bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicating Malingerers: A Case Study of Feigned Sickle Cell Disease
Authors: Welch A. , Sachdeva S. , Chung C. , Alao A. 
Published: March 2009

Speculation exists that bone pain crises among sickle cell disease (SCD) patients are not adequately treated. We counter this assertion with the case of a 17 year-old African American woman receiving narcotics while malingering SCD.There are various complications of SCD with the most common resulting from ischemia of the bone marrow. While depression, anxiety, and post-traumatic stress disorder have been described, psychiatric complications are not well documented in SCD.A 17 year old African American female entered the emergency room (ER) with right tibia and fibula fractures. She admitted to having SCD with bone pain crises previously treated with Ketorolac and Meperidine.On this occasion, radiological studies did not confirm sickle cell changes. A subsequent immunoglobulin electrophoresis came back hemoglobin AA. After the patient received notification she did not have SCD, she attempted to leave against medical advice. Her fractures were treated and she was discharged.DSM IV defines malingering as “the intentional production of false or grossly exaggerated physical or psychological symptoms”. One previous report of malingering sickle cell crises exists.1 This case demonstrates that the motivation to gain narcotic analgesics is a determining factor for malingering vis-à-vis factitious disorder, in which the primary goal is to assume the sick role.1Clinicians may assume the validity of a self-reported SCD history. In this case, ER physicians prescribed narcotics without objective evidence of SCD pathology. We suggest verification of SCD diagnosis in order to prevent unnecessary prescription of narcotics.
Help Seeking Behaviour of Chinese Living in Belfast, Northern Ireland
Authors: Yeung Y.-W. 
Published: March 2009

Aims:British Chinese have a low uptake of mental health servcies. Poor symptom recognition, language difficulty and mental illness stigma are the key barriers to accessing services. This study aims to explore their help seeking behaviours when they experience mental illness.Methods:About 96% of Chinese in Northern Ireland worked in catering business. Questionnaires (both in Chinese and English) were sent to ninety-one addresses occupied by catering businesses in Belfast. A bilingual covering letter was enclosed to encourage recipients to ask their families and friends to return the questionnaires.Results:Twenty-four questionnaires were returned. 66.6% reported that they visited their GP within the year prior to the study. Only one person visited the GP becasue of a mental / psychological problem. All others visited their GP for their physical illness. Racism (58.3%), physical ill health (50%) and lack of social support (41.7%) were the key stressors. 21% would visit their GP if they had a mental health problem and 45.8% would contact the GP if someone they knew became mentally unwell. Poor recognition of mental illness (41.7%) and mental illness stigma (25%) were the reasons for not seeking medical advice.Conclusion:Findings revealed that the Chinese do seek help from their GP. However, little evidence suggests that the community will approach their GP when they or someone they know actually become mentally unwell. Further investigation is needed to explore diifferent ways to provide information about mental illness symptoms and mental health services for the community.
Prevalence of Metabolic Syndrome and Coronary Heart Disease Risk in Patients with Schizoaffective Disorder: Clamors Study
Authors: Arango C. , Bobes J. , Aranda P. , Carmena R. , Garcia-Garcia M. , Rejas J. 
Published: March 2009

Aims:To assess the prevalence of metabolic syndrome (MS) and the coronary heart disease (CHD) risk in patients with schizoaffective disorder treated with antipsychotics.Methods:Schizoaffective patients from a multicentre cross-sectional study, in which 117 psychiatrists recruited consecutive outpatients meeting DSM-IV criteria for schizophrenia, schizophreniform or schizoaffective disorder and receiving antipsychotic treatment in monotherapy for at least 12 weeks. MS was defined as fulfilment of at least 3 of the following components (NCEP-ATP-III definition): waist circumference >102(men)/>88(women) cm; triglycerides >=150mg/dL; HDL-cholesterol < 40mg/dL(men)/< 50mg/dL(women); blood pressure >=130/85; fasting glucose >=110mg/dL. CHD risk was assessed by SCORE (10-year CV death) and Framingham (10-year all CV events) functions.Results:268 valuable patients with schizoaffective disorder (127 men, 48.1%), 41.9±12.3 years (mean±SD) were examined. MS was presented in 26.5% (95%CI:21.2-31.8) of subjects [26.8% in men (19.1-34.5), 27.0% (19.6-34.4) in women (p=0.966)]. the overall 10-year CV risks (CV death or any event) were 0.8±1.6 (SCORE) and 6.5±6.8 (Framingham), respectively. the 8.4% (95%CI:5.0-11.8) and 20.1% (95%CI:15.2-24.9) of patients showed high/very-high risk according to SCORE (≥3%) and Framingham (≥10%), respectively. A high/very-high risk of any CV event (Framingham≥10%) was associated with age above 40(men)/45(women) years [OR: 32.44 (9.59-109.71, p< 0.001)], and CGI-S=3-4; [OR: 4.32 (1.15-16.26, p=0.03)]. Women showed lower risk of any CV event [OR: 0.30 (0.14-0.65, p=0.002)].Conclusions:MS prevalence and CHD risk were high among patients with schizoaffective disorder treated with antipsychotics. Gender, age and poor disease control could be associated with CHD risk.*On behalf of the CLAMORS Collaborative Group.
Symptomatic Remission Amongst Elderly Schizophrenia Patients Treated with Long-acting Risperidone
Authors: Barak Y. , Baruch Y. , Tadger S. 
Published: March 2009

