Showing papers in "International Journal of Psychiatry in Medicine in 1991"
TL;DR: The need for further research to understand the relationship of poor performance on cognitive tasks to the etiology, maintenance and rehabilitation of pain problems is suggested.
Abstract: To assess the incidence and relationship of cognitive/intellectual impairments to pain problems, seventy-three adults with musculoskeletal pain seen in a PM&R outpatient clinic were screened using the Neurobehavioral Cognitive Status Examination (NCSE). Subjective pain complaints were assessed using portions of the McGill Pain Questionnaire. Patients with prior diagnoses of neurocognitive problems or those who had taken narcotic analgesics in the last 24 hours were excluded. Results showed that 32 percent of subjects had impaired performance in at least one cognitive domain. Individuals with poorer performance on the NCSE had higher levels of reported pain or disability and psychological distress. Possible factors contributing to poor performance on cognitive tasks include psychological disorders or distress, undiagnosed organic brain dysfunction, social/psychological factors such as education, or a combination of these. Results suggest the need for further research to understand the relationship of poor performance on cognitive tasks to the etiology, maintenance and rehabilitation of pain problems.
176 citations
TL;DR: Cognitive depression is an important, early, indicator of grave prognosis in patients treated for end stage renal disease and early recognition of and therapeutic efforts directed toward the treatment of depression might modify outcome in ESRD patients.
Abstract: A role of depression in affecting outcome in patients with end stage renal disease (ESRD) has been suggested but few have assessed psychological parameters and medical factors thought to influence survival simultaneously and prospectively. To assess whether depression or perception of illness influences survival in patients treated for ESRD, we prospectively evaluated fifty-seven patients with ESRD treated with hemodialysis (HD, n = 43) or continuous ambulatory peritoneal dialysis (CAPD, n = 14). Patients were interviewed and completed the Beck Depression Inventory (BDI) and the Illness Effects Questionnaire (IEQ). An ESRD severity coefficient was used to measure chronic illness severity. A cognitive item subset of the BDI (CDI) was used as an additional measure of depression. One and two years later, records were examined to determine survival. When initial results of the assessment of survivors and non-survivors were compared, at one year follow-up, there were no differences in mean age, duration of dia...
174 citations
TL;DR: The results to date indicate that there have been no fetal malformations, no greater frequency of complications during labor and delivery than in the normal population, only short-term withdrawal symptoms in the neonate, and no adverse effects on the breast-fed infants of mothers on TCAs.
Abstract: The management of severe depression during pregnancy and lactation is a serious concern to both physicians and parents, since the use of tricyclic antidepressant drugs (TCAs) has not been proven to be safe. This is a preliminary report of our ongoing studies of four groups of women treated with tricyclic antidepressants before and during pregnancy and/or lactation. The four groups are women who: became pregnant while on TCAs (n = 9); were prescribed TCAs during pregnancy (n = 9); were prescribed TCAs during lactation (n = 20); or were clinically depressed during lactation, but who refused TCAs (n = 5). Our results to date on the very small number of subjects indicate that there have been no fetal malformations, no greater frequency of complications during labor and delivery than in the normal population, only short-term withdrawal symptoms in the neonate, and no adverse effects on the breast-fed infants of mothers on TCAs. However, all of the lactating mothers who refused TCAs had exacerbation of symptoms; two required treatment in hospital, and all five ultimately had to discontinue nursing and commence treatment with TCAs.
98 citations
TL;DR: It is suggested that a significant proportion of patients with local recurrence of breast cancer suffer from major depressive illness, similar to that described by others at mastectomy.
Abstract: Twenty-two individuals who had suffered from local recurrence of breast cancer were interviewed to determine psychosocial morbidity. Psychometric assessment using the Hamilton Anxiety Scale, the Eysenck Personality Questionnaire and the Montgomery Asberg Depression Rating Scale was conducted prior to clinical evaluation including a structured interview, the Composite International Diagnostic Interview. Lifetime and current psychiatric diagnoses were established. Ten (45%) of the recurrence group had current psychiatric illness (anxiety and depression) at the time of local recurrence, a similar prevalence to that described by others at mastectomy. Previous psychiatric illness and trait neuroticism are predictive of vulnerability to psychiatric morbidity at local recurrence. These results suggest that a significant proportion of patients with local recurrence suffer from major depressive illness.
