bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-stroke acute elation shortly followed by pathologic jealousy - is there a common anatomic substrate?
Authors: Coutinho B. , Pinho J. , Machado Á.
Published: May 2011

Both mania and psychotic symptoms are well known to result from vascular brain injury, but their pathophysiology remains largely unknown.

A 69-year-old man with diabetes and hypertension was seen for sudden behaviour disturbance: euphoric, talkative and uninhibited, he continuously shouted he trusted in Medicine, called the doctor the “King of Medicine”, and repeatedly said “I love doctors, I love nurses, I love Hospitals”. He was overcompliant during neurologic exploration, clearly amused with it. Left sensitive hemi-inattention and left homonymous hemianópsia could also be found. MRI showed an acute right temporo-parieto-insular cortical infarction. The following day he was euthymic and embarrassed for what happened. When visited that afternoon by his wife, she noticed he was strangely suspicious, continuously surveilling all her moves. He progressively worsened, believing she was having affairs with several men. This delusion persisted for the following months, even on risperidone 1 mg/day, culminating in Christmas Eve, when the patient shocked his family saying that his wife was having an affair with one of their sons. At this time, risperidone was discontinued and replaced by quetiapine 200 mg/day, resulting in rapid fading of all symptoms.

Both post-stroke mania and psychotic symptoms have been consistently associated with right hemisphere damage, but, to our knowledge, were not previously reported after the same injury. We believe our patient provides evidence that the same anatomic dysfunction, in this case a temporoparietal infarct, can cause both psychiatric phenomena.
Applying the swedish performance assessment framework in practise: Assessment of efficiency and quality of psychiatric care
Authors: Björkenstam E. , Dahlgren C. , Lindelius B. , Ljung R. , Stefansson C.G.
Published: May 2011

Background

The National Board of Health and Welfare (NBHW) has developed a multi-dimensional performance assessment framework for open comparisons and assessment of health care. The framework includes the dimensions effectiveness, safety, patient-centeredness, timeliness, equity and efficiency.

Objective

To apply the framework to the area of psychiatric care in Sweden.

Aim

To identify disparities in the treatment and health outcomes of psychiatric patients in order to stimulate improvements.

Methods

More than 30 process and outcome indicators were developed using nationwide health data registers and were compared among regions or between patient groups.

Results

Among other results the study shows large disparities in somatic care between patients with and without comorbid psychiatric disease (equity), low compliance to antidepressant treatment with small regional variations (effectiveness), decreasing suicidal rates (safety), regional variations concerning timeliness of care, lack of national data to asses patient-centeredness and no obvious relationship between costs of psychiatric care and outcome (efficiency).

Conclusions

The study indicates that the quality of psychiatric care in Sweden does not differ to any great extent between regions. However, there are large disparities in somatic care between patients with and without comorbid psychiatric disease. The framework is a useful starting point for assessing psychiatric care but improved reporting to existing registers and development of new data sources, particularly related to psychiatric health care outcomes, could lead to more adequate and comprehensive assessments including all the six dimensions of the framework.
Assessment of quality of life in over-80 patients undergoing cardio-surgery: Is it feasible?
Authors: Pontoni G. , Ferrari S. , Gabbieri D. , Pedulli I. , Gambetti D. , Ghidoni I. , Rigatelli M.
Published: May 2011

Introduction

Cardiovascular disorders are the first cause of death among over-80 year-old patients and cardio-surgery is sometimes the one therapeutic option. No scientific assessment of Quality of Life (QoL) or other psycho-socially relevant consequences has been carried out. Aim of the study was to quantify and describe QoL on over-80 patients after cardio-surgery.

Methods

Study 1 was a one-arm cohort study on 192 subjects who underwent cardio-surgery between years 2003 and 2005 and were interviewed by phone 5 to 7 years after by means of SF-36 and the Seattle Angina Questionnaire, matching these with socio-demographics and clinical pre/post operative variables. Study 2 was a pre-post study on 21 subjects who underwent cardio-surgery in 2009-2010, who were interviewed face-to-face before the interventions and 6 months after, including assessment of anxiety and depression via the HADS.

Results

Study 1 patients reported satisfaction with treatment in 80%, freedom from cardiac symptoms in 62% and overall well-being in 78% of cases. Study 2 patients reported statistically significant improvement of QoL (SF-36 mean total score 57.1 vs. 73.5, p = .001), clinical conditions and anxiety-depressive symptoms (p = .001 both for HADS-anxiety and HADS-depression).

Conclusions

Assessment of QoL and anxiety-depressive symptoms should be included in routine evaluation of elderly surgical patients, though the present study also suggested the need for improvement of methodology of interview, being phone-calling and traditional self-assessment psychometric instruments particularly inappropriate for this patient population.
Charles bonnet syndrome (CBS): Successful treatment of visual hallucinations due to vision loss with trazodone in three cases
Authors: Hsu H.C. , Chen T.C. , Huang Y.S. , Fan W.X.
Published: May 2011

Background

CBS becomes more prevalent as the population ages and the number of patients with low vision increases. Clinical features of CBS have been described as complex visual hallucinations with insight due to the vision loss or visual ability decrease in patients who’re otherwise mentally normal. We describe three typical CBS patients whose visual hallucinations developed after bilateral severe visual impairment due to diabetic retinopathy. They responded well to treatment with trazodone. The effectiveness of trazodone in these patients adds to evidence implicating serotonergic pathways in the pathogenesis of visual hallucinations.

