatric illness is an important cause of vulnerability to abuse, especially when it is comorbid with other risk factors, such as physical frailty, sensory impairment, social isolation, and physical dependency. Health care providers are likely to encounter elder abuse regularly, and therefore have an important role in its detection and management, and in the treatment of subsequent psychiatric illness. This article reviews the relationships between psychiatric illnesses and elder abuse and neglect, examines the psychiatric consequences, and discusses how these may be treated. Copyright © 2014 Elsevier Inc. All rights reserved.

Resources for Psychiatric Clinicians Working With Breastfeeding Mothers.

PubMed

Terres, Nancy M

2018-04-17

In today's health care-focused climate, in which encouraging breastfeeding is part of national and international health care initiatives, clinicians in any field should have resources available for breastfeeding mothers. The current article provides information for psychiatric clinicians on how breastfeeding may affect women with psychiatric conditions, the type of lactation counselor likely to be best prepared to collaborate with psychiatric clinicians, and resources available regarding maternal psychiatric medications safe for breastfeeding infants. These resources can assist informed choices that support the mother's breastfeeding goals while providing the psychological care the nursing mother requires. [Journal of Psychosocial Nursing and Mental Health Services, xx(x),xx-xx.]. Copyright 2018, SLACK Incorporated.

Asperger Syndrome in India: Findings from a Case-Series with Respect to Clinical Profile and Comorbidity

PubMed Central

Sreedaran, Priya; Ashok, M. V.

2015-01-01

Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders. PMID:25969609

Asperger syndrome in India: findings from a case-series with respect to clinical profile and comorbidity.

PubMed

Sreedaran, Priya; Ashok, M V

2015-01-01

Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders.

Risk of psychiatric disorders in offspring of parents with a history of homelessness during childhood and adolescence in Denmark: a nationwide, register-based, cohort study.

PubMed

Nilsson, Sandra Feodor; Laursen, Thomas Munk; Hjorthøj, Carsten; Thorup, Anne; Nordentoft, Merete

2017-12-01

Children and adolescents from deprived backgrounds have high rates of psychiatric problems. Parental and social factors are crucial for children's healthy and positive development, but whether psychiatric morbidity is associated with parental social marginalisation is unknown. We aimed to analyse the association between mother's and father's history of homelessness and the offspring's risk of psychiatric disorders, including substance use disorder, during childhood and adolescence. We did a nationwide, register-based cohort study of 1 072 882 children and adolescents aged 0-16 years, who were living or born in Denmark between Jan 1, 1999, and Dec 31, 2015. Parental homelessness was the primary exposure, data on which were obtained from the Danish Homeless Register. The Danish Civil Registration System was used to extract the population and link offspring to parental information, and the outcome, psychiatric disorders in the offspring, was obtained from the Danish Psychiatric Central Research Register and the Danish National Patient Register. We analysed the association between parental history of homelessness and risk of psychiatric disorders in offspring by survival analysis using Poisson regression and incidence rate ratios (IRRs), adjusted for year and offspring characteristics, and additionally adjusted for parental factors (age at offspring's birth and parental psychiatric disorders). 17 238 (2%) offspring had either one or two parents with a history of homelessness, and 56 330 (5%) children and adolescents were diagnosed with any psychiatric disorder during the study period. The incidence of any psychiatric disorder was 15·1 cases per 1000 person-years (95% CI 14·4-15·8) in offspring with at least one parent with a history of homelessness, compared with 6·0 per 1000 person-years (95% CI 6·0-6·1) in those whose parents had no such history (IRR 2·5 [95% CI 2·3-2·7] for mother homeless, 2·3 [2·2-2·5] for father homeless, and 2·8 [2·4-3·2] for both parents homeless, after adjustment for year and offspring characteristics). This risk remained elevated after additional adjustment for factors including parental psychiatric disorders. IRRs in offspring were increased for most specific psychiatric disorders, with the highest risk for attachment disorder when both parents had a history of homelessness (IRR 32·5 [95% CI 24·6-42·9]) and substance use disorder when only the mother had a history of homelessness (6·9 [4·9-9·7]). In offspring whose mothers had a history of both homelessness and a psychiatric disorder, 35·9% (95% CI 27·1-44·8) had been diagnosed with a psychiatric disorder by the age of 15 years. Parental homelessness was associated with an increased risk of psychiatric disorders in offspring during childhood and adolescence. These findings have important implications for public health and policy because they suggest a need for improvement in the support of socially marginalised families to help prevent psychiatric illness in offspring. University of Copenhagen, The Lundbeck Foundation Initiative for Integrated Psychiatric Research (iPSYCH). Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Historical Collections in Psychiatry and Psychoanalysis.