91 citations
TL;DR: To examine the contribution of psychopathology to emergency room (ER) visits for atypical chest pain, two screening measures and the Structured Clinical Interview for DSM III-R (SCID) were administered to thirty-five subjects within seventy-two hours of their ER visit.
Abstract: To examine the contribution of psychopathology to emergency room (ER) visits for atypical chest pain, we administered two screening measures and the Structured Clinical Interview for DSM III-R (SCID) to thirty-five subjects within seventy-two hours of their ER visit. Follow-up SCID interviews were completed in thirty subjects at five to twelve months. Sixty percent of the sample had an initial Axis I diagnosis, predominately affective (34%) and anxiety (46%) disorders. Forty percent had multiple diagnoses initially. The most common diagnoses were panic disorder (31%) and major depression (23%). At follow-up 47 percent had Axis I diagnoses, 30 percent had multiple diagnoses, with only slightly decreases rates for panic disorder (27%) and major depression (17%). Many subjects had lost, gained, or switched diagnoses by follow-up, in spite of one consistent rater and a few subjects seeking treatment. ER physicians often do not recognize these psychiatric disorders in chest pain patients. The high risk of suicide in panic disorder and depression, and the high cost of disability in recurrent chest pain make it essential that ER physicians include these disorders in the differential of atypical chest pain.
55 citations
TL;DR: Couvade is the common but poorly understood phenomenon whereby the expectant father experiences somatic symptoms during the pregnancy for which there is no recognized physiological basis.
Abstract: Couvade is the common but poorly understood phenomenon whereby the expectant father experiences somatic symptoms during the pregnancy for which there is no recognized physiological basis. Symptoms commonly include indigestion, increased or decreased appetite, weight gain, diarrhea or constipation, headache, and toothache. Onset is usually during the third gestational month with a secondary rise in the late third trimester. Symptoms generally resolve with childbirth. Couvade has been seen as an expression of somatized anxiety, pseudo-sibling rivalry, identification with the fetus, ambivalence about fatherhood, a statement of paternity, or parturition envy. It is likely that the dynamics of couvade may vary between individuals and may be multidetermined.
50 citations
TL;DR: This open trial suggests that antidepressants may be effective in the treatment of some women with chronic pelvic pain, however, the frequent association of sexual abuse with this disorder indicates that accepted treatment trial designs may need to be altered.
Abstract: Although antidepressants have been used in the management of several types of chronic pain there have been no systematic trials of these medications in women with chronic pelvic pain. The authors report on the use of nortriptyline in fourteen women with chronic pelvic pain. Seven women dropped out of the study. These seven subjects were significantly different from the treated group only in lower tolerance of antidepressant side effects. Six of the seven treated subjects reported complete or partial relief from pain. Fifty seven percent of the drop-outs and the one nonresponding treated subject had histories of childhood sexual abuse. This open trial suggests that antidepressants may be effective in the treatment of some women with chronic pelvic pain. However, the frequent association of sexual abuse with this disorder indicates that accepted treatment trial designs may need to be altered.
43 citations
TL;DR: There is a lack of recent evidence for an association between WD and organic delusional disorders, but disorders of affect, behavior and personality are the most common features.
Abstract: Psychiatric symptoms are frequently encountered in Wilson's disease (WD). The recent resurgence of interest in neuropsychiatry has led to a more detailed consideration of the psychopathology associated with WD. As suggested by Wilson, disorders of affect, behavior and personality are the most common features. Contrary to Wilson's view, recent evidence suggests that such symptoms have an organic basis. Cognitive impairments tend to be mild and improve with treatment. There is a lack of recent evidence for an association between WD and organic delusional disorders.