Background:In elderly schizophrenia patients remission is difficult to determine due to long disease duration, exposure to differing treatments, long-standing side-effects, non-adherence, cognitive decline and physical co-morbidity.Methods:Retrospective chart review of elderly (60+ years) schizophrenia patients admitted to a university affiliated tertiary psychiatric center. Patients were experiencing an exacerbation at admission. Remission criteria were as defined by the APA's “Remission in Schizophrenia Working Group”. Clinical status and improvement were quantified using the Clinical Global Impression scale.Results:During 2006 forty-eight elderly schizophrenia patients were admitted to our center. of these, 25 patients were treated with long-acting risperidone (LAR), 18 women and 7 men, mean age 72 years (range: 62-81), mean disease duration 30.4 years (range:14-42) and mean number of previous hospitalizations 8.9 (range:1-21). Co-morbid physical illness was present in 12 patients (hypertension, diabetes, CHF and hypothyroidism). of 25 patients treated with LAR, 19 (76%) continued uninterrupted treatment for 6 months or longer. in 6 patients treatment was discontinued due to insufficient response. All patient's (N=25) clinical severity ratings with the CGI-S were in the range of 5 to 7 prior to treatment. Following 6 months of LAR treatment, mean dose 36.0 mg/2 weeks (range: 25-50), 18 patients were rated as “improved” or “very much improved” on the CGI-I scale. in 15/25 patients (60%) symptomatic remission was achieved.Conclusions:LAR may be effective in achieving remission among elderly schizophrenia patients. Tolerability was high and adherence rates improved. the inherent bias in a retrospective analysis need temper our observations.
Weight Gain and Hyperprolactinemia in Schizophrenic Patients Treated During Twelve Months with Long Acting Risperidone
Authors: Garcia F. Duarte , Duval F. , Lopera F. Gonzales , Mokrani M.-C. , Hode Y. , Fattah S. , Diep T. Son 
Published: March 2009

Background:Risperidone (RISP) may induce both elevated prolactin (PRL) levels and weight gain. the aim of this study was to evaluate body weight and mass index (BMI), and PRL modifications in schizophrenic patients treated for 1 year with long-acting risperidone (LAR).Methods:Body weight and BMI (calculated as weight in kilograms divide by height in meter squared) were determined at baseline and at endpoint in 19 schizophrenic patients (9 men and 10 women; mean[SEM] age 33.4[2.9] years). PRL levels were determined at baseline, after oral risperidone treatment (mean length of treatment: 79[30] days; mean dose: 5.8[0.5] mg daily) and during a 12 month treatment with LAR (mean dose: 50[10] mg every 2 weeks; PRL levels were measured before each injection).Results:At endpoint, a significant weight gain (Δweight: 8,1[1,4] kg) and BMI (ΔBMI: 2,9[0,5] kg/m²) was observed (both p< 0.0002). Compared with baseline, PRL levels were significantly increased (p< 0.0007; mean ΔPRL: 33[8] ng/ml). There was an association between ΔBMI>1,5 kg/m² and ΔPRL>40 ng/ ml (p< 0.04). Moreover ΔBMI was linked to the length of treatment (rho=0.47; n=19; p< 0.05).Conclusions:Our results suggest a link between weight gain and long term hyperprolactinemia in patients treated with LAR. It has been hypothesized that PRL may have a role in the regulation of food intake by increasing leptin synthesis and secretion.
Quetiapine and Hypothyroidism: A Literature Review
Authors: Kontaxakis V. , Karaiskos D. , Havaki-Kontaxaki B. , Skourides D. , Ferentinos P. , Pappa D. , Papadimitriou G. 
Published: March 2009

