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Available data does not recommend antipsychotic drug combinations in treatment of psychotic symptoms and monotherapy is nowadays considered the option with the highest scientific evidence. Nevertheless, antipsychotics combination is a common practice in countries such as USA (40-60%), Japan (90%) and Spain (50-70%).
To determine antipsychotic combinations frequency in patients with a diagnosis into the psychotic spectrum admitted in an acute psychiatric unit. to determine the differences among these combinations according to diagnosis. to analyze which are the associations more commonly prescribed as well as the theoretical basis that supports them according to receptorial profiles.
Demographic and clinical data of patients with a psychotic-spectrum diagnosis admitted to the Doctor Peset University Hospital acute unit during 2004-2007 were retrospectively analyzed. We observed the percentage of patients treated with more than one antipsychotic drug, as well as the combinations more frequently prescribed.
Out of 677 analyzed patients, 302 were treated with an antipsychotic combination therapy (45%). the associaton most commonly prescribed was an oral atypical antipsychotic + an intramuscular atypical antipsychotic (121 patients). According to diagnosis, 50% from each diagnostic group was treated with a combination antipsychotic therapy.
There is a high percentage of inpatients treated with more than one antipsychotic. We found no significant differences by diagnosis nor any clearly-defined key according to receptorial profiles.
Since the end of 19th century, mental health professionals have noticed that individuals who have experienced traumatic situations often present dissociative symptoms, such as amnesia or fugue states. Dissociation is a defensive mechanism that allows an individual to separate from conscience the psychological distress produced by the trauma. Our aim was to remark the association between Post-traumatic Stress Disorder (PTSD) and long-term dissociative disorders through the study of a clinical case.
A clinical case was followed and reviewed to illustrate this relationship.
Ten years ago, a 49-year-old man was diagnosed of PTSD after having witnessed several colleagues burnt in a tragic accident at work and having helped the emergency fire brigade to rescue other victims. His symptoms required treatment with antidepressants and psychotherapy, and fully remitted after one year. Nevertheless, during the last year, he has presented two dissociative amnesia episodes lasting for three days each, which were examined by a neurology service. More recently, he has suffered a ten-day episode of dissociative fugue, which required psychiatric hospitalization. Although the patient has been asymptomatic during a decade, it is remarkable that he has presented three dissociative episodes in a short period of time. One of them, the fugue state, is interesting because of its long duration and its relatively low prevalence in the general population.
This clinical case allows us to appreciate the long-term relationships between psychological trauma and dissociation, in addition to the well-known short-term effects.
The recent increase of immigrant population in some European countries represents a new social reality demanding an update of psychiatric clinical practice and resources. We aimed to:
1. compare the clinical and demographic profile of immigrant patients admitted to a Spanish acute psychiatric ward with that of native patients, and
2. detect changes over the last years regarding both the profile and the occupation of psychiatric beds.
Demographic and clinical data of immigrant patients admitted to the Doctor Peset University Hospital acute unit during 2005-2007 were retrospectively analyzed. For each case, a non-immigrant patient was assigned as a control. Immigrant subjects hospitalized during 2007 were compared to those admitted during 2000.
Over the three-year period, 38 immigrant individuals needed 45 hospitalizations (2.9-5.1% of total annual psychiatric admissions). Native patients presented similar demographics and produced a similar number of hospital stays, but had significantly more psychiatric (p=.02) and medical (p=.05) comorbid conditions. Immigrant patients hospitalized during 2007 (n= 12) were comparable to those admitted in 2000 (n=6), although the former accounted for a larger proportion of annual admissions (3.44% vs. 1.93%).
During the last seven years, the occupation of psychiatric beds by immigrant population has almost doubled but it is still in the low range. The clinical and demographic profiles of patients admitted to this acute ward were similar, regardless of their geographical origin.
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