41 citations
TL;DR: The prevalence, nature, associations and outcome of psychiatric morbidity among four hundred and fifty severe general medical admissions are described, and affective disorder was diagnosed in 13 percent of men and 17 percent of women.
Abstract: The prevalence, nature, associations and outcome of psychiatric morbidity among four hundred and fifty severe general medical admissions are described. Affective disorder was diagnosed in 13 percent of men and 17 percent of women. It was associated with a history of previous psychiatric disorder and current social problems. Persistent affective disorder after discharge was associated with continuing medical and social problems. Alcohol problems were common in men, especially in those with social problems, and often went unrecognized by medical staff. Cognitive impairment was confined to the elderly and was associated with longer hospital stay and high mortality. Patients with emotional and cognitive disorder make considerable demands on medical, social and psychiatric services during and following admission. The implications for improved recognition and management of psychiatric morbidity in general medical patients are discussed.
38 citations
TL;DR: Depression occurs in up to half of all stroke patients and is most frequently associated with left anterior cortical and subcortical infarctions.
Abstract: Neuropsychiatric disorders following stroke are common, and pathologic involvement of specific regions or functional systems results in behavioral syndromes similar to idiopathic psychiatric syndromes. Depression occurs in up to half of all stroke patients and is most frequently associated with left anterior cortical and subcortical infarctions. Mood changes interfere with cognitive, functional and social recovery. Treatment with heterocyclic antidepressants, stimulants, and electroconvulsive therapy is efficacious in most patients. Mania, delusions, hallucinations, personality alterations, obsessive-compulsive disorder, and changes in sexual behavior are less common but have also been described in post-stroke patients. Each behavioral syndrome is associated with a specific pattern of brain involvement. Investigation of these phenomena contributes to understanding the cerebral basis of psychiatric disorders.
37 citations
TL;DR: A case report of a patient with post stroke depression treated with fluoxetine was associated temporally with frequent short episodes of sexual excitement described by the patient as feeling like an orgasm.
Abstract: The purpose of this article to describe a unique potential side effect of fluoxetine. A case report of a patient with post stroke depression treated with fluoxetine is presented. Fluoxetine was associated temporally with frequent short episodes of sexual excitement described by the patient as feeling like an orgasm. The relationship was dose dependent. Serotonergic medications, like fluoxetine, may induce sexual stimulation as a side effect. The mechanism for this effect is unclear but patients with organic brain disease may be at higher risk for this complication.
TL;DR: It is hoped that this supplemental interview, used in conjunction with the SCID, will be helpful in further studies of the epidemiology, pathogenesis, and treatment of these possible forms of affective spectrum disorder.
Abstract: OBJECTIVE Recent evidence suggests that a number of psychiatric and medical conditions may be members or candidate members of a larger family of conditions, which we have termed "affective spectrum disorder (ASD)." In order to facilitate further research into this concept, we drafted seven interview modules, using the format of the Structured Clinical Interview for DSM-III-R (SCID), designed to diagnose the following psychiatric and medical disorders: irritable bowel syndrome, narcolepsy, Tourette's disorder, migraine, fibromyalgia, chronic fatigue syndrome, and kleptomania. METHOD Published operational diagnostic criteria for these seven disorders were sought in the literature. Questions in SCID format were then drafted in accordance with these operational criteria. Draft modules were then sent to experts familiar with each of the disorders and suggestions and revisions from these experts incorporated into the final modules. RESULTS The complete supplemental interview is presented with this report. Preliminary experience with this interview in more than 100 patients tentatively suggests that it is reliable for diagnosing the disorders in question; however, a formal test-retest reliability assessment is still required. CONCLUSIONS It is hoped that this supplemental interview, used in conjunction with the SCID, will be helpful in further studies of the epidemiology, pathogenesis, and treatment of these possible forms of affective spectrum disorder.
TL;DR: The results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression, and a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of Gynecologic tumors.
