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Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.
Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach.
Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients.
Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders.
Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.
The 161-ka Kos Plateau Tuff (KPT) eruption deposited widespread unwelded ignimbrites, but the Dikeos and Sympetro mountains on the SE of Kos Island blocked all but the most energetic pyroclastic flows. KPT remnants north of Sympetro mountain comprise reworked tuffite containing pumice and lithic clasts that petrologically and geochemically resemble those found in KPT unit E tephra, and reworked accretionary lapilli similar to those in KPT unit F. Tuffite is found only downslope from a 375-m-high pass between the Dikeos and Sympetro mountains, which was breached at the eruption climax by pyroclastic flows that then accelerated down the 10° north slope of Sympetro. The tuffite crops out in the palaeocliffs of a prominent terrace at an elevation of 75 m, interpreted as the transgressive ravinement surface of the first interglacial marine highstand after the KPT eruption during marine isotope stage (MIS) 5e. A similar ravinement surface cuts KPT deposits in central Kos at elevations of up to 135 m and implies post-MIS 5e uplift rates of 0.7–1.0 m ka−1, confirmed by the elevation of a previously reported raised beach beneath the KPT. A Holocene raised beach on the east coast of Kos contains pumice clasts from the Yali-4 eruption at 4–3 ka. Its elevation of 2 m above sea level is consistent with the elevation of the local MIS 5e terrace. Its present erosion results from the blocking of discharge from ephemeral streams by human infrastructure. Our study provides the first integrated chronologic and neotectonic interpretation of the prominent plateau and terrace surfaces on Kos Island.
Fibronectin(FN) is a multidomain adhesive glycoprotein present in connective tissue on cell surfaces in insoluble fibrilar form.
Because of reported experimental evidences for a very large elasticity of the FN molecule and in view of the hypothesis that conformational changes precede its function, we were interested in analyzing: 1)the eventual appearance of macromolecular form of fibronectin, 2) the expressions of the cellular, collagen, fibrin, and C-terminal fibronectin domains in the blood plasma of Alzheimer's(14 patients, mean age 70.2+/-6.5), vascular dementia patients(24 patients, mean age 73.1+/-5.3), and age-matched control(30 subjects, mean age 73.4+/-7.4).
The fibronectin domain concentrations were determined by ELISA using panel of domain-specific monoclonal antibodies. Western immunoblotting by the use a monoclonal antibody was performed to analyze the FN molecular forms.
Immunoblotting pattern of plasma fibronectin of both dementia groups and age-matched group consisted of two FN bands(220-230 kDa), and some of them showed additionally of 2-3 macromolecular bands having molecular masses 260 and 350 kDa. However, the appearance of macromolecular fibronectin forms(260 and 350 kDa) happened more frequently in Alzheimer's dementia(85% of samples)than in samples with vascular dementia(50%) as well as in age-matched control(53%).Among the analysed domain expression on fibronectin, only the concentration of the C-terminal fibronectin domain(747.1+/-79 ug/ml)was significantly higher(p<0.004)than that in age-matched control group(635.7+/-120ug/ml, whereas its level was negligible different in vascular dementia(659.2+/-137ug/ml).
The occurence of macromolecular forms of fibronectin seems to be associated more frequently with Alzheimer's dementia. Increased concentration of C-terminal domain suggests some conformational alterations of fibronectin present in Alzheimer's samples.
The diagnostic and statistical manual of mental disorders (DSM) is an evolving document that serves the many mental health care disciplines as the primary reference guide for classifying mental disorders. While the successive framers of the DSM have attempted to base it on scientific evidence, political and economic factors have also shaped the conceptualization of mental illness. These economic and institutional forces have reinforced the DSM's use of a medical model in understanding psychopathology. Though the scientific evidence for a medical model is mixed and evidence for other types of conceptualizations have been given less attention, the medical model provides for reliable diagnoses that allot diverse benefits to treatment providers and researchers, as well as to the pharmaceutical and healthcare industries. This article will outline the development of a medical model of mental illness, highlighting connections between this model and corporate and political interests, and will show how this model relates to the various revisions of, and developments within, the DSM. Such an analysis is especially relevant today as the field looks towards the publication of the newest revision of the DSM and attempts to understand and integrate its proposed changes into current treatment, theory, and research.