Case report

The characteristics of 3 patients and their reactions are listed in table 1.

Discussion

This is the first report describing the effectiveness of trazodone in treating typical CBS patients. It indicates that trazodone is an safer option for the treatment of CBS, especially in the elderly, diabetic population. In addition to having fewer interactions with comedications, trazodone has fewer adverse effects and relative lower body weight gain risk compared to anticonvulsants and neuroleptics. CBS is a condition that many clinicians aren’t very familiar with, yet it’s a surprisingly high prevalence rate (10%-30%) among the visually impaired. Clinicians must therefore keep in mind and ask elderly people with visual impairment whether they’ve hallucinations.
Growing up with the families of B-thalassaemia major using an accelerated longitudinal design
Authors: Khairkar P. , Malhotra S. , Marwaha R.
Published: May 2011

Introduction

It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like β-thalassaemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature.

Aim and objectives

We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of β-thalassaemia major patients attending a tertiary care hospital in north India.

Methods

The accelerated longitudinal design was used. The sample consisted of 100 children with β-thalassaemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course.

Results

Overall 54 per cent of children had significant psychopathology. Within the parents groups, 10 per cent had adjustment disorder, 33.3 per cent depressive disorder, and 10 per cent had anxiety disorder and 11 per cent somatoform disorder. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness.

Conclusions

Growing up with β-thalassaemic family was analyzed. Such a design can test the hypothesized aetiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.
Childhood trauma, dissociation in patients with fibromyalgia and rheumatoid arthritis
Authors: Kilic O. , Taycan O. , Aksoy Poyraz C. , Erol T.C. , Tecer O. , Emul H.M. , Sar V. , Ozmen M.
Published: May 2011

Introduction

The contribution of childhood trauma and dissociation to the unknown pathophysiology of fibromyalgia has been the subject of considerable debate.

Objectives

To assess and compare the relationship of childhood trauma and somatoform dissociation between patients with fibromyalgia and rheumatoid arthritis both of which are characterized by chronic pain and disability.

Aims

Early life and prolonged trauma may affect brain modulatory circuitry of pain and emotions. The findings of relationship between traumatic events, dissociation and fibromyalgia can lead to a better understanding of the etiology and suggest new treatment modalities.

Methods

Thirty-one patients with fibromyalgia and 19 patients with rheumatoid arthritis were enrolled in the study. All participants were asked to fill in the Childhood Trauma Questionnaire, Somatoform Dissociation Questionnaire and Dissociation Questionnaire.

Results

Physical neglect score was higher in fibromyalgia group than rheumatoid arthritis group (p < 0.05) although there was no significant difference between two groups in other subscores of childhood trauma and the rest of the dissociation scores. Total trauma scores were positively correlated with dissociation scores in fibromyalgia group whereas this correlation was not seen in rheumatoid group.

Conclusions

Among childhood trauma types, physical neglect seems to have a more important role in fibromyalgia than rheumatoid arthritis. Fibromyalgia may be related to early life stress or prolonged trauma, affecting brain modulatory circuitry of pain and emotions in genetically susceptible individuals.
Correlates of depression and quality of life in patients with inflammatory arthritides
Authors: Krishnadas R. , Mallon V. , Mcinnes I. , Cavanagh J.
Published: May 2011

Depression is a major co-morbidity in patients with inflammatory arthritides. In addition to the inflammatory processes, factors like pain, quality of life and trait emotional intelligence or the awareness on one's emotion and the ability to regulate these effectively may be associated with the presence of depression in this population.

Aims

The aims of the present study were to determine the rates of depression in patients with psoriatic (PsA) and rheumatoid arthritis (RA) attending a tertiary referral centre, and to investigate possible factors that are associated with depression in this population.

Methods

Interim data pertaining to depression (HADS), pain (British Pain Society Pain scale), quality of life (EuroQoL), physical function (HAQ-DI), inflammation (CRP) and emotional intelligence (Trait Emotional Intelligence Questionnaire - TEIQue-SF) were analysed from data from 100 patients (50 PsA and 50 RA).

Results

Upto 30% of patients with PsA and RA were found to be depressed. Similarly, upto 25% of patients with PsA and RA fulfilled the criteria for caseness on the HADS A subscale.

None of these patients were on therapeutic doses of an antidepressant. There was significant correlation between depression scores and scores on quality of life, disability and emotional intelligence. Together, they explained almost 50% of the variance in depression scores.