Abstract: We examined the utility of patient self-report forms in identifying those gynecologic oncology patients who would be diagnosed by an experienced consultation-liaison psychiatrist as suffering from major depression. Sixty-five women with gynecologic tumors were evaluated by a consultation-liaison psychiatrist, using standardized (DSM-III) criteria. Each patient also completed a Carroll Rating Scale for Depression (CRS). The CRS demonstrated sensitivity and specificity of 87 percent and 58 percent, respectively. Used as a screening instrument to rule out depression, the CRS yielded a negative predictive value of 94 percent. We identified a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of gynecologic tumors, and compared the performance of this non-cancer related symptoms subscale (NCSG) to that of the CRS. The NCSG did not significantly outperform the CRS; its sensitivity and specificity were 87 percent and 62 percent, respectively. Because our study population was relatively homogeneous (i.e., non-ovarian gynecologic oncology patients without severe debilitation who were not receiving chemotherapy, radiation therapy, or other invasive procedures), the findings should not be generalized to other oncologic populations at this time. Our results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression.
TL;DR: Cases of mania associated with acquired immune deficiency syndrome (AIDS) are reviewed in an attempt to elucidate patterns that may be helpful in guiding treatment, determining prognosis, and understanding pathophysiology.
Abstract: Cases of mania associated with acquired immune deficiency syndrome (AIDS) are reviewed in an attempt to elucidate patterns that may be helpful in guiding treatment, determining prognosis, and understanding pathophysiology. Fourteen well-described cases in the English language literature were critically reviewed. Data was collected regarding chronological appearance of signs and symptoms, specific psychiatric symptoms, associated neurologic and cognitive function, objective testing of brain structure and function, and outcome. When mania or hypomania occur in the setting of a human immunodeficiency virus (HIV) infection, it frequently occurs once and does not recur. AIDS-associated manic states are adequately responsive to available anti-manic agents, however, AIDS patients may be more prone to deleterious side effects. Although mania or hypomania may be the presenting complaints that lead to the discovery of human immunodeficiency virus (HIV) seropositive status, mania tends to occur in people exhibiting ...
TL;DR: Findings suggestpanic disorder may be prevalent in older patients with chest pain and no evidence of coronary artery disease and that panic disorder may begin later in life.
Abstract: In the context of administering psychiatric diagnostic interviews to cardiology patients with chest pain and no evidence of coronary artery disease, the authors found twenty-seven patients over the age of sixty-five, nine (33%) of whom fit panic disorder criteria. Their mean age of onset was sixty-two (SD = 23 years). Only two patients reported onset of panic disorder earlier than age sixty-two. All nine were widows while the comparison group of non-panic subjects over age sixty-five included only seven of eighteen (40%) who were widows. These findings suggest panic disorder may be prevalent in older patients with chest pain and no evidence of coronary artery disease and that panic disorder may begin later in life.
TL;DR: Higher levels of neuropsychological functioning were associated with enhanced psychosocial functioning and/or immunological status and the importance of conducting longitudinal studies using a multidimensional approach in which HIV-infected persons and their most significant other family members are evaluated within a biopsychosocial model.
Abstract: This study evaluated twenty-nine symptomatic and asymptomatic HIV-infected homosexual/bisexual men between eighteen and forty-five in the areas of psychiatric/psychosocial, neuropsychological, family, and immunological functioning. The subjects were referred by physicians, nurses, and mental health professionals from the Tulane/Louisiana State University AIDS Clinical Trials Unit and the C-100 outpatient Primary Care Clinic for HIV-infected patients served within the Charity Hospital of Louisiana at New Orleans. All subjects and their significant others were evaluated between November 1987 and October 1988 at the C-100 Clinic. The outcome measures were mood disturbance, psychological distress, and CD4 cell count. The most significant other family member, as selected by each subject, completed family measures. The subjects experienced psychological distress and neuropsychological problems. Active-behavioral coping appeared adaptive (related to enhanced mood) as did perceived social support (related to positive mood and lower psychological distress). Higher levels of neuropsychological functioning (verbal memory, visual memory, motor speed, and visual-motor sequencing) were associated with enhanced psychosocial functioning and/or immunological status. The findings from this study highlight the importance of conducting longitudinal studies using a multidimensional approach in which HIV-infected persons and their most significant other family members are evaluated within a biopsychosocial model.