ERIC Educational Resources Information Center

Mylenki, Mary

1982-01-01

Describes historical collections of major psychoanalytic libraries--American Psychiatric Association, Boston Psychoanalytic Society, Chicago Institute for Psychoanalysis, Insititue of Living, Los Angeles Psychoanalytic Society, Menninger Foundation, New York State Psychiatric Institute, Payne Whitney Psychiatric Clinic, Pittsburgh Psychoanalytic…

PREVALENCE OF MENTAL AND BEHAVIOURAL DISORDERS IN INDIA : A META-ANALYSIS

PubMed Central

Reddy, Venkataswamy M.; Chandrashekar, C.R.

1998-01-01

A meta-analysis of 13 psychiatric epidemiological studies consisting of 33572 persons in 6550 families yielded an estimate prevalence rate of 58.2 per thousand population. Organic psychosis (prevalence rate 0.4), schizophrenia (2.7), affective disorders (12.3) contributed a rate of 15.4 for psychoses. The prevalence rate for mental retardation (6.9), epilepsy (4.4), neurotic disorders (20.7), alcohol/drug addiction (6.9; and miscellaneous group (3.9) were estimated. Higher prevalence for urban sector, females, age group of 35-44, married/widowers/divorced, lower socioeconomic status, and nuclear family members were confirmed. Epilepsy and hysteria were found significantly high in rural communities. Manic affective psychosis, mental retardation, alcohol/ drug addiction and personality disorders were significantly high in males. The findings indicated that there are 1.5 crore people suffering from severe mental disorders (psychoses) in India, and that severe diseases have higher representation at specialized as well as general hospital clinics. Among other things, the results aid in conducting morbidity surveys by more methodological approach. PMID:21494462

Relationship Among HIV-Related Stigma, Mental Health and Quality of life for HIV-Positive Patients in Tehran.

PubMed

Rasoolinajad, Mehrnaz; Abedinia, Nasrin; Noorbala, Ahmad Ali; Mohraz, Minoo; Badie, Banafsheh Moradmand; Hamad, Abdulqader; Sahebi, Leyla

2018-01-02

People living with HIV/AIDS (PLHA) face several challenges in terms of the medical management of their disease. Alongside this are stigma, discrimination and psychosocial issues associated with HIV infection. In this study, the relationships associated with HIV-related stigma, mental health and quality of life for HIV-positive patients were investigated. This cross-sectional study examined a sample of 450 HIV positive patients from the Infectious Diseases and Behavioral Health Clinic of Imam Khomeini Hospital in the city of Tehran, Iran. PLWHA completed Socio-Demographic Characteristics, Berger Scale Stigma (BSS), General Health Questionnaire (GHQ-28), WHO Quality of life-BREF (WHOQOL-BREF) and Philips Social Support Appraisals (SSA). Stigma was significantly correlated with psychological variables, social support, and quality of life. A prevalence of psychiatric disorders was reported by 78.8%. Findings suggested that psychosocial interventions reduce HIV related stigma, address psychological disorders and build social support to improve quality of life for people living with HIV.

Acute myeloid leukemia risk by industry and occupation.

PubMed

Tsai, Rebecca J; Luckhaupt, Sara E; Schumacher, Pam; Cress, Rosemary D; Deapen, Dennis M; Calvert, Geoffrey M

2014-11-01

Acute myeloid leukemia (AML) is the most common type of leukemia found in adults. Identifying jobs that pose a risk for AML may be useful for identifying new risk factors. A matched case-control analysis was conducted using California Cancer Registry data from 1988 to 2007. This study included 8999 cases of AML and 24 822 controls. Industries with a statistically significant increased AML risk were construction (matched odds ratio [mOR] = 1.13); crop production (mOR = 1.41); support activities for agriculture and forestry (mOR = 2.05); and animal slaughtering and processing (mOR = 2.09). Among occupations with a statistically significant increased AML risk were miscellaneous agricultural workers (mOR = 1.76); fishers and related fishing workers (mOR = 2.02); nursing, psychiatric and home health aides (mOR = 1.65); and janitors and building cleaners (mOR = 1.54). Further investigation is needed to confirm study findings and to identify specific exposures responsible for the increased risks.

