Showing papers in "International Journal of Psychiatry in Medicine in 2004"
TL;DR: The findings in this study confirm the association between religious struggle and emotional distress in these three groups of medical patients and clinicians should be attentive to signs of religious struggle.
Abstract: Objectives:For some people, diagnosis with a serious illness or other adverse life events can precipitate a period of religious struggle. While evidence of the harmful effects of religious struggle...
222 citations
TL;DR: Depressive disorders in primary care attenders are very common in Tarragona and general practitioners should be aware of this fact so that these disorders can be detected and treated correctly.
Abstract: Objective: Depressive disorders are considered to be a public health problem. Primary health care plays an important role in the treatment of such disorders. Our aim is to determine the prevalence and determinant factors of major depression and dysthymia in consecutive primary care attenders. Method: The study took place in medical consultations in 10 Primary Care Centers in Tarragona (Spain). It was designed as a two-phase cross-sectional study.
87 citations
TL;DR: Older adults in the primary care setting may be less willing to accept mental health services than younger adults, which may indicate the need for age-specific educational messages and services targeted to older adults in primary care.
Abstract: Objective:To compare mental health treatment history and preferences in older and younger primary care patients.Method:We surveyed 77 older (60+) and 312 younger adult primary care patients from four outpatient medical clinics about their mental health treatment history and preferences.Results:Older adults were less likely than younger adults to report a history of mental health treatment (29% vs. 51%) or to be currently receiving treatment (11% vs. 23%). They were also less likely to indicate that they currently desire help with emotional problems (25% vs. 50%). Older adults were more likely to hold a belief in self-reliance that could limit their willingness to accept treatment for mental health problems, although they were less likely than younger adults to identify other barriers to treatment. Older adults reported that they were less likely to attend programs in primary care targeting mental health issues (counseling, stress management) than younger adults, although they were as willing as younger ad...
75 citations
TL;DR: Religion may have a protective effect on the physiological effects of stress among women with fibromyalgia, and associations of religiosity and intrinsic religiosity with the diurnal cortisol rhythm are revealed.
Abstract: Objective:Fibromyalgia has been characterized as a basic disorder of endocrine stress responses in which psychological stress has been linked both with etiology and symptom severity. This study investigated associations of religiosity and spirituality with psychological and physiological (endocrine) measures of stress in a sample of women with fibromyalgia.Method:Ninety-one participants provided self-reports of religiosity and spirituality using the Duke University Religion Index (DUREL) and the Index of Core Spiritual Experiences (INSPIRIT). Psychological outcomes were measured with the Perceived Stress Scale (PSS), and diurnal salivary cortisol profiles were measured as an indicator of neuroendocrine regulation.Results:Hierarchal regression analyses controlling for age and medications likely to affect cortisol levels revealed significant associations of nonorganizational religiosity and intrinsic religiosity with the diurnal cortisol rhythm. Patients reporting medium or high religiosity had rhythmic cor...
72 citations
TL;DR: Analysis using proportional hazard models indicated that social isolation was a significant predictor of mortality in patients with stable, symptomatic congestive heart failure, and further research is required to confirm these findings and to illuminate the mechanisms behind the relationships between social isolation and mortality.
Abstract: Congestive heart failure is a major cause of morbidity and mortality within the Western world, and yet psychosocial impact of this disease is under-researched. The aim of this study was to evaluate the possible effects of social relationships (perceived social support and perceived social isolation) on mortality risk in 119 patients with stable, symptomatic congestive heart failure. Fifty-one deaths were registered during the six-year follow-up period, all from cardiac causes. Analysis using proportional hazard models indicated that social isolation was a significant predictor of mortality (relative risk, 1.36; confidence interval, 1.04 to 1.78; p < 0.03), controlling for neuroticism, heart failure severity, functional status, gender, and age. The small sample size was a limitation of the study; therefore, further research is required in order to confirm these findings and to illuminate the mechanisms behind the relationships between social isolation and mortality.
62 citations
TL;DR: Many depressed patients, at any level of seriousness, do not receive appropriate treatment, but these are often the patients who present with the mildest forms of depression and for whom the benefits of detection are far from clear.