TL;DR: In this sample, social maladjustment as well as psychiatric symptomatology was significantly greater than in normals and closer to that in psychiatric outpatient norms, and was independent of cycle phase.
Abstract: The NIMH Diagnostic Interview Schedule (n = 43), and the Hopkins Symptom Checklist and Weissman Social Adjustment Scale (n = 35) was administered to assess the prevalence of psychiatric disorders a...
TL;DR: The authors suggest that patients receiving rifampin and nortriptyline, (or other psychotropic drugs) be monitored closely and that similar drug interactions be anticipated.
Abstract: This case illustrates a pharmacokinetic interaction between the tricyclic antidepressant, nortriptyline, and the antituberculosis drug, rifampin. Higher than expected doses of nortriptyline were required to obtain a therapeutic drug level while the patient was receiving rifampin. Following the discontinuation of rifampin, the patient became drowsy and the serum nortriptyline levels rose precipitously into the toxic range. The authors suggest that patients receiving rifampin and nortriptyline, (or other psychotropic drugs) be monitored closely and that similar drug interactions be anticipated.
TL;DR: The findings suggest that postictal psychosis results from increased epileptiform activity and continued cerebral dysrhythmia, has a latency in onset and is not due to the immediatePostictal delirium, and reflects an exacerbation of underlying psychopathological tendencies.
Abstract: Patients with epilepsy have a higher incidence of psychosis. Epilepsy-related psychotic behaviors include a chronic interictal schizophreniform illness, an "alternating psychosis" which remits with seizure activity, and ictal or perictal psychotic behaviors. In addition, there is an uncommon and less understood psychosis characterized by brief psychotic episodes during the postictal period. This report describes two patients with postictal psychosis and correlates their behavior with the pattern of seizures, electroencephalographic discharges, and anticonvulsant and psychotropic medications. The findings suggest that postictal psychosis results from increased epileptiform activity and continued cerebral dysrhythmia, has a latency in onset and is not due to the immediate postictal delirium, and reflects an exacerbation of underlying psychopathological tendencies. This report further discusses the potential pathophysiological mechanisms and management of this disorder. Language: en
TL;DR: Both MFO inducers (barbiturates) and inhibitors (cimeditine, fluoxetine and neuroleptic drugs) are described so that clinicians can enhance the ability to monitor drug interactions of psychotropic agents.
Abstract: The authors review drug biotransformation. Phase I reactions are preconjugation processes that take place through cytochrome P-450—a hepatic mixed function oxidase (MFO) enzyme system with multiple isozymes to metabolize foreign substances. Phase II reactions are conjugation processes of the substrates. Based on the characteristics of the cytochrome P-450 microsomal enzyme systems, the authors explain the clinical phenomena of induction and inhibition of these enzymes when psychotropic agents interact. This article describes both MFO inducers (barbiturates) and inhibitors (cimeditine, fluoxetine and neuroleptic drugs). With this information, clinicians can enhance the ability to monitor drug interactions of psychotropic agents.
TL;DR: The patient became clearly sexually disinhibited while treated with clonazepam, a high potency anti-anxiety benzodiazepine, and her “inappropriate” sexual behavior ceased when the medication was discontinued.
Abstract: We are reporting a case of a woman with a history of drug abuse, alcohol abuse, and sexual promiscuity as a teenager who later on in life had become very religious, sober and sexually abstinent. A few years later, she began having anxiety and panic attacks, typically when in physical proximity to men and sought treatment. The patient became clearly sexually disinhibited while treated with clonazepam, a high potency anti-anxiety benzodiazepine, and her "inappropriate" sexual behavior ceased when the medication was discontinued. Given her history, it is likely that the medication weakened the already fragile defenses by the removal of the "warning signals" represented by her panic attacks. The result was a more direct expression of her sexual drive in the form of strip tease dancing and sexual promiscuity. This case suggests the importance of carefully examining the history of a patient's capacity for regulating sexual drive before prescribing an anti-anxiety drug.