Conclusion

The prevalence of depression is high in people with inflammatory arthritides. Disability, Quality of life and trait emotional intelligence seems to be important factors associated with inflammation and presence of depression in this population.
Liaison psychiatry: pathology medical-psychiatric concomitant to the cognitive impairment
Authors: Ledo A.I. , Coullaut-Valera J. , Sanchez I.M. , Soto A. , Lopez I.
Published: May 2011

Objectives

1

Determine the prevalence of cognitive impairment in the population to study.

2

Determine treatment antidemential more prescribed in the population to study.

3

Determine the drugs more associated with the treatment antidemential.

4

Determine what is the pathology psychiatric more associated with cognitive impairment.

5

Determine the profile patient with cognitive impairment.

Method

A retrospective and observational study. Sample size of 2628 patients. The criterions for inclusion were: persons admitted to the HCUV in 2006–2010, assisted by the service of liaison psychiatry hospitalized and that gave the informed consent. Was carried out valuation neuropsychological (MMS and CDR). Diagnostic as DSM-IV-TR.

Results

The prevalence of cognitive impairment was 15.2%.

The specialties that most requested the service of psychiatry at link were: internal medicine: 31.6%; Traumatology: 11.9%; 83.6% had been hospitalized for somatic reasons 9,6% for psychiatric reasons. The most common psychiatric pathology was Delirium 32.9%; Adaptive Disorder 30.7%, Cognitive Impairment 15.2%. Out of the 15.2% of patients with dementia, 85% receives specific treatment with at least a drug antidemential. The most used was Citicoline85,3%. In 71% observed concomitantly neuropsychiatric symptoms:

Agitation(63,2%), anxiety(6,7%). The main associated treatments were Tiapride(70,1%) and Quetiapina and (21,9%).

Conclusions

The prevalence of cognitive impairment in patients of liaison psychiatry hospitalized in the HCUV is high, 15%. The frequency grows up with age increases as well as the related medical pathology. In the specific treatment have been used mainly:

Donepezilo, Rivastigmine [3] Memantine. The evolution of the patients was favorable in 88,9%.
Higher case fatality after cardiovascular event for patients with comorbid psychiatric disease
Authors: Lindelius B. , Bjorkenstam E. , Dahlgren C. , Ljung R.
Published: May 2011

Introduction

The National Board of Health and Welfare in Sweden has recently published regional comparisons and assessment o the psychiatric care in Sweden. More than 30 health care quality indicators are used that comprises processes and results of the care for the mentally ill. There are indications that psychiatric patients do not receive adequate treatment of their somatic illness. The study exemplifies that.

Objectives

To investigate whether patients with mental disorders are more likely to die after being hospitalized for acute myocardial infarction or stroke.

Aims

To pinpoint possible disparities in physical health outcomes/mortality among patients with mental illness.

Method

Patients were identified in the National Patient Register and Cause of Death Register. Mental illness was defined as having a registered psychiatric main diagnose at least once in the past five years.

Results

In 2007 30% of the patients in total that had an acute myocardial infarction died witin 28 days. Among patients that also had psychiatric diagnose 44% died within 28 days. Case fatality within 28 days after a stroke was 22% and 34% respectively. There are differences in outcome between the regions.

Conclusions

Our study indicates that the case fatality after a cardiovascular event is much higher in patients with comorbid psychiatric disease. Many reasons can be plausible, including bad compliance to treatment. But the higher case fatality might also be an indicator of non-optimal processes within the health care system for mentally ill people.
Independent factors associated with depression in type 1 diabetes mellitus
Authors: Góis C. , Manarte L.
Published: May 2011

This study identifies independent factors associated with depression in individuals with type 1 diabetes. In order to do this, we completed a descriptive transversal study with 110 type 1 diabetes patients, obtaining data on demographics, social status (Graffar score), diabetes (number of years from diagnosis, existence of initial admission at diagnosis, glycated hemoglobin, number of complications, insulin dose, number of injections of insulin per day, admission for ketoacidosis or hypoglycemia and specific diabetes complications as: nephropathy, retinopathy, peripheral neuropathy, coronariopathy, and amputation) and depressive symptoms evaluated by the Hamilton Score. T-tests were used to determine significant associations between the possible covariates and depression. Women had more symptoms of depression, and we have identified four factors independently associated with depression in individuals with type 1 diabetes mellitus: age, Graffar score, admission for ketoacidosis and insulin dose.
The levels of anxiety and depressive symptoms in COPD and lung cancer patients
Authors: Karkanias A. , Lekka D. , Giotakis K. , Anagnostopoulou M. , Tselios I. , Louridas A. , Nikoviotis D. , Bratis D. , Tselebis A. , Moussas G.
Published: May 2011

Introduction

It is known that patients with chronic and life - threatening diseases often presents anxiety and depressive symptoms.

Objectives

The comparison of the levels of anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and in patients with lung cancer.

Methods

The completion of the HADS scale was requested in 42 randomly selected patients (21 with lung cancer and 21 with COPD).

