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To determine the clinical profile of patients diagnosed of delusional disorder (DD) admitted to a psychiatric ward.
Retrospective chart review of inpatients with diagnoses of delusional disorder (DD) according ICD-10 criteria admitted to a psychiatric ward (Hospital de Conxo, Santiago de Compostela) between January 1998 and December 2008. Sociodemographic and clinical variables were collected, with special attention to comorbidity and presumed risk factors.
The sample consisted in 56 inpatients (30 women, mean age 54 ± 11). 64.3% were single including never married (33.9%), divorced, separated and widowed and 33.9% lived alone. The most frequent type of DD was persecutory (67%) followed by mixed type (16%). 16.1% presented hallucinations (most frequent auditory). In comparison with the other types, patients with persecutory delusions usually lived alone (p < 0.05). Most frequent comorbidities were substance abuse and affective disorders. Familiar background of psychoses was recorded in 21.4% and history of emigration in 12.5%. 5.4% suffered deafness. During the period studied 53.6% were admitted two or more times. After the most recent admission 32.1% were on depot antipsychotic.
In concordance with other previous reports, DD seemed to be more prevalent in women in middle or late adulthood and persecutory were the most frequent delusions. In our sample, most patients were not married and high prevalence of family antecedents of psychoses was found. It could be related with its hospital origin; then it could be hypothesized living alone and having familiar background of psychoses to be risk factors of hospitalization.
In our work we propose to use the adult developmental eye movement test (A-DEM) of Gene Sampedro et al, for the study of saccadic movements in schizophrenia.
To study the importance of saccades and attention in a sample of institutionalized patients with schizophrenia in a Unit of Psychosocial Rehabilitation.
Sample formed by 30 people.15 patients and 15 controls. 15 patients were corresponding to all the schizophrenic patients admitted in January, 2009 in a Unit of Psycosocial Rehabilitation of Conxo's Psychiatric Hospital. The 15 of the group control were selected of random form between sanitary personnel without psychiatric pathology, homogenizing the variables chronological age and sex with regard to the group of investigation.
The A-DEM vertical half to 44.37 seconds in the control group versus 59.54 seconds in the sample of patients. Regarding the results of the horizontal A-DEM obtained an average score of 47.07 seconds compared to control group obtained 60.68 seconds in the group of patients. The schizophrenic patients are characterized for having an attention diminished in 87 %, opposite to 47 % of the group control that they have a normal attention and 40 % increased. These differences of saccadic movements and of the attention are statistically significant.
Schizophrenic patients have few saccades both horizontally and vertically slower than normal people.
Schizophrenic patients show a marked deficit of attention to the normal population.
To explore the relationship between symptomatic and functional outcomes in adults (age 18-65 years) with ADHD during open label treatment with PR OROS MPH.
Post hoc analyses of a 7-week open-label extension (OLE) (N=370) of a 5 week, placebo controlled double-blind study (DB) which explored safety, efficacy, functional and quality of life outcomes in subjects with a diagnosis of ADHD (DSM-IV). Medication was flexibly dosed (18-90 mg/day) and adjusted individually to best effect during OLE. Regression analyses were performed on the change from DB baseline at OL endpoint in functionality and quality of life as measured by the Sheehan Disability Scale (SDS) and Quality of Life (Q-LES-Q). Baseline score, country, randomization group, sex, change from baseline in CAARS Hyperactivity / Impulsivity, CAARS Inattention and CGI-S at DB endpoint were included as covariates in the analyses.
337 / 370 patients completed the 7-week open label treatment. Improvement on CAARS Hyperactivity / Impulsivity at DB endpoint was significantly related with improvement in SDS “work”, “social life”, “family life” (at least p< 0.005) and “total score” as well as quality of life (p< 0.05) at the end of open label treatment. Change in CGI-S and CAARS Inattention at DB endpoint vs. DB baseline were not related with improvements in any of the functional or quality of life scales at OL endpoint (p>0.05).
These results indicate that improvement in daily functioning and QOL under active treatment may be particularly related to improvement in hyperactivity symptoms.
Symptoms of mania in geriatric patients (> 65 years old) have received much recent attention, in part due to Akiskal's Bipolar Spectrum classification (Akiskal, 2000), in which subtype VI is «bipolarity in the setting of dementia». The authors present a through revision of the issue, and 3 clinical cases are presented.
Data was collected through Medline/Pubmed website research, literature revision and other sources. Three clinical cases are presented (identifying data and sociodemographic details, history of present illness, personal history, …), which were obtained through direct observation of the patient and consultation of hospital inpatient clinical file.