TL;DR: An unusual case of Munchausen's syndrome is described in which a former microbiology technician was suspected of inoculating himself with contaminated material to produce sepsis and ingesting warfarin in the form of rat poison to cause hematuria.
Abstract: An unusual case of Munchausen's syndrome is described in which a former microbiology technician was suspected of inoculating himself with contaminated material to produce sepsis and ingesting warfarin in the form of rat poison to cause hematuria. This combination of factitious disorders has rarely been reported. Other unusual features included a nonemergent presentation through the hospital emergency room and a clinical profile not typical of previously published cases.
TL;DR: The following case highlights the diagnostic and therapeutic dilemmas encountered in a middle-aged patient who presented with dementia and apathetic hyperthyroidism.
Abstract: Apathetic hyperthyroidism was first described in the medical literature by Lahey in 1931. It is a form of hyperthyroidism found principally in the elderly population. In this disorder the usual hyperkinetic presentation of thyrotoxicosis is replaced by apathy and inactivity, often leading to an erroneous psychiatric diagnosis. Although there is a paucity of literature on apathetic hyperthyroidism, it has been described in the elderly and as an extremely rare complication of hyperthyroid disorder in children. It was described only rarely in middle age. The following case highlights the diagnostic and therapeutic dilemmas encountered in a middle-aged patient who presented with dementia and apathetic hyperthyroidism.
TL;DR: The case for an association between NCA and neuroticism independent of the presence or absence of MVP is supported, with no differences as a function of MVP status, nor was there an interaction of MVP and coronary arterial status.
Abstract: Patients with chest pain and normal coronary arteries (NCA) score higher on measures of neuroticism than patients with coronary artery disease (CAD). This relationship, coupled with findings linking mitral valve prolapse (MVP) and anxiety disorders, led us to examine prospectively the possibility that a greater incidence of MVP among NCA patients accounts for their elevated neuroticism scores. One-hundred-forty-four patients completed psychological tests and a structured interview prior to cardiac catheterization. Forty-one of the 144 patients (28%) had normal coronary arteries. Within the NCA group 29 percent had MVP; within the CAD group only 13 percent had MVP. Despite the significant difference between NCA and CAD groups on measures of neuroticism, there were no differences as a function of MVP status, nor was there an interaction of MVP and coronary arterial status. These findings support the case for an association between NCA and neuroticism independent of the presence or absence of MVP.
TL;DR: Physicians should consider the occurrence of psychogenic “HIV infection,” part of the symptomatology may be psychogenically determined, or indeed frankly simulated.
Abstract: The case of a man who falsely represented himself as being HIV positive is reported. In less than one year he was admitted twice with symptoms suggestive of HIV infection. The diagnoses malingering...
TL;DR: Positive correlations were found between six SCL-90R subscales (including DEP and GSI) and cardiac index, refuting the initial hypothesis and suggesting patients with the best cardiac function reported the worst psychological distress and that patientsWith the worst cardiacfunction reported the least psychological distress.
Abstract: Measurements of cardiac function and Symptom Checklist-90R (SCL-90R) data were retrospectively analyzed in two independent groups of cardiac transplant candidates in an effort to identify organic correlates of depressive syndromes. In the first study, no significant inverse correlations were found between depression measures and cardiac index as had been predicted. However, elevated right atrial pressure was associated with increased scores of the SCL-90R depression subscale (DEP) and global symptom index (GSI). A significant positive correlation was also found between the phobia subscale and cardiac index. In a second sample, again, cardiac index did not correlate inversely with DEP or GSI. The phobia-cardiac index correlation was replicated but the right atrial pressure correlations were not. Combining both groups, there were significant correlations between six SCL-90R subscales (including DEP and GSI) and cardiac index. All were positive correlations, refuting the initial hypothesis and suggesting pat...