Results

Higher rates appeared in the subscales of anxiety and depression of the HADS (12.88 SD 5.03 and 13.45 SD 5.60, respectively) compared to the general hospitalized patients. Pathological rates of anxiety appeared at the 59.5% of the sample, while pathological rates of depression were found at 45.2%. Patients with lung cancer presented higher total score at HADS against patients with COPD (29.48 SD 9.3 vs 23.19 SD 8.26, t test p < 0. 05). In the subscale of anxiety appeared statistically higher average rate in patients with cancer against patients with COPD (14.43 SD 4.97 vs 11.33 SD 4.33, t test p < 0.05). Among the demographic factors, only age seemed to participate to the anxiety variation.

Conclusions

Patients with COPD such as patients with lung cancer are presented with high rates of anxiety and depressive symptoms. Patient's age seems to be a significant factor at the variation of the anxiety symptoms.
Mental health of patients undergone myacardial infarction
Authors: Nehir S. , Çam O.
Published: May 2011

Physical, psychological and social variables influence adaptation to disease. Psychological disease-adaptation affects all the factors related to disease and treatment. Similarly, psychological disease-adaptation may affect the course of disease favorably or adversely. Also patients’ disease-adaptation may vary depending on individual's personality, physical and psychological strength, socio-cultural characteristics, psycho-social stressors, tendency toward disease, negative feelings about disease, coping methods, previous experiences, life-style, hereditary features, support received from family members, type of disease or loss and the approach of therapy team to patient. The mental and behavioral problems that accompany physical diseases affect patient's adaptation, care, length and cost of treatment, wellbeing, course of disease, mortality and morbidity adversely. Cardiac diseases and especially myocardial infarction (MI) are among the diseases where psychiatric complications develop most often. In myocardial infarction, psychological problems as well as serious physical problems may appear in individuals who suffer from a disease which causes a threat for death and bodily image. Individuals, along with their personal characteristics, are influenced from such factors as depression, anxiety, stress, need for information related to disease, to manage disease under control and need for social support. When literature was reviewed it was reported that patients’ mental health was influenced by factors such as self-respect, social stress, social support, psychological support, emotional problems, status of physical and psychological efficiency, perceptions toward disease, coping strategies, relationships with health professionals and cooperation.
Innovative practice. applying academic psychosmatic medicine in rural California
Authors: Ng B.
Published: May 2011

Background

Imperial County is designated as medically underserved and one of the poorest counties in CA. Our practice started in 1994 and serves the gap between the County Mental Health Services (CMHS) that treats the severely and chronically ill and the general medical community that faces the unmet need of specialty care for “less” severe patients.

Methods

A plan was started to provide both psychiatric care and liaison activities. The community has 2 community general hospitals. Contracts were established with CMHS and private insurers to assure coverage of services. The plan was extended to dialysis units and long term facilities. Systematic collection of consult data was started in 1998.

An electronic medical record was established with specific fields designated for research purposes. Working in association with UCSD, we established a number of IRB approved protocols. In addition, we contracted with a number of pharmaceutical companies to become a research site for mult-center trials.

Results

Over 300 consultations were performed yearly. The most common consultations involved assessments of: elderly agitated patients, conservatorship evaluations and suicide attempts.

Conclusion

PM strategies added value in the provision of psychiatric services and contract negotiation in this rural community. Applying an academic model decreased the gap between CMHS and the medical community. Patients appeared satisfied to see the same psychiatrists at different treatment settings (i.e. general hospital, dialysis unit, NSF). All interventions were covered by the diverse payment sources.
Risk health behavior and psychological reactions after cardiac event
Authors: Nikolic G. , Zikic O. , Tosic S. , Manojlovic S.
Published: May 2011

Introduction

Risk health behavior can influence coronary syndromes outcome, especially associated with undesirable psychological reactions. Anxiety and depressive syndromes could be associated with higher frequency of smoking, alcohol consumption and lack of physical activity.

Objectives

Assesment of differences in psychological and behavior parameters between acute coronary and healthy controls and influence on 6 months re- hospitalization rate.

Method

Comparation between K group = 33 of first myocardial infarction patients and E group = 30 healthy persons at baseline and after 6 months. Instruments applied:

Semistructured psychiatric interview, M.I.N.I., Beck Anxiety Inventory (BAI) for anxiety level, Beck Depression Inventory (BDI) for depression level, KON-6 sigma Aggression Scale and Holms-Rahe (H-R) Stress Life Events Scale and Questioner for risk health behavior. Parameters differences were assessed by t-test chi square test, for p< 0,05. Regression analysis for 6 months re-hospitalization.

Results

Anxiety-depressive and Anxiety syndromes were present at 23% of K group and 10% of E group. Anxiety level of K group was higher than E: (BAI = 8,15 ± 4,37:4,83 ± 2,60; t = −3,62), for p < 0.01, depression level was also higher (BDI = 8,67 ± 3,94: 4.63 ± 2.04; t = −5,02). Lack of physical exercise, was more present at K group. After 6 months there were 11 rehospitalization in K group. Family history of coronary disease and alcohol consumption had significant influence on 6 months re-hospitaization of infarct patients.