Abstract: Objective:Many patients with depression who attend primary care are not detected and are unaware of the benefits of therapeutic intervention. Our aim is to evaluate the recognition and management of depressed patients presenting in primary care in Spain.Methods:This was a two-phase cross-sectional study in primary care centers in Tarragona (Spain). In the first phase, we screened 906 consecutive patients using the Zung's Self-Rating Depression Scale. In the second phase, all 209 patients whose results were positive and 97 patients whose results were negative (1/7 at random) were given the Structured Clinical Interview for DSM-IV Disorders, a series of questionnaires, and the judgment of the physician about the presence of depression was determined. In the 120 patients with major depression and/or dysthymia, predictors of detection and treatment of depression were determined.Results:Seventy-two percent of depressed patients were detected. The detection was associated with educational level, severity of the...
58 citations
TL;DR: Despite a somewhat greater likelihood of discontinuation of BZ therapy among those with potentially problematic use, the largest impact of the TPP was a substantially greater relative reduction in access to BZs among non- problematic users.
Abstract: Objective:Benzodiazepines (BZs) are safe, effective drugs for treating anxiety, sleep, bipolar, and convulsive disorders, but concern is often expressed about their overuse and potential for abuse. We evaluated the effects of physician surveillance through a Triplicate Prescription Program (TPP) on problematic and non-problematic BZ use.Method:This study uses interrupted time series analyses of BZ use in the New York (intervention) and New Jersey (control) Medicaid programs for 12 months before and 24 months after the New York BZ TPP. The regulation required NY physicians to order BZs on triplicate prescription forms with one copy forwarded by pharmacies to a state surveillance unit. Study participants were community-dwelling persons over age 18 continuously enrolled between January 1988 and December 1990 in New York (n = 125,837) or New Jersey Medicaid (n = 139,405).Results:During the baseline year, 20.2% of New York and 19.3% of New Jersey cohort members received at least one BZ prescription. After the ...
58 citations
TL;DR: Depression scales that are responsive to changes in clinical symptoms are important for clinical monitoring and outcomes assessment in longitudinal studies and for use in European Americans, the HSCL-D-13 and 20-item versions have similar responsiveness to change.
Abstract: Objective:Depression scales that are responsive to changes in clinical symptoms are important for clinical monitoring and outcomes assessment in longitudinal studies. We evaluated the psychometric properties and responsiveness to clinical change of the 13- and 20-item versions of the Hopkins Symptom Checklist Depression Scale (HSCL-D).Methods:A secondary data analysis from a large 11-week, multicenter clinical trial, comparing three treatments was performed. Adult patients with minor depression or dysthymia and a score of ≥ 10 on the Hamilton Depression Rating Scale (HDRS) were recruited from primary care clinics. Item-total correlations and Cronbach alphas were computed for HSCL-D-13 and HSCL-D-20. Clinical response at 11 weeks was defined by a Hamilton Depression Rating Scale (HDRS) < 10, clinical remission by a HDRS < 7, and criterion symptom remission by ≤ 1 DSM-III-R criterion symptoms. Standardized effect sizes and Guyatt's responsiveness statistic were determined for the 13- and 20-item HSCL-D.Resu...
56 citations
TL;DR: There appears to be some convergance between findings from studies of the neuropsychology of idiopathic OCD and neuro-imaging of OCD following brain injury.
Abstract: Objective: This article reviews obsessive-compulsive disorder (OCD) following acquired brain injury. OCD type symptomatology without any other cognitive, behavioral, or emotional problems following a brain injury appears to be rare. However, the first onset of obsessions and compulsions following a brain injury has been described, but cognitive impairments can potentially color the presentation. Method: This article reviews obsessive-compulsive disorder (OCD) after brain injury, including traumatic brain injury, cerebrovascular accidents, brain tumors and brain infections. Overlapping symtomatology between OCD and brain injury is discussed. Results: Findings regarding the neuro-imaging of OCD after brain injury are reviewed and integrated with neuropsychological data from studies with idiopathic OCD. Conclusion: There appears to be some convergance between findings from studies of the neuropsychology of idiopathic OCD and neuro-imaging of OCD following brain injury. (Int’l. J. Psychiatry in Medicine 2004;34:363-377)
55 citations
TL;DR: In future clinical studies of dissociation in patients with conversion disorder and chronic pelvic pain more complex models may be needed with less exclusive reliance on historical antecedents such as childhood abuse and more emphasis on recent potentially traumatizing experiences or co-morbid psychiatric disorders.