We found 11272 articles, of which 458 were reviews. We were involved in direct care to 3 elderly manic patients, in our clinical activity in 2 Psychiatric Hospitals in Lisbon.
Elderly mania is a relatively rare and ill-defined syndrome, with many possible causes (genetic, iatrogenic, metabolic, infectious, oncological, traumatic SNC injuries, epilepsy, and many other neurological disorders). Appropriated exclusion of organic pathology through a correct differential diagnosis is mandatory to obtain a suitable therapeutic approach and favorable prognosis. The growing life expectancy suggests that this neuropsychiatric syndrome should be a focus of attention for psychiatrists, internists, and other health care technicians, especially those directly involved in the care of elderly patients in settings such as state/private hospitals, private clinics, day care facilities and nursing homes.
Presence of A1 allele of the DRD2 gene has been associated with a predisposition for alcoholism although there are limited data about its phenotypic expression in alcoholism.
To determine the importance of the A1 allele in clinical variables of alcohol dependence.
A sample of 103 alcohol-dependent males was studied. All patients were recruited consecutively from the general hospital and community settings. The diagnostics were made with the structured clinical interview for DSM-III-R (SCID); and the International Personality Disorder Examination (IPDE). Diagnosis of family alcoholism was made by direct interview or with the Research Diagnostic Criteria-Family History (RDC-FH). The Addiction Severity Index (ASI) and the Severity of Alcohol Dependence Scale (SADS) were used to assess alcohol dependence severity. Genotyping was done by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods.
Approximately 39% of the sample carried the A1 allele (A1+ group). This group had higher prevalences of antisocial personality disorder (60% vs. 15.9%); and alcoholism family history (72.5% vs. 52.4%). Also A1+ had early onset alcohol abuse and more drinking problems. The presence of A1+ was the main factor to explain the diagnosis of antisocial personality disorder, but the weight of this factor was not sufficient to explain the complications assessed by the ASI.
Our results support the existence of an association between the A1 allele and factors resulting from dopaminergic deficiency, otherwise denominated reward deficiency syndrome.
Chronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.
Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.
To describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.
To study the relationship between CFS and ADHD.
The initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.
38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).
ADHD is frequent in CFS patients and it is associated with more severe clinical profile.
Prospective, randomized, two-arm, parallel assignment. 150 individuals diagnosed with major depression disorder (MDD) according to DSM-IV-TR criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control and aerobic exercise. The study protocol was approved by the Institutional Review Board. All participants provided written informed consent. Study protocol Exercise group: individuals were assigned moderate intensity exercise, in addition to their usual pharmacological therapy. Control group: individuals who were not assigned any exercise and remained taking their usual pharmacological therapy. Both groups maintained the pharmacological therapy unchanged during the 12 week study period. All participants were evaluated at baseline (time 0: before starting the physical activity program), and at 4, 8 and 12 weeks for depressive symptoms, functional assessment and Quality of Life.
Results show that participants in the exercise group improved their quality of life parameters, suggesting that exercise could be an effective therapeutic adjuvant for non-remitted MDD patients.
Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in western industrialized countries and account for disability and loss of productivity. Type D personality and depression are established psychosocial factors with a negative impact on prognosis following acute events.
We evaluated 65 patients admitted to a coronary unit with ACS regarding type D personality (DS-14), depression (BDI-II, HADS), anxiety (HADS), clinical depression (clinical interview following DSM-IV-TR criteria) and quality of life (SF-36). SPSS 12.0 was used for statistical analysis and significance considered for p< 0.05.
We found that 38.5% of patients had type D personality and divided the sample into two groups. No significant differences were found regarding social and demographic factors but differences were found regarding diagnosis on admission: type D patients had more AMI with ST elevation (p< 0.05). Type D patients had significantly higher scores in depression and anxiety scales of the HADS (p< 0.01) and worse quality of life in most SF-36 subscales (p< 0.01). There was a negative and significant correlation between the HADS and all the SF-36 subscales, strongest in the mental health subscale (p< 0.01).
Type D patients have higher indices of anxiety and depression and worse quality of life when compared with other patients, and constitute a high risk group of worse prognosis. Our results also suggest differences between groups regarding the type of acute event but these results require further confirmation.
Musical hallucinations are a rare phenomenon in clinical practice. The purpose of this study was to analyze the clinical spectrum of musical hallucinations.