Conclusion

Anxiety and depression levels are mild in K group. Risk health behavior has been present at bouth groups but alcohol consumption and family disposition are important for re-hospitalization
Intermed self-assessment: developing an instrument to evaluate biopsychosocial complexity
Authors: Piemonte C. , Disavoia A. , Ferrari S. , Simoni E. , Huyse F. , Rigatelli M.
Published: May 2011

Introduction

INTERMED is a method to assess biopsychosocial case complexity and a screening instrument to identify patients with multiple care needs. It is based on an interview, brief and easy to use, that can be conducted also by a nurse. Various studies in the last 10 years have confirmed its face-validity and reliability as a clinimetric tool. Its self-assessment version (IM-SA) was developed for further implementation in clinical settings.

Aim

To evaluate language, structure and fluency of the IM-SA questionnaire.

Methods

IM-SA, Italian version 1.0, was administered to 25 patients admitted to an internal medicine ward and to other 25 in the waiting room of a Primary Care outpatient clinic. At the end of the questionnaire, nine extra-questions were specifically added to evaluate comprehension and difficulties encountered by patients while filling in the questionnaire.

Results

Patients admitted to the hospital scored higher and were found to be “more complex” (p < .01). 90% of respondents found the questionnaire easy to answer and 96% answered that the structure of the sentences was not too complex. The majority of patients found IM-SA useful and/or interesting. Contradictions in results also were found, suggesting need for improvement of structural and linguistic properties of the tool.

Conclusion

IM-SA seems to be a feasible and reliable self-assessment method to evaluate biopsychosocial complexity. Further similar studies in different languages are being organized to reach a final version of IM-SA, which will be afterwards compared to the IM professional interview.
Measuring psychological discomfort in severe functional gastrointestinal disorders: Is the Hospital Anxiety Depression (HAD) scale helpful?
Authors: Rodríguez-Urrutia A. , Braquehais M.D. , Accarino A. , Bel M.J. , Quesada M. , Lusilla P. , Parramon G.
Published: May 2011

Introduction

Patients suffering from Functional Gastrointestinal Disorders (FGD) experience a high degree of psychological discomfort difficult to measure with current psychometric tools.

Objectives

- To describe the presence of affective symptoms measured with the Hospital Anxiety Depression (HAD) Scale in FGD inpatients.

- To analyze the differences in HAD subscales scores between motor functional gastrointestinal disorders (MFGD) and non-motor functional gastrointestinal disorders (NMFGD).

Material and method

46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the HAD scale and results from the two HAD subscales - Anxiety subscale (HAD-A) and Depression subscale (HAD-D)- were analyzed.

Results

The mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. Thirty-one patients met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both diagnoses. The mean scores of the HAD were: HAD-A = 8.12 ± 5.23) and HAD-D = 5.20 ± 4.20. MFGD patients’ HAD results were: HAD-A = 7.00 ± 5.74 and HAD-D = 4.55 ± 4.52 while NMGFD HAD results were: HAD-A = 8.21 ± 4.98 and HAD-D = 4.96 ± 3.77. No statistically significant differences were found between both groups.

Conclusions

According to our findings, MFGD patients do not meet HAD criteria of anxiety or depression while NMFGD patients only fulfill criteria for probable anxiety or depression. New psychometric tools should be developed in the future to study the psychological discomfort these patients usually complain of.
Difficulties in assessing alexithymia in motor and non-motor functional gastrointestinal disorders
Authors: Rodríguez-Urrutia A. , Braquehais M.D. , Accarino A. , Bel M.J. , Quesada M. , Lusilla P. , Parramon G.
Published: May 2011

Introduction

Alexithymia is said to be an important feature of functional gastrointestinal disorders (FGD). Most studies focus on the presence of alexithymia in patients suffering non-motor FGD (NMFGD) but few studies have analyzed its occurrence in motor FGD (MFGD) patients.

Objectives

- To describe the presence of alexithymia, measured with the Toronto Alexithymia Scale (TAS-20), in a sample of FGD inpatients.

- To analyze the differences in alexithymia, measured with the TAS-20, between MFGD and NMFGD inpatients.

Material and method

46 inpatients admitted to the Vall d’Hebron Digestive System Research Unit to study the existence of FGD were evaluated from January 2008 to July 2010. All patients completed the Toronto Alexithymia Scale (TAS-20).

Results

The mean age of the sample was 41.02 ± 16.86 years, 89.1% were women and 10.9% were men. With regard to their diagnostic condition, 31 met criteria of NMFGD, 13 of MFGD, and 2 did not met criteria of both disorders. The mean TAS-20 total score was: 46.24 ± 13.60. MFGD patients obtained a mean score of 45.45 ± 12.53, and patients with NMFGD had a mean score of 45.75 ± 12.53. No statistically significant differences were found between both subtypes with regard to alexithymia.