Abstract: Objective: The purpose of this study was to: a) assess the link between sexual and/or physical abuse and dissociation in conversion disorder and chronic pelvic pain patients; and b) assess whether this effect is independent of level of general psychopathology. Method: This report examines data from four separate samples. Fifty-two patients with chronic pelvic pain, 61 patients with non-epileptic seizures, and two samples of patients (102 and 54) with predominantly motor or sensory types of conversion disorder were studied. Results: Using point-biserial correlations no compelling evidence for a consistent and positive association of sexual and/or physical abuse with dissociation was found. After statistically controlling for level of psychopathology using multiple regression analyses, in most of the cases the association of abuse with dissociation was no longer statistically significant. Only physical abuse predicted level of somatoform dissociation over and above level of psychopathology. Conclusion: In future clinical studies of dissociation in patients with conversion disorder and chronic pelvic pain more complex models may be needed with less exclusive reliance on historical antecedents such as childhood abuse and more emphasis on recent potentially traumatizing experiences or co-morbid psychiatric disorders.
41 citations
TL;DR: The findings suggest that psychiatric disorders are common among young people of Arab origin attending primary care facilities, and that doctors need to be vigilant about this possibility.
Abstract: Objectives:Physical and psychiatric comorbidity is relatively common in general practice but there have been few systematic studies using clinical interviews of children attending the primary care ...
TL;DR: Screening instruments for poststroke depression are culture-specific and even scales well established in other cultures should be tested before being used in clinical practice and research.
Abstract: Objective:To determine which screening instrument is most suitable for detecting depression in Chinese stroke patients.Method:A random sample of 60 Chinese subjects recruited from consecutively admitted patients with first-ever stroke to a rehabilitation facility were assessed using the Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the Geriatric Depression Scale (GDS). Psychiatric diagnoses, which served as a benchmark for the comparison of screening instruments, were made using the SCID-DSM-III-R. Rating instruments were compared with respect to response rate, sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves.Results:The VAMS was not useful in screening for depression in Chinese stroke patients while both the HADS and the GDS demonstrated satisfactory accuracy in detecting depression in Chinese stroke patients.Conclusions:Screening instruments for poststroke depression are culture-specific and e...
TL;DR: It is demonstrated that clozapine may be cautiously continued in selected patients who showed marked psychiatric improvement with clozAPine in the face of liver enzyme elevation, using a case report to discuss the treatment alternatives when liver enzymes reach three times the upper normal limits during the clazapine therapy.
Abstract: Objective:Clozapine-induced hepatotoxicity is not infrequent and usually transient. It mostly causes asymptomatic elevation of liver transaminases. “Elevation in liver enzymes to what extent should preclude further treatment?” or “Is only a dose-reduction sufficient?” are questions yet to be answered. The present article uses a case report to discuss the treatment alternatives when liver enzymes reach three times the upper normal limits during the clozapine therapy.Methods:In the following case report, the authors describe a 27-year-old male patient diagnosed with schizophrenia, resistant to different atypical and typical antipsychotics. Based on the pathological findings of our patient and a review of the literature, the author summarizes the reasons for the liver enzymes increase and treatment alternatives during clozapine treatment.Results:Substantial improvement was achieved with clozapine therapy. Increase in liver enzymes at the beginning of the clozapine treatment was successfully managed with a mu...
TL;DR: All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.
Abstract: Pellagra is caused by nicotinic acid deficiency; it is rarely encountered in developed countries, and it is mainly related to poverty and malnutrition, as well as with chronic alcoholism. We report the case of an alcoholic patient who was diagnosed with pellagra and administered B-complex vitamin tablets that did not contain niacin. A few weeks later, the patient developed nervousness, irritability, insomnia and, consequently, delusional ideas and hallucinations, for which he had to be hospitalized. After his admission, the patient manifested loss of consciousness and myoclonus. All of his symptoms (cutaneous, neurological, and psychiatric) resolved fully with treatment with niacin in combination with other B-complex vitamins. All undiagnosed encephalopathies in alcoholic patients should be treated with multiple vitamin therapy, including nicotinic acid.