Objective:Recently, there is an interest on the possible association between quetiapine and hypothyroidism. the aim of this study is to critically review all the reported cases in the international literature.Methods:A Medline search for all studies dealing with quetiapine induced hypothyroidism was carried out from January 1997 to June 2008.Results:Published literature on quetiapine's impact on thyroid function consists of 1 double-blind study, 1 observational study, 2 open studies, 3 case reports and data from the product monograph. A study on elderly psychotic patients revealed only small decreases in T4 levels, while another one in adolescents show trends for decrease in T4 and a marked increase in TSH. an observational study of thyroid function in patients treated with quetiapine and other antipsychotics, found a decrease in T4 with no changes in TSH and T3 and another one only slight increases in TSH. in the case reports all patients excibited clinical hypothyroidism. in one case there was a positive history for hypothyroidism, while in another one the patient had experienced lithium induced hypothyroidism in the past. According to quetiapine manufacturer 0.4% of the patients experienced TSH increases with half of them requiring thyroid replacement treatment. in studies, where quetiapine was adjunct to lithium or divalproate, 12% of patients had elevated TSH levels.Conclusion:We suggest a careful thyroid monitoring for patients initiating quetiapine, since hypothyroidism may emerge and masquerade psychopathologic manifestations. However, there is an open question whether thyroid dysfunction is a permanent or reversible condition.
Prevalence of Extrapyramidal Side Effects in Patients Receiving Depot Antipsychotic Medication
Authors: Luft B. , Berent E. 
Published: March 2009

Introduction:Long-acting depot antipsychotic medication is associated with extrapyramidal side effects (EPS). This may reduce adherence to medication, and precipitate relapse (1). Clearly, EPS is a major drawback and early detection is essential. However, in an earlier review of patients’ medical notes, we identified only one patient with an examination that recorded the presence of EPS. Despite the fact that a number of rating scales are available. We proposed that the application of these rating scales, would allow us to improve the assessment of EPS.Method:All patients prescribed a depot antipsychotic or long-acting risperidone injection, were identified. the Barnes Akathisia Scale (2) was chosen to rate akathisia, a modified Simpson-Angus scale (3) was chosen to rate parkinsonism and the Abnormal Involuntary Movement Scale (4) was chosen to rate tardive dyskinesia.Results:A total of 43 patients were evaluated. 23 (53%) patients showed drug induced EPS. the total number of positive cases of akathisia was 12 (28%), and 10 (23%) patients were found to have tardive dyskinesia. 13 (30%) patients were found to have drug induced parkinsonism.Conclusions:Our screening programme has identified high rates of previously undiscovered drug induced EPS.
Do Antipsychotic Drugs Lengthen QT Interval?
Authors: Sarotar B. Novak , Pregelj P. , Kocmur M. 
Published: March 2009

Objectives:Prolongation of myocardial repolarization, i.e. lengthening of the QTc interval on surface electrocardiogram, with increased risk of cardiac arrhythmias, has been recognized as a side effect of many drugs. Most conventional and atypical antipsychotic drugs can cause dose-related prolongation of QTc, although there are important differences in the potency of individual agents. Antipsychotic polipharmacy increases the risk for sever cardiac side effects.Subjects and methods:In this prospective clinical investigation, we analyzed ECGs in 46 patients suffering from schizophrenic disorder who were treated with different antipsychotic drugs one week after the admission to the psychiatric hospital. Hearth rate, QT interval and QTc interval were assessed. the average daily dose of prescribed antipsychotic drugs was calculated and transformed to chlorpromazine units.Results:Average QTc interval in patients undergoing our clinical investigation was 417 msec, only 3 out of 46 (6,5%) patients had QTc over 450 msec and only one patient (2,2%) had QTc over 500 msec.We found no differences in QTc interval between patients who were treated either with conventional or atypical antipsychotic or with combination of both, and no gender differences for QTc interval were found.Conclusions:Our results raise the question of the clinical relevance of a single ECG for diagnostics of cardiac complications in schizophrenia patients and suggest the need to conduct ECG monitoring in patients with high risk for cardiac complications during antipsychotic treatment.
Off-label use of Atypical Antipsychotics at the Crisis Intervention Unit
Authors: Sarotar B. Novak , Segrec N. , Pregelj P. 
Published: March 2009