TL;DR: The neuropsychiatric effects of the major classes of antihypertensive agents (ganglionic blockers, centrally acting agents, diuretics, vasodilators, beta-blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) are reviewed.
Abstract: Algorithms have been developed to guide the treatment of simple hypertension. The basic algorithms are modified in the face of concurrent medical conditions, taking into account the various pharmacological effects of antihypertensive agents. This article reviews the neuropsychiatric effects of the major classes of antihypertensive agents (ganglionic blockers, centrally acting agents, diuretics, vasodilators, beta-blockers, calcium channel blockers and angiotensin converting enzyme inhibitors). The purported efficacy of some antihypertensive agents in the treatment of psychiatric conditions is also discussed. Beneficial as well as adverse neuropsychiatric effects are reviewed. In this way, guidelines for the treatment of hypertension are suggested which take into account a broad spectrum of neuropsychiatric considerations.
TL;DR: Close attention to the identification and treatment of alcohol problems and their complications in this population may reduce the need for physical restraint and shorten length of hospital stay.
Abstract: Behavioral problems resulting in the use of physical restraint is a clinical problem seen in the acute phase of recovery from cerebral contusion. However, little is known about the frequency of physical restraint, factors that might predispose to its use, the pattern of adjunctive psychotropic drugs used or the outcome for patients needing this form of management. In order to examine these issues, a retrospective study of all patients (N = 34) admitted with cerebral contusion to a neurosurgical service over a one-year period was undertaken. Physical restraint was used in twelve patients (35%) for an average length of 4.3 days. The use of physical restraint was associated with presumptive evidence of alcohol abuse or dependence but not with level of consciousness on admission. Restrained patients were frequently prescribed psychotropic drugs during hospitalization. Patients requiring physical restraint stayed in hospital nearly twice as long as those not needing restraint. Close attention to the identification and treatment of alcohol problems and their complications in this population may reduce the need for physical restraint and shorten length of hospital stay.
TL;DR: A male patient with chronic paranoid schizophrenia developed delusions of substitution that were of abrupt onset and short duration that coincided with the detection of diabetes mellitus, which varied with the control of his diabetic status.
Abstract: A male patient with chronic paranoid schizophrenia developed delusions of substitution that were of abrupt onset and short duration. This coincided with the detection of diabetes mellitus. Over the next three years, despite being on continuous moderate dose neuroleptic treatment the re-emergence and resolution of delusions of substitution varied with the control of his diabetic status. A selective review of reports on organic contributors to delusions of substitution is presented. It is suggested that the abruptly appearing, short lasting delusions of substitution may be more likely to have a known organic contributor.
TL;DR: Families were most clearly differentiated using discriminant analysis by social variables; specifically hospital care families had poorer scores than home care families on social contact indices, highlighting the necessity for focusing on the wider social context in efforts at decreasing the incidence of childhood hospitalization.
Abstract: Nonmedical factors are often important considerations when choosing treatment options for illness. High levels of childhood hospitalization are of concern for psychological as well as medical and economic reasons. This study compared medical and psychosocial attributes of children managed at home or in hospital for childhood gastroenteritis to identify factors differentiating type of care. Parents of children under two years with gastroenteritis managed at home (n = 76) or in hospital (n = 76) were interviewed. Medical details and a range of intra-family factors (e.g., parenting skills, marriage) and extra-family factors (e.g., neighborhood, social contacts) were queried. Doctors (n = 6) rated the severity of symptomatology of each case based only on medical details. There was no difference in the medical severity of the gastroenteritis episodes for hospital and home care groups. Instead families were most clearly differentiated using discriminant analysis by social variables; specifically hospital care families had poorer scores than home care families on social contact indices. This highlights the necessity for focusing on the wider social context in efforts at decreasing the incidence of childhood hospitalization.