TL;DR: The findings suggest that at the time of diagnosis it is not possible to predict who is most likely to benefit from Collaborative Care, and outcomes of treatment should be routinely monitored among depressed patients to ensure optimal response.
Abstract: Objective This article uses data from two studies that have demonstrated the overall effectiveness of Collaborative Care interventions to evaluate factors associated with poor outcomes overall (general prognostic factors) and factors associated with greater or lesser effects of treatment (differential treatment effects). Methods Adult primary care patients initiating antidepressant treatment for major depression were randomized to usual care or to Collaborative Care, a structured depression treatment program that included planned, proactive and coordinated care with a health care team and informed, activated patients (n = 156, mean age = 43, 85% white). Response to treatment was defined as a 50% or greater reduction in depression at four months. Results High neuroticism and a history of recurrent major depression (3+ episodes) or dysthymia predicted poor outcomes in general. While the magnitude of the intervention effects differed, frequently cited predictors of persistence of depression (age, gender, depression severity, medical and psychiatric comorbidity) were not significantly associated with greater or lesser benefit from Collaborative Care (no differential treatment effects). Results demonstrate the robustness of intervention effects across numerous groups at risk for persistence of depression. Conclusions These findings suggest that at the time of diagnosis it is not possible to predict who is most likely to benefit from Collaborative Care. Instead, outcomes of treatment should be routinely monitored among depressed patients to ensure optimal response.
TL;DR: Kallmann's Syndrome and schizophrenia represent a rare clinical association rather than a syndrome with a common pathogenesis, which if present should be confined to the olfactory dysfunction.
Abstract: Objective:Kallmann's Syndrome is a heritable disorder characterized by the association of hypogonadotropic hypogonadism and anosmia or hyposmia. A common pathogenesis for KS and schizophrenia had been proposed based on shared pathologies of these two disorders, although no such clinical associations have ever been reported.Method:We report a 35 year old man with schizophrenia and Kallmann's Syndrome. The patient presented with signs and symptoms of hypogonadism, severe hyposmia and normal endocrine functions of the anterior pituitary. Hyposmia has been attributed to the absence of the olfactory bulbs and tracts and atrophy of the olfactory gyri, but normal olfactory mucosa. The patient presented with paranoid schizophrenia with persecutory delusions, auditory hallucinations, thought disorder, depersonalization, and gradual but marked global deterioration.Results:Psychiatric evaluation revealed an entirely different psychopathological and personality profile between the patient and the six other Kallmann p...
TL;DR: Lay people have a limited knowledge of depression and its treatment, and are less able to recognize symptoms of depression without the help of patient guideline, which prime lay people to better recognize symptoms and their relationship to diagnosis.
Abstract: Objective:To evaluate the effectiveness of a patient guideline for educating the public in the recognition and treatment of depression.Method:Lay subjects were interviewed regarding their knowledge and beliefs about depression through the use of a semi-structured questionnaire. They were asked to “think aloud” while evaluating two clinical scenarios about depression, both with and without the use of a patient guideline. All interviews were audio taped, transcribed, and analyzed for subjects' thought processes and accuracy of responses in the presence and absence of the guideline.Results:Subjects with no prior history of depression identified fewer symptoms of depression listed in the patient guideline than did subjects with a history of depression. In the absence of the guideline, only 50% and 38% of subjects provided accurate diagnosis of depression for the simple and complex problems respectively. In the presence of the guideline, 92% and 83% of subjects provided an accurate diagnosis of depression for ...
TL;DR: Two of the three cases of children and adolescents with cystic fibrosis who were diagnosed with depression and treated with a combination of antidepressant medications and other psychosocial interventions suggest that treatment with antidepressant medications has a positive influence on psychological outcomes.