Conclusions

Alexithymia, measured with the TAS-20, may not be present in FGD. Discordances of our results with previous findings in FGD may be due to complex psychosocial factors and to psychometric difficulties in assessing alexithymia in this group of patients.
Case report and discussion on the use of essential fatty acids in the treatment of an organic affective and personality disorder
Authors: Roy B.B. , Rao K.P.
Published: May 2011

We present the case of Mr CD, who presented to the psychiatric services about 12 years ago with features of Affective instability (short periods of elation, longer periods of depression); Significant self harm and suicidal behaviour; dysfunctional coping mechanisms ; non-compliance with treatment and alcohol dependence. His predominant complaint was that he was unable to feel any emotions. He described his symptoms as “Narcasm” (described by himself as a sense of narcissism and a lack of emotions).

He was resistant to treatment with conventional psychotropics.

He was investigated and discovered to have abnormalities on MRI scanning. The MRI brain scan showed - Mild global cerebral atrophy, small focal areas of sub-cortical and basal ganglia high signal as well as cerebral white matter lesions, particularly in the right frontal regions. These lesions had progressively worsened between 2006 and 2009.

It was formulated that he was suffering from a complex neuropsychiatric illness, which would not fit into any definite diagnostic criteria.

He finally improved on a combination of an antipsychotic (Quetiapine) and Essential Fatty Acids (EFAs).

Several research papers have demonstrated the role and importance of EFAs in mental illness.

It is evident that there are a large number of studies that support the growing evidence of the importance of EFAs in the management of mental disorder. In the case that we have presented, it can be seen that even in complex neuropsychiatric illnesses, EFAs can play a significant and beneficial role in treatment and prognosis.
Pre-procedural and post-procedural anxiety among relatives of coronary angiography patients
Authors: Sayın Y. , Tel H. , Tel H. , Yılmaz M.
Published: May 2011

Introduction

As the heart is a vital organ, diagnostic and therapeutic heart procedures can cause fear and anxiety not only in patients, but also among their relatives.

Objectives

This is a descriptive study conducted to determine pre-procedural and post-procedural coronary angiography anxiety among patients’ relatives.

Methods

The relatives of 141 coronary angiography patients were included in the study. A personal information form and Spielberger's State-Trait Anxiety Inventory were used for data collection.

Results

The average age of the patients’ relatives who participated in the study was 44.64 ± 13.22 years. 85.8% of the study participants were married and 61.0% were first-degree relatives of the patients. It was found that patients’ relatives had a moderate level of pre-procedural anxiety (mean = 53.333 ± 15.678), and that they had a low level of post-procedural anxiety (mean = 37.184 ± 18.528). State anxiety scores were higher among relatives who were married, and among those related to a patient who underwent a diagnostic procedure and previously underwent coronary surgery. Post-procedural state anxiety scores were higher among participants related to a patient who was recommended to undergo by-pass.

Conclusion

It was found that pre-procedural anxiety was higher than post-procedural anxiety among the relatives of patients who underwent coronary angiography. Therefore, prior to angiography, patients’ relatives should be informed about the procedure, and efforts should be made to reduce their anxiety.
Medical consultations of acute psychiatric inpatients: differences due to age
Authors: Serván Rendón- Luna B. , Morón Nozaleda M.D. , Bautista Garrido O. , Machín Vázquez-Illá M. , Trebbau López H. , Montes Montero A. , Marco Martínez J.
Published: May 2011

Introduction

Patients suffering serious mental diseases have more medical comorbidity and a higher mortality than the general population, something that has important clinical an economical impact. Age is an influential variable in a patient’s clinical course.

Objectives

Descriptive retrospective study from September 2007 to May 2010. Centralized database explotation. Center: San Carlos Clinic Hospital, Madrid. Variables: number of patients, mean age, median stay, number of visits, % resolved in first visit, mortality and delay.

Three groups of comparison are established depending on the age: 18–44, 45–75 and > 75 years of age. A p≤0,05 has statistical significance.

Results

606 patients are included. Table 1 shows all variables for the three groups.

Conclusions

Statistical significance exists for all variables analyzed and for every comparison established apart from mortality. Mortality is very low (just one death in group age >75). Group age 45–75 years presents major number of consultations to internal medical liaison Unit. Age is a decisive variable in the clinical course of patients with medical problems.
Takotsubo syndrome: A theoretical review over a clinical case
Authors: Silva-Carvalho F. , Moutinho A.
Published: May 2011

The clinical case serves as an introductory note to the description of the Takotsubo Syndrome.

The Takotsubo Syndrome has gained recent notoriety. It is estimated that this diagnosis is made in 2% of acute coronary syndromes. In up to 75% of the cases, a psychological stressor can be found, usually traumatic, and 25–40% of the patients meet the diagnostic criteria for depressive or anxious pathologies. It presents as an acute coronary syndrome, with pre-cordial pain and dyspnea, and in 90% of the cases there is elevated Troponin I, in average 0.49 ng/mL. There is mild ST-wave elevation and T-wave invertion, mostly on V2 and V3. The ventriculography presents the typical image, with apical ballooning and hypokinesia, that reverse in 20 days, average.