Second-generation antipsychotic drugs (eg, olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone) have a reduced incidence of extrapyramidal side effects compared with first-generation neuroleptics, leading to increased use in psychiatric practice. However, some second-generation antipsychotic drugs can increase cardiometabolic risk by increasing risk for weight gain, dyslipidemia, and insulin resistance. Growing evidence, including baseline metabolic data from the CATIE study, indicates that patients with schizophrenia have an increased prevalence of metabolic syndrome (obesity, hypertension, hyperglycemia, dyslipidemia, and hyperglycemia). In CATIE Phase 1 and 2, treatment with different antipsychotic medications is associated with different effects on weight, plasma lipids and risk of hyperglycemia, ranging from clinically significant increases to decreases in metabolic risk. While mortality related to cardiovascular disease is elevated in this patient population, cardiovascular disease risk is under-monitored and under-treated. Current public health efforts aim to increase attention to this at-risk population. Long-term treatment strategies in persons with mental illness should aim to address psychiatric illness as well as key medical comorbidities.
Coronary artery bypass grafting (CABG) is a worldwide used myocardial revascularization procedure, which despite the modern advantages still has a spectrum of complications, especially in old age population.
The relatively old age of the patients who undergo CABG and their widespread atherosclerotic disease are possible reasons for vascular sequels leading to neurological and psychic dysfunctions. Delirium in the elderly after CABG surgery is common, according to some authors and our investigation, is detected in about 20- 34% causes and is often under-diagnosed. Its occurrence may be predisposed by a history a stroke and precipitated by a longer duration of cardiopulmonary bypass.
Increasing age, blood urea level, cardio-thoracic index, hypertension, smoking habits, blood replacement during bypass, atrial fibrillation(AF), pneumonia and blood balance in the post-operative period are the main risk factors for delirium. No specific factor associated with the CABG (eg. perfusion pressure, number of grafts) is correlated with increased risk for delirium post-operatively.
The number of studies (and our observations) have shown that patients in whom delirium develop have more complication rates, longer hospital stays, an increased rates of transfer to rehabilitation or long –term care facilties.
Finally, the identification and control of the risk factors for delirium should bring a decrease in delirium morbidity and mortality.
Multiple sclerosis (MS) is the most common cause of neurological disability in young adults and is frequently accompanied by symptoms of depression and anxiety. The aim of this study was to explore the association of depression and anxiety with health status in younger and older MS patients.
223 MS patients (67.3% female; mean age 38.9±10.8 years; mean disease duration 5.8±5.2 years) were divided into younger and older age groups (< 45 and ≥45 years). They completed questionnaires focusing on sociodemographic data, depression and anxiety (HADS), and physical and mental health status (SF-36). Functional disability (EDSS) was assessed by a neurologist. To analyse the data, a U-test and multiple linear regression analyses were performed.
A model consisting of age, gender, marital status, EDSS, depression and anxiety explained 46.6% of the variance in physical health status and 60.8% of the variance in mental health status (p≤.001). Depression was a significant predictor of physical health status in older MS patients and was associated with mental health status in both age groups (p≤0.001). Anxiety was related to worse physical and mental health status in younger MS patients, but not in the older ones.
Depression in MS patients is associated with mental health status and with physical health status only in the older group; anxiety is associated only in younger MS patients with regard to their health status. Psychiatric diagnostics focusing on depression and anxiety might be important for treatment of MS patients in order to contribute to improving a patient's health status.
The AMSP-Project is a prospective multicenter program for continuous assessment of adverse drug reactions of marketed psychotropic drugs in psychiatric inpatients under naturalistic conditions of routine clinical treatment. It corresponds to a dynamic cohort study and currently about 55 German, Swiss and Austrian hospitals are participating, monitoring approximately 30,000 inpatients per year.
to measure the incidence and relative risk ratios of weight gain in association with psychotropic treatment.
All cases of severe weight gain over 10% of initial body weight between the years 2001 through 2005 were reviewed and causality assessment discussed at (inter-)national meetings. Incidence was calculated by number of patients under treatment and relative risks were calculated between the individual treatment regimens.
The risk of severe weight gain is highest under treatment with olanzapine, being responsible for > 40% of the total cases while only 15% of the cohort is treated with olanzapine. The relative risk of olanzapine cases versus the total number of cases was 12 (CI 6.86 – 22.03), taking only those cases into account where only one compound was judged to be responsible (in some cases, drug combinations are imputed.