We analysed demographic and clinical features of cases published in English, Italian, French or Spanish between 1991 and 2006 registered in MEDLINE, including three of our own cases. The cases were separated into four groups according to their main diagnoses (hearing impairment; psychiatric disorder; neurological disorder; toxic or metabolic disorder).
115 patients with musical hallucinations were included, of which 63.5% were female. The mean age was 57,25 years. Main diagnoses were: psychiatric disorder (46.1%; schizophrenia 30.4%), neurological disorder (21,7%), hearing impairment (17,4%), toxic or metabolic disorder (12.2%) and 2.6% other diagnoses.
61.7% patients presented simple diagnoses while 36.5% presented two or more diagnoses. 2.1% of patients didn't receive any diagnoses. 35.7% of patients and 60.9% of non psychiatric patients presented hearing impairment.
Both instrumental and vocal were the more frequent musical hallucinations and most of the patients had insight about the abnormality of their perceptions. Another kind of hallucinations was present in 40.9% of patients, auditory hallucinations being the most common. Also, 38,3% of the global sample had abnormalities in brain structural image (MRI, CT).
Musical hallucinations are a heterogeneous phenomenon in clinical practice. published cases describe them as more common in women and in psychiatric and neurological patients. Hearing impairment seem to be an important risk factor in the development of musical hallucinations.
The TaqIA polymorphism linked to the DRD2 gene has been associated with alcoholism. The aim of this work is to study attention and inhibitory control as per the continuous performance test and the stop task in a sample of 50 Spanish male alcoholic patients split into two groups according to the presence of the TaqIA1 allele in their genotype. Our results show that alcoholics carrying the TaqIA1 allele present lower sustained attention and less inhibitory control than those patients without such allele.
The co-occurence of depression and congestive heart failure (CHF) represents a great challenge and opportunity for those interested in exploring the complex interactions between the brain and the heart. The cumulative effect of these medical conditions has an evident effect on quality of life.
The objective of this study was to evaluate the quality of life and symptoms of depression among a group of 103 adult patients with CHF recruited from an outpatient cardiology practice and determine the factors related to a poor outcome. The challenge was to identify the group of patients who are at risk of suffering from depression and poor quality of life as early as possible and try to provide them appropriate psychiatric treatment.
The results of this study lead us to suggest that an older female patient with a more severe illness (NYHA ≥ II) and renal impairment is at great risk of presenting simultaneously depressive sintomatology and poorer perception of quality of life, thus beeing a strong candidate to a very negative evolution of her cardiac condition.
These findings allow us to define a group of patients that would surely benefit from a closer psychiatric and cardiac management.
The high prevalence of depression, the complexity of managing it and the recent evidence demonstrating that depression is associated with increased morbidity and mortality suggests that is important the development of collaborative and integrative approaches combining the medical expertise and interest of psychiatrists, cardiologists and internists and the involvement of psychologists and social workers.
The research goal is to describe and characterize the psychological dynamics of the adolescents diagnosed with Borderline Personality Disorder (BPD) and their parents, observing the dominant personality styles in adolescents with BPD and the personality traits of the parents (mother and father).
Considering that recent studies underline the importance of family interactions in the pathogenesis of BPD we will analyze the relation between personality characteristics of the adolescents with Borderline Personality Disorder and the parents’ personality traits.
The exploratory and comparative study has a sample comprised of 21 adolescents (11 boys and 10 girls) with ages between 16 and 18 years old, observed in child mental health services and 34 parents (N = 55).
Adolescents will be assessed with the Millon Adolescent Clinical Inventory (MACI) and the parents with the Millon Clinical Multiaxial Inventory (MCMI-III).
The results showed that the parents obtained high mean scores in the Compulsive and Narcissistic Personality Traits. the adolescents showed high mean scores on the Unruly, Forceful and Egotistic personality styles scales.
The studies on BPD have some limitations, namely the fact that they normally observe the adult population, with fewer research dedicated to adolescents.
We consider that there is a need to search for the aetiological factors of the disorder and possible developmental patterns and if it is a personality disorder research should look to the personality traits of the adolescents and to their relational environment as a way to overcome those limitations.
Large discrepancies in psychiatric compulsory admission rates have been found in the different European countries. However, some trends seem to exist in most studies: compulsorily admitted patients are more frequently male, unemployed, with a lower level of education, are more likely to belong to racial minorities (mainly black), and the most frequent diagnosis is schizophrenia.
To compare demographic and clinical characteristics of patients voluntarily and compulsorily admitted to a Portuguese psychiatric unit.