Abstract: Objective:Cystic fibrosis is an autosomal recessively inherited multi-system disorder of children and adults characterized by the obstruction and infection of airways presenting as a wide variety of symptoms. It has varying degrees of psychological impact on patients and their families, requiring numerous adjustments in their life styles. Newer sophisticated medical treatments of cystic fibrosis has led to an increase in life expectancy; however, the same kind of progress has not been made in the psychological interventions available to treat emotional disturbances.Method:We report three cases of children and adolescents with cystic fibrosis who were diagnosed with depression and treated with a combination of antidepressant medications and other psychosocial interventions.Results and Conclusions:Two of the three cases suggest that treatment with antidepressant medications has a positive influence on psychological outcomes. We further propose clinical studies to test efficacy, safety, and long-term effects...
TL;DR: Adherence to antidepressant treatment was not significantly associated with HbA1c levels among diabetic patients who are antidepressant users, and younger age, use of insulin and oral medications, and female gender were all significant associated withHbA 1c levels over time.
Abstract: Objective: To examine the relationship between adherence to antidepressant medications and HbA 1c levels among patients with diabetes in a managed care setting. Method: The analysis included measures of HbA 1c levels before, during, and after initial antidepressant use among 568 patients with diabetes enrolled in the Harvard Pilgrim Health Care insurance plan from 1991-1995. Adherence was defined as four refills in a six-month period after the first antidepressant prescription. General linear models using SAS PROC MIXED were used to estimate the effects ofcovariates including antidepressant adherence on HbA 1c levels over time, comparing patients who were adherent to antidepressant medications to those patients who were non-adherent to antidepressant medications. Results: Adherence to antidepressant treatment was not significantly associated with HbAic levels among diabetic patients who are antidepressant users. Younger age, use of insulin and oral medications, and female gender were all significantly associated with HbA 1c levels over time. Conclusions: Although we did not observe any association between level of adherence to antidepressant therapy among diabetic patients and levels of glucose control, our results confirm previously established associations between patient characteristics and glycemic control. Further research is needed to disentangle the complex relationship among antidepressant treatment adherence and diabetes outcomes.
TL;DR: Hispanic ethnicity and language were not significantly related to physician-patient communication about depression or patient use of alternative treatments for depression.
Abstract: Objective:To examine the relationship between Hispanic ethnicity and language spoken with physician communication about depression and patient use of alternative treatments for depression.Method:This is a secondary data analysis from a trial of depression screening conducted in four primary care clinics. Patients with Hispanic or non-Hispanic White ethnic backgrounds and those meeting DSM-III-R criteria for current major depression, minor depression, dysthymia as well as those that screened positive on a depression screening instrument (n = 141) are included in this analysis. We labeled those who screened positive for depression but did not meet DSM-IIIR criteria for a current depressive disorder as “distressed.” Clinicians' use of counseling and patient use of alternative treatments were based on patient self-report.Results:Forty-two percent (n = 59) of the sample stated that their physician had either told them that they had depression, treated them for depression, or recommended that they seek help for...
TL;DR: The physicians in the two clinics did not diagnose mental illnesses in their patients, even when written checklists of self-reports were available to them.
Abstract: Objectives: To assess the prevalence of mental disorders in inner city outpatient clinics and to improve the diagnosis of mental illness in primary care. Methods: The Problem Oriented Patient Report (POPR), a patient self-report checklist, was administered to 362 outpatients at two inner-city Buffalo primary care clinics. Patients’ completed POPR checklists were evaluated to identify those with potential mental illness diagnoses and were available for the physicians’ review during the patients’ visits. After the visit, clinical charts were reviewed to determine the frequency of new mental illness diagnoses among continuing and new patients. Results: The screening checklist (POPR) revealed potential mental illnesses in 148/362 outpatients, of which 98% had not been identified by the physicians who had reviewed the patients’ completed POPR forms. Only five new diagnoses of mental illnesses were independently made by clinics’ physicians—all in follow-up (continuing) patients. Conclusions: The physicians in the two clinics did not diagnose mental illnesses in their patients, even when written checklists of
TL;DR: The majority of patients wished to be informed about their illness condition, and no correlation was found between psychiatric morbidity and desire for information.