Objectives:Antipsychotic medications are registered for the use in psychosis, mania and agitation. the aim of our study was to assess the off-label use of atypical antipsychotics (AA) at the Crisis Intervention Unit (CIU).Methods:Hospital records of 280 patients that were treated at the CIU in year 2007 were included to the observational study. Patients were screened for diagnosis (ICD-10), gender, age, suicidal behaviour and for prescribed psychotropic medications. Off-label use of atypical antipsychotics for diagnoses other than psychosis was evaluated.Results:Most hospitalised patients suffered for stress related disorders: adjustment disorder F43.2 (34%), acute stress disorder F 43.0 (2%), mixed anxiety-depression disorder F41.2 (19%), depression (24%), anxiety disorders (4%) and other disorders (17%). Patients were treated with antidepressants (92%), benzodiazepines (55%), hypnotics (44%) and mood stabilising drugs (9%) during their stay at the CIU. at discharge from hospital benzodiazepines (31%) and hypnotics (12%) were prescribed in lower percentages. 51% of patients received AA at least once during their stay at the CIU, 49% received AA for off-label use and it was prescribed for most of the hospital stay (for 87% of the time). Average daily CPU at admission to the hospital was 107.52 and at the discharge it was 100.33. No significant differences were noted among the different diagnoses for off-label AA use.Conclusions:Atypical antipsychotics are widely used for indications other than psychosis, even though the long-term effects of their use are not yet known and safety issues remain to be examined further.
Adherence with Antipsychotic Treatment Medication in Outpatients with Schizophrenia: 36- Month Results from the Schizophrenia Outpatients Health Outcomes (soho) Study
Authors: Novick D. , Suarez D. , Haro J.M. , Haddad P.M. 
Published: March 2009

Objective:To assess frequency and baseline factors associated with adherence with antipsychotic medication during long-term treatment in outpatients with schizophrenia.Methods:SOHO is a 3-year, prospective, observational study that included 10 972 patients changing or starting a new antipsychotic medication Treatment adherence during 4 weeks prior to the visit was assessed at each visit by participating psychiatrists as:•the patient has not been prescribed medication;•the patient almost always adheres;•the patient adheres half of the time; and•the patient never adheres to antipsychotic medication.Logistic regression models were fitted to analyze the baseline factors associated to compliance during follow-up.Results:6731 patients with at most one missing visit were analysed. Data from the missing visit were imputed from the previous visit; 71.2% were considered to be adherent and 28.8% non-adherent over the 3-year follow-up period. the strongest predictor of medication adherence during follow-up was adherence at baseline (OR = 4.01, 95% CI: 3.46-4.64). other baseline predictors of adherence included not using antipsychotics in the previous 4 weeks, receiving treatment for first time, being socially active, and a higher body mass index. Baseline predictors of non-adherence were alcohol dependence, substance abuse, hospitalisation in previous 6 months, living independently housing and having hostile behaviours.Conclusions:Alcohol dependence, substance abuse and living independently were associated with non-adherence. Previous adherence, being socially active and receiving medication for the first time was associated with better adherence. Limitation: medication adherence was assessed by the psychiatrist through a single item question.
Relapse Prevention in Schizophrenia and Schizoaffective Disorder with Risperidone Long-acting Injectable Versus Quetiapine: Randomized, Long-term, Open-label, Clinical Trial Results (constatre)
Authors: Gaebel W. , Bergmans P. , de Arce R. , Rouillon F. , Cordes J. , Eriksson L. , Schreiner A. , Smeraldi E. 
Published: March 2009

Objective:The ConstaTRE study was designed to compare long-term relapse in stable patients treated with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.Methods:This was a randomized, open-label, prospective, active-controlled, multicenter, 2-year trial in symptomatically stable patients with schizophrenia or related disorder who were switched from stable treatment with oral risperidone, olanzapine, or oral conventional antipsychotic to RLAI or quetiapine. Primary efficacy measure was time-to-relapse. Positive and Negative Syndrome Scale (PANSS) scores and safety (adverse events [AEs] and Extrapyramidal Symptom Rating Scale [ESRS]) evaluations were reported.Results:710 patients were randomized (n=355 per group), with 666 patients (n=329 RLAI and n=337 quetiapine) being evaluable. Mean doses were 32.8±8.0 mg every-two-weeks for RLAI and 396.8±141.9 mg/day for quetiapine. Kaplan-Meier analysis indicated a significantly longer relapse-free period with RLAI treatment (log rank: p< 0.0001). Relapse occurred in 16.5% of RLAI and 31.3% of quetiapine patients. Mean duration of treatment was 483.8±277.8 and 400.7±290.6 days for RLAI and quetiapine, respectively. Total PANSS scores improved significantly from baseline to endpoint for the RLAI-treated group (p< 0.001). the endpoint difference favors RLAI over quetiapine (p< 0.001). Treatment-emergent AEs were similar between groups. ESRS total scores decreased for both groups. Possibly prolactin-related AEs occurred more often with RLAI than quetiapine (4.6% versus 1.5%, respectively). Somnolence was reported less often with RLAI than quetiapine (1.8% versus 11.3%, respectively).Conclusions:Time-to-relapse was significantly longer and relapse rates were significantly lower for RLAI compared with quetiapine. both treatments were well tolerated.
Long-term Remission in Schizophrenia and Schizoaffective Disorder: Results from the Risperidone Long-acting Injectable Versus Quetiapine Relapse Prevention Trial (constatre)
Authors: Smeraldi E. , Cavallaro R. , Smalc V. Folnegovic , Bidzan L. , Ceylan E. , Schreiner A. , Lex A. 
Published: March 2009