The AMSP project is a valuable tool in detecting and confirming ADR in a psychiatric hospital setting. The pros and cons of the project are equal to intensive spontaneous monitoring systems. The incidence and relative risk of weight gain is established for psychotropic treatment.
The well known benefits of treatment should be carefully balanced with the problems of weight gain.
Dementia is progressive, age related, chronic condition and can profoundly affect the lives of patients and their families.The main question in care becomes how to promote well being and maintain an optimal Quality of Life QOL. But is not always clear what QOL means.The conceptualizations of QOL vary because most instuments are developed for patients in different stages of dementia, and the relevant life domains for QOL vary with the progression of the disease. As a consequence most instruments are unsuitable for assessing QOL in the whole range of mild to severe dementia.This presents a problem for the daily care for people with dementia and for the evaluation of interventions aimed at improving QOL, as changes in QOL with the progression of the disease are difficult to detect and assess with existing instruments.This presentation following conceptual definition offered. Dementia specific QOL is the multidimensional evaluation of the person environment system of the individual, in terms of adaptation to the perceived consequences of the dementia.
To compare the risk of treatment-emergent diabetes(TED) in schizophrenic patients treated with atypical(AAP) versus typical(TAP) antipsychotic medications.
We conducted a retrospective database analysis on episodes of care initiated after 1/1/2000 using data from the California Medicaid program. We included episodes for patients 18 years or older with schizophrenia who switched medications with a minimum “wash out” period of 15 days and no evidence of diabetes in the previous 6 months. If selection bias was present we used a simultaneous bivariate probit model to estimate the risk of TED in patients treated with AAP in comparison to TAP, otherwise we used a univariate probit model. Sensitivity analyses estimated the effect of olanzapine, risperidone and quetiapine independently versus TAP.
A Wald test of the correlation coefficient of the disturbances suggests that treatment selection is exogenous in our model(rho=0.005(p=0.95)) using a Huber-White sandwich estimator of the variance. The univariate probit model results suggest that AAPs were not associated with an increased risk of TED relative to TAPs(p=0.324). Sensitivity analysis showed quetiapine to be associated with a statistically significant decreased risk of TED relative to TAPs. No statistically significant association was shown with olanzapine or risperidone. A bivariate probit model omitting numerous variables demonstrates selection bias(rho=-0.650(p=0.0029)).
The results of this study show that AAPs are not associated with an increased risk of TED relative to TAPs. Explanatory variables that may explain treatment selection that were included in our model were sufficient to control for choice of therapy.
This abstract reports the first phase of a two-phase project that examines utilization and identifies patterns of antidepressants treatment (Phase-I), and compares physician and patient reasons for treatment patterns (Phase-II).
Prescription database of a US national pharmacy chain was queried to identify treatment-naïve patients receiving a new prescription for an SSRI or SNRI. Date of new prescription served as the index date. Patients were classified based on utilization patterns over a 3-month follow-up period post index date. A multinomial logit model was used to predict antidepressant treatment pattern. Statistical analyses were performed with two-tailed alpha 0.05.
The sample consisted of 108,229 patients, with mean age of 43 years, majority females (71%) and with 82% initiating a SSRI treatment at index. Average index copayment for the antidepressant was $23, and 90% of the sample had third-party insurance. Over the follow-up period, 40%, 58%, 2%, and <1% were classified as continuers, discontinuers, switchers and augmenters, respectively. Compared with continuers, augmenters were 34% less likely (95%CI=0.46-0.95) and discontinuers and switchers were 4 and 29% more likely (95%CI=1.00-1.07 and 1.12-1.48) to have an index SNRI vs. SSRI. Discontinuers were 62% more likely than continuers to be cash-paying vs. third-party-paying (95%CI=1.55-1.69). Compared to continuers, augmenters/discontinuers/switchers were more likely (19-79%) to have received their index-prescription from a psychiatrist vs. an internist (p<.05).
Patient, physician, drug and economic factors predicted change in the utilization of antidepressant prescription, discontinuation being the most prevalent. Determinants of discontinuation (lack of efficacy/tolerability/feeling better) will be further explored.
Deinstitutionalisation may put part of the severe mentally ill patients at risk to deteriorate in the community, mainly because they are difficult to engage with services. Assertive community treatment (ACT) is widely seen as an adequate answer for these difficult to engage patients. ACT is now rapidly implemented in many European mental health services, but recently the evidence base is questioned. Positive results of randomised trials in the US could not be replicated in the UK.