The ratio of ß1 and ß2 receptors in the human heart is 4:1, and norepineprhin acts mostly in the former. It is released by the sympathetic terminals in the heart, which are 40% more dense in the basal region. Thus, the catecholaminergic action at the apex is mostly performed by circulating epinephrine, via ß2 receptors. The phenomena that occurs at supra-physiologic levels of epinephrine is called “stimulus trafficking” and results in a net change of intracellular signaling from Gs protein to Gi protein. The effect exists to protect against apoptosis in such conditions, but results in negative inotropism, most evident at the apex, where ß2 receptors are most prevalent.

At last, this poster points some pathophysiologic factors in common between anxious pathologies and Takotsubo syndrome.
Behavioral intervention team: A multidisciplinary approach to co-morbidity in hospital level care
Authors: Sledge W.H. , Zimbrean P. , Desan P. , Bozzo J.
Published: May 2011

Introduction

Psychiatric illness complicates physical medical care and prolongs hospital stay.

Objectives

To implement and measure the effect of a multidisciplinary (psychiatry, nursing and social work) team in an academic medical center general hospital.

Aims

To test the hypotheses that early recognition and management of co-morbid mental illness threatening to interfere with hospital level care for physical illness will reduce the fiscal burden of hospital level care.

Methods

Before and after comparison of patients on three medical units examining conventional consultation liaison approach vs the Behavioral Intervention Team (BIT) on four outcome measures: length of stay (LOS), denied days (uncompensated days waiting on medical service for hospital level care of psychiatry when the patient no longer requires hospital level medical care), constant companion use, and thirty day readmission rate.

Result

Consultation liaison patients from August 1, 2008 through June 30, 2009 were compared to BIT patients on the same three units from August 1, 2009 through June 30, 2010; the BIT patients had a lower length of stay (9.99 days vs 11.33 days, Wilcoxon Two Sample Test = 200953, p < .01, two tailed) with a reduction of constant companion use by 8.7%, and elimination of denied days altogether. Thirty day readmission was reduced 2.5% but was not statistically significantly different.

Conservative economic analysis demonstrates that the intervention begins to generate a profit when the hospital reached budgeted census at least 3.5% of the time.

Conclusions

Interdisciplinary care can be feasible, effective and efficient in a hospital based consultation liaison setting.
The quality of sleep and the quality of life among the elderly people
Authors: Tel H.
Published: May 2011

Introduction

Sleep problems are commonly seen among the elderly people and these problems affect the quality of sleep and the quality of life.

Objectives

The current research was conducted in order to determine the quality of sleep and the quality of life of the elderly people.

Methods

The research was conducted with 187 elderly people. Personal information form, Pittsburgh Sleep Quality Index and Turkish Version of WHOQOL-Bref-Quality of Life Scale were used for the data collection.

Results

The ages of the participant individuals ranged from 65 to 83 and mean age was 72.5 ± 5.24. It was determined that all of the elderly people had a bad quality of sleep. There was a significant negative correlation between areas of the quality of life and the quality of sleep. It was found out that scores of all of the areas of the quality of life were low among the elderly who were illiterate and had a chronic physical disease and that their quality of sleep was worse. The widowed and women had lower scores in physical, psychological and social areas of the quality of life scale and their quality of sleep was worse.

Conclusions

The quality of sleep and the quality of life are closely interrelated among the elderly people. A decrease in the quality of sleep causes a decrease in the quality of life. The quality of sleep should be continued by ensuring sleep hygiene among the elderly people and thus the quality of life should be increased.
Persistent mania and psychosis in a case of novel influenza a (H1N1) virus encephalitis
Authors: Teng J.Y. , Lee T.-S.
Published: May 2011

Neurologic complications associated with novel influenza A (H1N1) virus infection include seizures, encephalitis, encephalopathy and Reye syndrome. Mania and psychotic episodes are less commonly described, and there have been limited studies on the long-term neuropsychiatric sequelae of H1N1 infection.

Here, we report a case of H1N1 infection with concurrent onset of acute manic and psychotic symptoms. Despite completing a full course of the antiviral medication oseltamivir, the patient's behaviour worsened over the next four weeks and he required readmission for psychiatric treatment. Based on the temporal sequence of events, we considered the possibility that these symptoms were sequelae of Novel influenza A (H1N1) infection. Moreover, the manic symptoms persisted weeks after the acute infection had abated, which gives rise to the consideration of long-lasting direct or indirect neuronal insult by the influenza virus. However, it is also possible that his symptoms may have represented a primary psychiatric disorder precipitated by or coincident with the viral infection.

After treatment with antipsychotic medication and a mood stabiliser, his manic and psychotic symptoms became significantly attenuated. His behaviour improved considerably such that he was able to return to school. Medications were stopped after one month of outpatient follow-up at his behest. Four months after discharge, he was completely free of symptoms and was performing well in school.