Objective:To report the long-term remission results from the relapse prevention trial (ConstaTRE) in stable patients treated either with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.Methods:Clinically stable adults with schizophrenia or schizoaffective disorder treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to treatment with RLAI or oral quetiapine. Dosing was according to package-insert recommendation. Efficacy and tolerability were recorded for up to 24 months of treatment. Remission was defined as achieving and maintaining mild or less symptoms of schizophrenia over a 6-month period as defined by Andreasen et al, (2005).Results:710 patients were randomized (n=355 per group) to either RLAI or quetiapine. Demographics were similar between treatment groups. Relapse occurred in 54 RLAI (16.5%) and 102 quetiapine (31.3%) patients (p< 0.001). Full remission was achieved by 51% RLAI and 39% of quetiapine-treated patients (p=0.003) and was maintained until the end of the trial by 44% of RLAI and 31% of quetiapine patients. Mean duration of full remission was 540.8±181.4 and 508.1±188.0 days for RLAI and quetiapine groups, respectively (p=0.1325). Tolerability was similar between treatment groups. Most adverse events (AEs) were transient. Six RLAI and 10 quetiapine patients discontinued study treatment due to AEs.Conclusions:Among stable patients with schizophrenia or schizoaffective disorder, remission was more likely to occur in patients switching to RLAI when compared with quetiapine. both RLAI and quetiapine treatments were well tolerated.
Descriptive Analyses of the Aripiprazole Arm in the Risperidone Long-acting Injectable Versus Quetiapine Relapse Prevention Trial (constatre)
Authors: de Arce R. , Eding E. , Marques-Teixeira J. , Milanova V. , Rancans E. , Schreiner A. 
Published: March 2009

Objective:A recent randomized, open-label, relapse prevention trial (ConstaTRE) of risperidone long-acting injectable (RLAI) versus quetiapine and the oral atypical antipsychotic aripiprazole was carried out. Here we report the descriptive analysis of the aripiprazole arm.Methods:Clinically stable adults with schizophrenia or schizoaffective disorder previously treated with oral risperidone, olanzapine, or oral conventional antipsychotic were randomized to treatment with RLAI, quetiapine, or aripiprazole (in some countries). Efficacy and tolerability were monitored for up to 24 months of treatment.Results:A total of 45 patients were treated with aripiprazole (10-30 mg/day) and 329 patients with RLAI. Relapse occurred in 27.3% aripiprazole and 16.5% RLAI-treated patients. Kaplan-Meier estimates of mean relapse-free period were 314 versus 607 days for aripiprazole and RLAI patients, respectively. Full-remission, as defined by Andreasen et al, (2005), was achieved by 34% aripiprazole and 51% RLAI patients and was maintained until the end of the trial by 30% aripiprazole and 44% RLAI patients. According to Clinical Global Impression-Severity, there were 61% aripiprazole and 62% RLAI patients moderately ill or worse at baseline, and 59% aripiprazole and 45% RLAI at endpoint, respectively. Tolerability was generally similar between aripiprazole and RLAI treatment groups. However, weight gain, extrapyramidal adverse events (AEs), and possibly prolactin-related AEs were more common with RLAI treatment. Gastrointestinal disorders were more common in aripiprazole-treated patients.Conclusions:Time-to-relapse in stable patients with schizophrenia or schizoaffective disorder tended to be longer in RLAI-treated patients when compared with aripiprazole-treated patients. both RLAI and aripiprazole treatments were generally well tolerated.