Retrospective data of all the patients admitted to a psychiatric inpatient unit, from January 2004 to December 2007, were reviewed. The demographic and clinical characteristics of compulsorily and voluntarily admitted patients were compared.
In a total of 1434 admissions, 180 were compulsory (11.2%). Compared to voluntarily admitted patients, those admitted compulsorily were significantly younger (38.2 vs. 43.6 years), more frequently male (62.8 vs. 47.1%), and black (27.8% vs. 19.9%), received more often a diagnosis of schizophrenia (34.4 vs. 19.0%), and had a longer average length of stay (27.0 vs. 18.5 days). There were no statistically significant differences in the seasonality of admissions or the number of readmissions in both groups.
The results are similar to those obtained in other studies, except for a higher rate of compulsory admissions. That can be explained by, among other factors, the low socioeconomic level and high percentage of immigrants in the local population. The comparison with voluntarily admitted patients helps identify characteristics associated with the two groups.
In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders, helping to improve not only depression parameters but also quality of life. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.
To assess the effect of a moderate intensity 12 week exercise program on the quality of life of a population sample of patients with non-remitted Major Depressive Disorder (MDD).
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Instruments WHOQOL-Bref and SF-36, two validated instruments to assess quality of life.
At the end of the exercise program, participants in the exercise group showed improvement on the physical domain of SF-36 and on the social domain of WHOQOL-Bref (p < 0.05).
Results suggest that exercise could help improve some aspects of the quality of life in non-remitted MDD patients.
Compliance is essential to achieve the best results in serious mental illness like schizophrenia.
It was expected that the use of second-generation oral antipsychotics with less extrapyramidal side effect profile would improve the compliance, but the results do not support these expectations except in the case of risperidone long-acting injection.
The aim of this study is to assess the degree of compliance in outpatients who were started treatment with RLAI while they were hospitalized for an acute psychotic episode in psychiatric unit.
A retrospective study was conducted by reviewing medical records of hospitalized patients for psychotic episodes over the past 5 years in three hospitals in Mallorca (Balearic Islands, Spain) -Hospital de Manacor, Hospital son Llatzer and Hospital de Inca). Due to computerization of medical records, we knew the degree of compliance with treatment and outcome in outpatient clinics. We designed a case report data (CRD) to assess specific variables in our study that was completed for each patient.
The mean duration of treatment in patients who continue with RLAI was 38.8 months. Overall. 69.5% continued with the treatment after 5 years. The patients who continued treatment were rehospitalazed 20% less than the ones who discontinued.
The compliance with RLAI in outpatients was high even in patients with substances abuse. The patients who remain on treatment from hospital discharge have less readmissions. The most common dosis of RLAI is 50 mg. Lack of insight was the most frequent cause of discontinuation.
Known by many different names-culture broker, community interpreter, medical interpreter, and communication facilitator-the intercultural mediator has as a primary task the facilitation of communication and the therapeutic relationship in the presence of linguistic and/or cultural difference. The Immigration Plan of “la Caixa” Social and Cultural Outreach Projects has undertaken an ambitious project to train all of the cultural mediators in Spain, including both those currently working and those newly entering the field, to meet existing needs. In the first phase of the project, the training was developed in Catalunya, in collaboration with the the Catalan Department of Health, executed by the Psychiatry Department of the Vall d'Hebron University Hospital (Autonomous University of Barcelona) and certified by the Health Studies Institute of the Department of Health. Drawing from the four years experience of the NGO SURT and the Department of Psychiatry of the Vall d'Hebron University Hospital, the program provides 200 hours of theoretical and 1200 hours of practical training. 50 currently employed intercultural mediators and 30 novices are being trained. In subsequent phases the training will be adapted to needs of other autonomous regions of Spain. Modules include medical anthropology, Western biomedicine, community health, linguistic interpretation, cultural competence, professional identity, and ethics. Small group supervision provides a supportive environment to facilitate the application of theory to practice. Finally, high quality training materials were developed specifically for the course. Preliminary evaluations of the project are positive despite some unanticipated complications.
In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.
To assess the effect of a moderate intensity 12 week exercise program on depression and functional parameters in a population sample of patients with non-remitted Major Depressive Disorder (MDD).
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Assessed parameters HAMD17, Beck Depression Inventory (BDI), Global Assessment of Functioning (GAF), Clinical Global Impression Scale - Severity (CGI-S).
Participants in the exercise group showed better depression and functional parameters at the end of the study, both compared to the beginning of the study and compared to the control group (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05).
Results suggest that exercise could be an effective adjuvant therapy for non-remitted MDD patients.