Abstract: Objective The communication and disclosure of medical information to cancer patients has been an important issue in oncology, reflecting changes in the physicians' approach when dealing with the patients' ethical right to receive information. The aim of this study was to assess the general and specific information desired by cancer patients regarding their health conditions and to evaluate minor psychiatric symptoms. Method Two-hundred and ninety-eight patients were examined at an oncological cancer center in Sao Paulo, Brazil, using a questionnaire designed to investigate patients' preferences about cancer information and evaluate minor psychiatric symptoms. Result Ninety-five percent of the patients were interested in obtaining information on their health condition, with regard to whether they had cancer (95%), the chances of recovery (89%), and the side effects during treatment (94%). Younger patients tended to show more interest in obtaining information than the elderly. The Self-Reporting Questionnaire classified 25.8% of the sample as a probable psychiatric case, but no correlation was found between Self-Reporting Questionnaire scores and patients' desires for medical information. Conclusion The majority of patients wished to be informed about their illness condition, and no correlation was found between psychiatric morbidity and desire for information.
TL;DR: There may be a relationship between fluoxetine-related memory impairment and genetic factors, and this side-effect appears to be specific to fluoxettine treatment.
Abstract: Objective:Fluoxetine, a selective serotonin reuptake inhibitor antidepressant agent, has been implicated in learning and memory. Here, we report four cases from the same family of fluoxetine-related memory-impairment.Results:Memory-impairment resulted after fluoxetine treatment and disappeared after changing to another selective serotonin reuptake inhibitor.Conclusions:There may be a relationship between fluoxetine-related memory impairment and genetic factors, and this side-effect appears to be specific to fluoxetine treatment. Possible mechanisms underlying this effect may be the drug's influence on the central serotonergic system or brain-derived neurotrophic factor.
TL;DR: A unique relationship appears to exist between hypochondriasis and panic disorder that is positively correlated with anxiety symptoms as well and the nature of this relationship and its implications for classification are discussed.
Abstract: Objective:To gain perspective on the relationship between hypochondriasis and panic disorder, we compared the occurrence of hypochondriasis in patients with panic disorder (N = 59) and major depressive disorder (N = 27)Methods:Patients who participated in separate drug treatment trials were assessed at baseline and eight weeks using the Whiteley Index of Hypochondriasis.Results:At baseline, the Whiteley Index score was greater for patients with panic disorder than for those with major depressive disorder. At eight weeks, a statistically significant reduction in the mean hypochondriasis score was observed in panic patients who had improved but not in major depressive patients who had improved. Modest correlations were observed between hypochondriasis and symptoms of panic and major depressive disorder, but in depressed patients, hypochondriasis was positively correlated with anxiety symptoms as well.Conclusion:A unique relationship appears to exist between hypochondriasis and panic disorder. The nature of ...
TL;DR: Both accidental and non-accidental head injury are discussed, and the legal aspects of SBS are addressed, both for the perpetrators and the unfortunate victims.
Abstract: Primary care physicians and psychiatrists should be aware of the incidence, causes, diagnosis, and prognosis of the conditions of Shaking Baby Syndrome (SBS). This article discusses both accidental and non-accidental head injury, and also addresses the legal aspects of SBS. Incidence, potential causes, explanations, prevention, and treatment of the condition, both for the perpetrators and the unfortunate victims, are considered. Of special importance is the fact that SBS is difficult to diagnose with absolute certainty. Hence the identification of a potential perpetrator can be difficult and injustices can occur.
TL;DR: It is considered that a complex interplay of hyperventilation followed by expiratory apnea increased intrathoracic pressure and respiratory spasm, and breath-holding spells can occur beyond childhood.
Abstract: Breath-holding spells (BHS) are commonly seen in childhood However, there are no case reports of BHS occurring in adolescents or young adults We report two young adult cases and discuss the pathogensis, both physically and psychologically BHS occurred for 1-2 minutes after hyperventilation accompanied by cyanosis in both cases Oxygen saturation was markedly decreased Each patient had shown distress and a regressed state psychologically These cyanotic BHS occurred after hyperventilation, and we considered that a complex interplay of hyperventilation followed by expiratory apnea increased intrathoracic pressure and respiratory spasm Breath-holding spells can occur beyond childhood
TL;DR: This case is presented of a 66-year-old non-diabetic, schizophrenic woman with psychogenic polydipsia and normal renal function who developed hyperkalemia secondary to excessive orange juice consumption while an inpatient, demonstrating this previously undescribed medical comorbidity of schizophrenia.