In Groningen (The Netherlands) a psychiatric case register (PCR) is in operation since 1986, and now covers a catchment area of 1.6 million inhabitants. It is a perfect tool to study the transition from inpatient to community care.
We did a randomized controlled trial (RCT) to study the effectiveness of the first ACT team in our region, using the PCR to measure primary outcomes. It is the only RCT of ACT in the Netherlands. In total 118 patients were randomized to two conditions. The primary research questions were:
• Is ACT better than standard care in maintaining contact with patients?
• Is ACT better than standard care in reducing the use of inpatient care?
ACT was superior in engaging patients to services, but no effect on the use of inpatient beds were found. Moreover, we did not find benefits in functioning, quality of life and unmet needs.
Too many patients are lost in standard care and therefore we highly value the sustained contact ability of ACT.
Ginkgo biloba extract EGb 761® improved neuropsychiatric symptoms (NPS) in patients with dementia in a series of trials.
To explore the effects of EGb 761® on NPS in patients with mild cognitive impairment (MCI).
A randomized, placebo-controlled, double-blind, 24-week, multi-center trial was conducted, including 160 patients with MCI who scored at least 6 on the 12-item Neuropsychiatric Inventory (NPI). Effects on NPS were assessed using the NPI, the state sub-score of the State-Trait Anxiety Inventory (STAI-X1) and the Geriatric Depression Scale (GDS). Further outcome measures were the Trail-Making Test (TMT, Forms A and B) and global ratings of change. Descriptive statistical analyses followed the intention-to-treat principle.
The NPI composite score decreased by 7.0 ± 4.5 (mean, standard deviation) points in the EGb 761®-treated group and by 5.5 ± 5.2 points in the placebo group (p = 0.001). Improvement by at least 4 points was found in 78.8% of patients treated with EGb 761® and in 55.7% of those receiving placebo (p = 0.002). Significant superiority of EGb 761® over placebo was also found for the STAI-X1 score, the informants' global impression of change and both TMT scores. There were statistical trends favoring EGb 761® in the GDS and the patients' global impression of change. Adverse events were reported by 37 patients taking EGb 761® and 36 patients receiving placebo; there were no serious adverse events.
EGb 761® improved NPS and cognitive performance in patients with MCI. The drug was safe and well tolerated.
Mounting evidence has implicated oxidative stress in severe psychiatric disorders, including major depressive disorder (MDD). Glutathione (GSH) is the major intracellular antioxidant that protects cells against oxidative stress.
To test the hypothesis that oxidative stress is implicated MDD by measuring cortical GSH in MDD patients and in matched healthy controls in vivo, using magnetic resonance spectroscopy (MRS).
Fifteen psychotropic medication-free patients with MDD diagnosed according DSM-IV-TR criteria and 13 healthy volunteers (HV) participated in the study. A history of other axis I diagnoses or substance/alcohol abuse was exclusionary for all subjects. In vivo brain GSH levels, expressed in institutional units, were obtained from a single 3 × 3 × 2-cm3 occipital lobe voxel at 3.0 Tesla using MRS spectral editing.
Statistical comparisons revealed a 20.6% mean cortical GSH decrease (p< .003) in MDD (2.3 ± 0.4) compared to HV (2.9 ± 0.6), which remained significant after adjusting for age, sex, bmi, and smoking status. In addition, we found GSH levels to correlate negatively with depressive symptoms and with indices of emotional and functional disability across all participants.
To our knowledge, this is the first study to report a significant cortical GSH deficit in vivo in MDD, a finding that supports a role for oxidative stress in the pathophysiology of the disorder, and suggests the viability of treatment strategies based on using synthetic GSH precursors, such as N-acetylcysteine, to spur in situ synthesis and elevation of the antioxidant and mitigate the pathogenic effects of oxidative stress.
The impact of personality dysfunctions in neurotic/anxiety disorders, especially in chronic and recurrent ones, are evident. Those dysfunctions seems to be different from specific personality disorders, being frequently co-morbid with neurotic disorders.
Research on personality traits associated with neurotic syndromes led to construction of neurotic personality questionnaire (KON-2006). The usefulness of this diagnostic tool was assessed in Polish, Czech and Russian populations.
The paper presents the results of studies on neurotic personality traits measured by this questionnaire and the results of a comparative study in Polish, Russian and Czech populations as well as the clinical experience with the use of this instrument in diagnosis and therapy (psychotherapy) outcome assessment.