Objective:Restraint use is not monitored in the US, and only institutions that choose to do so collect statistics. In 1999, investigative journalists reported lethal consequences proximal to restra...

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Adverse effects associated with physical restraint.

Research into the relationship between physical illness and schizophrenia has revealed that patients with schizophrenia may be at decreased risk for certain disorders, such as rheumatoid arthritis and allergies, but at increased risk for others, including substance abuse and polydipsia. Although such knowledge may ultimately help determine the underlying causes of schizophrenia, the principal concern of practicing clinicians should be to diagnose and treat medical comorbidity in individual patients. Nearly 50% of patients with schizophrenia have a comorbid medical condition, but many of these illnesses are misdiagnosed or undiagnosed. A fragmented health care system, lack of access to care, patient inability to clearly appreciate or describe a medical problem, and patient reluctance to discuss such problems all contribute to the lack of attention to medical problems in patients with schizophrenia. Psychiatrists and primary care practitioners who treat patients with schizophrenia should make an effort to uncover medical illnesses by using a structured interview or routine physical examination whenever a patient is seen for care.

https://www.psychiatrist.com/read-pdf/11456

Medical illness in patients with schizophrenia.

Physical consequences of schizophrenia and its treatment: The metabolic syndrome

BACKGROUND The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner.

METHODS A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both in-patient and community-based services.

RESULTS Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders.

CONCLUSIONS The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

Sudden death in psychiatric patients.

The purpose of this study was to investigate the effect of adding sustained-release (SR) bupropion to cognitive behavioral therapy (CBT) on smoking behavior and stability of psychiatric symptoms in patients with schizophrenia. We conducted a 3-month, double-blind, placebo-controlled trial of bupropion SR, 150 mg/day, added to a concurrent CBT program with 3-month follow-up in 19 stable outpatients with schizophrenia who wanted to quit smoking. Eighteen subjects completed the trial. Bupropion treatment was associated with significantly greater reduction in smoking, as measured by self-report verified by expired-air carbon monoxide (6/9 subjects, 66%), than placebo (1/9 subjects, 11%) during the 3-month active treatment period and the 3-month follow-up period. One subject in the bupropion group (11%) and no subjects in the placebo group achieved sustained tobacco abstinence for the 6-month trial. Bupropion treatment was associated with improvement in negative symptoms and greater stability of psychotic and depressive symptoms, compared with placebo, during the quit attempt. Subjects in the bupropion group experienced significant weight loss, compared with those on placebo during the smoking cessation attempt. These data suggest that bupropion SR, 150 mg/day, combined with CBT, may facilitate smoking reduction in patients with schizophrenia while stabilizing psychiatric symptoms during a quit attempt.

A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia.

OBJECTIVE Obesity is a major health problem among children and adolescents which is potentially affected by socioeconomic status (SES). The high risk group (HRG) comprises those youths with a body mass index (BMI) between the 85th and 95th percentile (at risk for overweight) and > or = 95th percentile (overweight). We sought a potential link between the HRG and SES. METHODS Public schools in Chesterfield County, Virginia measured BMI among students in kindergarten and third, seventh, and tenth grades. We assessed SES based on eligibility for the National School Lunch Program and the percentage of the school-age population living in poverty based on per capita income from the 2000 Census. RESULTS From 28 to 38% of children and adolescents were in the high risk group. Low SES had robust and highly significant correlations with HRG status with r-values ranging from 0.565 to 0.842, P < 0.0001. CONCLUSIONS Low SES appears to be an important factor in childhood and adolescent obesity.

Correlation between high risk obesity groups and low socioeconomic status in school children.

Objective:The primary purpose of this review of medical disorders in the schizophrenic patient is to provide the clinician interested in Consultation/ Liaison psychiatry and psychosomatic issues a comprehensive and current review of the subject.Method:The authors used the Index Medicus and Medline to find recent review articles and research articles related to medical disorders in the schizophrenic patient. Also, the authors described their clinical experience in Consultation/Liaison psychiatry working with schizophrenic patients in a large, tertiary-care academic medical center.Results:The authors divided their review into: 1) mortality and morbidity in schizophrenia, 2) differential diagnosis, 3) specific comorbidity management problems, 4) caring for schizophrenics on medical/surgical wards, and 5) antipsychotic drugs in the medical setting. Schizophrenia remains an important subject for Consultation/Liaison psychiatrists.Conclusions:Schizophrenia and its protean manifestations confound the care of the...

Medical Disorders in the Schizophrenic Patient

Objective:The authors seek to extend understanding and treatment of hospitalized schizophrenics presenting with complications of polydipsia and dilutional hyponatremia. Attending physicians may ask the consultation/liaison psychiatrist to see schizophrenics with hyponatremically-induced delirium or other psychiatric syndromes. The referring physician may or may not have identified polydipsia and dilutional hyponatremia and their complications. This article will help the consultation/liaison psychiatrist recognize early evidence of water imbalance, describe evaluation, and provide somatic and behavioral treatment approaches to this life-threatening syndrome.Method:Over the past ten years, the authors have treated more than 100 patients with the polydipsia-hyponatremia syndrome. The authors discuss their and others' experience with drugs that help and hinder patients suffering from dilutional hyponatremia. They review current key articles from the polydipsia-hyponatremia syndrome literature including articl...

The Consulting Psychiatrist and the Polydipsia-Hyponatremia Syndrome in Schizophrenia:

We report our experience treating 14 elderly psychiatric patients with altered sodium states. Hypernatremia occurs more commonly among elderly psychiatric patients than among their younger counterparts, and elderly hypernatremic psychiatric patients suffer most commonly from dementia. Dilutional hyponatremia is less common and less severe among elderly schizophrenic patients compared with younger patients with schizophrenia. Central nervous system changes induced by altered sodium states among elderly psychiatric patients are sufficiently similar whether hyper- or hyponatremia is present; therefore, the clinician must not wait for specific features to develop, but must quickly measure serum sodium concentration in elderly psychiatric patients with altered mental states. Treatment of hypernatremia involves rehydration with normal saline or hypotonic solutions, and treatment of dilutional hyponatremia largely involves fluid restriction.

Hyper-and Hyponatremia among Geropsychiatric Inpatients

Postprandial hypotension is more common among the elderly than among the young. Complications of postprandial hypotension potentially include falls, fractures and death. We studied 21 ambulatory patients in a university-affiliated, state-operated geropsychiatric hospital. Subjects had major psychiatric diagnoses and received vasoactive drugs for those diagnoses. After baseline measurements, study subjects ate lunch within 15 minutes. The next day, we repeated the procedure except that study subjects did not eat lunch until after they completed the protocol. Mean blood pressure progressively dropped during the 45-minute period following eating with the greatest difference between eating and not eating values occurring at 45 minutes. Our study results more closely approximated the findings in the literature for community-dwelling elderly than geropsychiatric patients in residential settings. Age alone may explain study differences. Based on our preliminary findings, it may be that major psychiatric illness and/or its treatment do not alter age-related cardiovascular hemodynamics in geropsychiatric patients compared with their non-psychiatric counterparts.

Victor Vieweg

Papers

Correlation between high risk obesity groups and low socioeconomic status in school children.

Medical Disorders in the Schizophrenic Patient

The Consulting Psychiatrist and the Polydipsia-Hyponatremia Syndrome in Schizophrenia:

Hyper-and Hyponatremia among Geropsychiatric Inpatients

Postprandial blood pressure changes in geropsychiatric patients