Treatment of influenza with antiviral medications has been shown to reduce the rate of complications. However, the effectiveness of antiviral treatment to prevent influenza-associated neuropsychiatric sequelae is unknown.
P01-404-Differences in hospitals create different models of functioning in consultation-liaison service
Authors: Theochari A. , Mouzas O. , Angelopoulos N.
Published: May 2011

The aim of this study is to investigate differences in Consultation-Liaison (C-L) service between two General Hospitals in Greece in order to provide better health services to our patients.

We try to examine referral causes from C-L Psychiatry Unit of an urban General hospital (G.H.) and a local University hospital (U.H.) and find out potential differences. 492 data were gathered (G.H = 96 U.H. = 396) within a 6 months period.

Most liaison referrals (n = 260, 52,8%) were of Internal Medicine Units. The bulk of referrals were either drug adjustment (n = 157 31,9%) or suicide attempts (n = 122 24,8%). According to our findings the vast majority were diagnosed of depression (n = 67 22,9%) or delirium. 153 patients had Psychiatric history and in 86 of them (56,2%) we were called for help with their drug therapy (rearranging drug doses or preventing side effects with recent medication). 71 patients although were found of no psychiatric problem and cause of referral were management behavioral problems, such as patients negation or irritation.

Both hospitals found out of similar needs in most examined elements. C-L service is the link between psychological process and physical illness. Further research in sociodemographic characteristics and cause of referrals in different kind of Hospitals may enlighten the needs of C-L service in each case.
Normal 0 14 general punitiveness and direction of hostility in chronic prostatitis patients
Authors: Tournikioti K. , Christodoulou C. , Nika S. , Korkoliakou P. , Gourgoulis G.-M. , Tsiodras S. , Panagopoulos P. , Petrikkos G. , Lykouras L.
Published: May 2011

Introduction

Chronic prostatitis has been long considered a psychosomatic illness. We have previously studied alexithymic and obsessive-compulsive features in chronic prostatitis patients.

Aims

To evaluate introverted, extroverted and total hostility in patients with chronic prostatitis.

Methods

Patients diagnosed with chronic prostatitis at a tertiary care ID clinic were evaluated with the Hostility and Direction of Hostility Questionnaire (HDHQ), a questionnaire with 5 subscales designed to assess total hostility or punitiveness and direction of hostility. Patients were categorized according to the NIH Consensus Classification System for Prostatitis Category and the NIH Chronic Prostatitis Symptom Index (CPSI) was calculated.

Results

82 patients (median age 37.5 yrs old; IQR 30-45.5 yrs) were evaluated. According to the NIH Prostatitis Classification patients were categorized as type II: 45.1%, IIIa: 9.7%, IIIb: 39%, IV: 2.4%. Median CPSI score was 19.5 (IQR: 14.5-24.3). Median introverted, extroverted and total hostility scores were 3 (IQR: 2-6), 9 (IQR: 7-13) and 13 (IQR: 9-18) respectively. Results from the Extroverted Hostility HDHQ subscale correlated (r squared = −0.25, p = 0.024) with subscales of the TAS (Toronto Alexithymia Scale). These results were independent of CPSI scores.

Conclusions

Chronic prostatitis patients’ total hostility scores are similar to those of the general population reported by other studies. However, chronic prostatiitis patients show more outward directed hostility. The relationship between TAS subscale scores and measures of extroverted hostility needs further elucidation. Patients with chronic prostatitis are potentially at risk for psychiatric disturbances and thus may need psychiatric counseling and therapy.
Dissociative fugue of the patient of maternity ward - A case report
Authors: Załuska M. , Żurko R. , Kuroń M. , Jakiel G. , Dudel A.
Published: May 2011

Introduction

Mothers after childbearing are vulnerable to many stress related disorders.

Objective

to emphasize the role of the past obstetric complications, as so present infant pathology as risk factors for the mother's post partum stress related disorders.

Methods

The case analysis.

Case description

The thirty-year-old, women left the maternity ward with her baby unnoticed on the fourth day after giving birth. She was referred to psychiatry ward, after finding her by the police. In the past history the patient had spontaneous miscarriage in the first pregnancy. She has waited with her husband 6 years long for the next baby. The second pregnancy was at risk, the labor was premature and the infant has palatoschisis. The mother had difficulties with feeding. She feared about baby's life, and had feeling of being neglected by the staff. In psychiatry ward she did not reveal any symptoms of mental illness. She was interested in her child, however the period of the flight was covered with memory gap. The predominance of immature defense mechanisms, as so mild cognitive dysfunctions were revealed in psychological testing. The dissociative fugue was diagnosed. The patient was discharged without any medication to ambulatory psychotherapy.

Commentary

The interaction of past and present traumatic experiences in the patient with cognitive dysfunctions and immature defense mechanisms could impair ability of post-partum coping with fear about the child and consequently led to the loss of conscious control over the memory. Early diagnosing and supporting problematic patients of the maternity ward is needed.