Consideration of species differences in developing novel molecules as cognition enhancers.

PubMed

Young, Jared W; Jentsch, J David; Bussey, Timothy J; Wallace, Tanya L; Hutcheson, Daniel M

2013-11-01

The NIH-funded CNTRICS initiative has coordinated efforts to promote the vertical translation of novel procognitive molecules from testing in mice, rats and non-human primates, to clinical efficacy in patients with schizophrenia. CNTRICS highlighted improving construct validation of tasks across species to increase the likelihood that the translation of a candidate molecule to humans will be successful. Other aspects of cross-species behaviors remain important however. This review describes cognitive tasks utilized across species, providing examples of differences and similarities of innate behavior between species, as well as convergent construct and predictive validity. Tests of attention, olfactory discrimination, reversal learning, and paired associate learning are discussed. Moreover, information on the practical implication of species differences in drug development research is also provided. The issues covered here will aid in task development and utilization across species as well as reinforcing the positive role preclinical research can have in developing procognitive treatments for psychiatric disorders. Copyright © 2012 Elsevier Ltd. All rights reserved.

Hierarchical Structure and Cross-Cultural Measurement Invariance of the Norwegian Version of the Personality Inventory for DSM-5.

PubMed

Thimm, Jens C; Jordan, Stian; Bach, Bo

2017-01-01

The Personality Inventory for DSM-5 (PID-5) was created to aid a trait-based diagnostic system for personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013a ). In this study, we aimed to evaluate the Norwegian version of the PID-5 by examining its score reliability, hierarchical structure, congruency with international findings, and cross-cultural measurement invariance with a matched U.S. For this purpose, 503 university students (76% females) were administered the PID-5. The Norwegian PID-5 showed good score reliability and structural validity from 1 to 5 factors. The 5-factor structure was generally congruent with international findings, and support for measurement invariance across the Norwegian and a matched U.S. sample was found. Conclusively, the results indicate that scores on the Norwegian PID-5 have sound psychometric properties, which are substantially comparable with the original U.S. version, supporting its use in a Norwegian population.

Reasons Underlying Treatment Preference

PubMed Central

Cochran, Bryan N.; Pruitt, Larry; Fukuda, Seiya; Zoellner, Lori A.; Feeny, Norah C

2008-01-01

Very little is known about what factors influence women’s treatment preferences after a sexual assault. To learn more about these factors, data were collected from 273 women who read a standard “if this happened to you, what would you do” scenario describing a sexual assault and subsequent trauma-related psychiatric symptoms. After reading standardized treatment options for a pharmacotherapy (sertraline) and a psychotherapy (cognitive behavioral treatment), participants made a hypothetical treatment choice and reported the main reasons for their choice. Women often cited reasons surrounding the effectiveness of a treatment as the primary reason for their treatment preference, suggesting potential masking of symptoms with the medication and more logical, long-lasting effects with the psychotherapy. Other common reasons underlying treatment preference were wariness of the medication and positive feelings about talking in psychotherapy. Better understanding factors that influence treatment preference may aid in refining psychoeducation materials regarding the psychological consequences of sexual assault and their treatment for the lay public and in helping clinicians further tailor their discussion of treatment alternatives for these women. PMID:18162641

Trauma informed care: a radical shift or basic good practice?

PubMed

Isobel, Sophie

2016-12-01

There is significant multidisciplinary work contributing to the implementation of trauma informed care (TIC) into mental health policy and practice in Australia. Within psychiatry, there may be potential confusion about how to navigate the integration of TIC into a speciality built upon treating psychological distress; creating dismissive reactions of a patronising approach and paradoxical radicalism. This paper aims to discuss the need for psychiatry to view TIC as a significant and urgent paradigm shift required to integrate existing knowledge about the prevalence and effects of trauma into a progressive articulation of the relational and interpersonal underpinnings of modern psychiatric practice; and to lead and support its widespread implementation. Active consideration of the intent of TIC may aid in reducing misunderstanding and misaligned resistance while allowing services and individuals an important opportunity to reflect on how to deliver mental health treatment that is universally sensitive to the dynamics of trauma in the care environment. © The Royal Australian and New Zealand College of Psychiatrists 2016.