Abstract: Some fruit juices have very high potassium content. However, only several cases of juice-induced hyperkalemia have been reported that involved non-psychiatric, diabetic outpatients with renal compromise. We present a highly unusual case of a 66-year-old non-diabetic, schizophrenic woman with psychogenic polydipsia and normal renal function who developed hyperkalemia secondary to excessive orange juice consumption while an inpatient. In addition to demonstrating this previously undescribed medical comorbidity of schizophrenia, this case highlights the need for careful attention when communicating with both nursing and patients when managing psychogenic polydipsia.
TL;DR: Future research should refine the clinical criteria for FTD using clinicopathological correlation in addition to working on the development of neurobiological markers.
Abstract: The clinical diagnosis of frontotemporal dementia (FTD) can be challenging even to experienced clinicians. In the absence of a definitive clinical test, this diagnosis relies on behavioral criteria. Difficulty applying these criteria arise for four main reasons. First, FTD patients present with social and personality changes that defy the neuropsychological model of dementia. Second, FTD is not a single disorder but a spectrum of clinical syndromes with asymmetric and motor variants. Third, there may be qualitatively different symptoms during stages of FTD. Finally, pathologic and genetic variability contributes to the clinical variability. Future research should refine the clinical criteria for FTD using clinicopathological correlation in addition to working on the development of neurobiological markers.
TL;DR: Depression among patients with substance abuse problems is a common problem and the rates are higher than for other countries and highlight the need for Polish primary care clinicians to routinely screen for depression in patients with Substance use disorders.
Abstract: OBJECTIVE: Depression and co-morbid substance abuse disorders are a major public health problem. Information is limited for patients attending Polish primary care clinics. This article addresses 30-day and lifetime prevalence of major depression in a heavy drinking population from 12 Polish primary care clinics. METHOD: 277 heavy drinkers were interviewed by a researcher in each clinic. Heavy drinking was defined as more than 20 drinks per week for males, or more than 13 drinks per week for females, or consumption of more than four drinks five or more times in the previous 30 days, or two or more positive replies to the CAGE questions. Criteria from the Diagnostic and Statistical Manual were used to assess lifetime and past 30-day depression. RESULTS: 35% of women and men met criteria for depression in the 30 days prior to the interview. Lifetime rates were 45% for women and 52% for men. Men and women with a CAGE score of 4 were at higher risk for both 30-day (67%, OR = 3.85 [1.47, 10.08]) and lifetime (78%, OR = 3.28 [1.12, 9.66]) depression. Recreational drug users and patients reporting symptoms of anti-social personality disorders were at increased risk for lifetime depression. Subjects reporting symptoms of a childhood conduct disorder were at higher risk for 30-day depression. CONCLUSIONS: Depression among patients with substance abuse problems is a common problem. The rates are higher than for other countries and highlight the need for Polish primary care clinicians to routinely screen for depression in patients with substance use disorders. Language: en
TL;DR: A case of factitious disorder in which a female smeared menstrual blood on her face in which her symptoms decreased over two months and did not reoccur three to nine months after treatment is presented.
Abstract: This article presents a case of factitious disorder in which a female smeared menstrual blood on her face. The patient was admitted to our otolaryngology clinic complaining of bleeding from the mouth, nose, ears and eyes. This event reportedly occurred three to four times on a daily basis. She acknowledged nine prior admissions to different specialists over the last two years. Following psychiatric consultation, we diagnosed factitious disorder with predominantly physical signs and symptoms. She was started on Fluoxetine 20 mg/day and supportive interviews were organized. After diagnosis, we observed that her symptoms decreased over two months. The symptoms did not reoccur three to nine months after treatment. This case report outlines two important features. The first is that a case of this type has not been reported before, and the second feature is that this case demonstrates the effect of cultural factors greatly different from those seen in classical factitious disorder.