RESUMEN
The clock-drawing test (CDT) is used widely to evaluate cognitive disorders, but its role in the assessment of psychotic disorders has not been studied. We sought to examine whether the CDT plays a role as an indicator of psychosis and to establish its sensitivity to clinical improvement of psychosis. The CDT was administered twice to 53 hospitalized patients without dementia but with psychosis: once at admission and again before discharge. The CDT scores were calculated in a random order by two independent senior psychiatrists who were blinded to the patients' status (admission or discharge). The inter-rater reliability was high (0.89 at admission, 0.85 at discharge, P<0.01 for both). The severity of psychosis was assessed by the Positive and Negative Syndrome Scale (PANSS). Patients had significantly lower CDT scores at admission than at discharge (2.87±1.39 vs. 3.91±1.08, respectively, P<0.01). The PANSS-total score of the patients showed a significant improvement (84.90±17.77 vs. 69.18±16.23, P<0.01). An inverse correlation was found between CDT performance and psychosis severity, as reflected by the PANSS-positive symptom subscale at admission (R=-0.279, P<0.05). Our findings suggest that the CDT may aid in the assessment of psychotic states and in their clinical monitoring.
Asunto(s)
Pruebas Neuropsicológicas , Trastornos Psicóticos/diagnóstico , Enfermedad Aguda , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Psicometría , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the parasympathetic modulation in elderly inpatients with major depressive disorder (MDD) before and after electroconvulsive therapy (ECT) using both linear and nonlinear methods of heart rate variability (HRV) analysis. METHOD: A measure of local dimensional complexity (pointwise correlation dimension, PD2), as well as spectral analysis measures (LF, low-frequency range; HF, high-frequency range) were calculated for the heart rate time series of 10 elderly inpatients with MDD (70+/-7 years) before and after ECT. Hamilton Depression Rating Scale (HAM-D) was evaluated concomitantly. RESULTS: Only the responders to ECT (n=7; >or=50% reduction in HAM-D) exhibited a significant increase in PD2 (P=.0035), which showed a tendency towards a correlation with symptom improvement (r=.73, P=.06). Spectral analysis measures did not show a significant difference after ECT. CONCLUSION: Elderly patients with MDD, who respond to ECT, might show increased vagal modulation. Since nonlinear HRV measures have been shown to be reduced by aging, similar to cholinergic deficit, they might shed light on the increased risk for cardiac mortality in depression.
Asunto(s)
Trastorno Depresivo Mayor/fisiopatología , Trastorno Depresivo Mayor/terapia , Terapia Electroconvulsiva , Frecuencia Cardíaca/fisiología , Anciano , Anciano de 80 o más Años , Trastorno Depresivo Mayor/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
There is little data on suicide among elderly depressed patients seeking psychiatric help. Recent studies have demonstrated that physical illness may increase this risk. We aimed to assess, retrospectively, the association between suicide and physical illness among depressed elderly psychiatric patients. All medical records of patients admitted during a 10-year period to an acute psychiatric ward, after having attempted suicide, were reviewed. Inclusion criteria were: age>65 years, diagnosis of a depressive disorder and intact cognition. The comparison group consisted of previous or subsequent admissions, closest (by date), of elderly patients, matching the inclusion criteria, but without previous record of attempting suicide, into the same ward. The cumulative illness rating scale (CIRS) score was calculated for each patient. 78 admissions of elderly depressed patients, who had attempted suicide before hospitalization, were examined. The comparison group (n=87) consisted of the subsequent admission of a similar but not suicidal pre-admission patient. The CIRS total score was significantly higher among suicidal patients (10.2 vs. 8.0; p=0.0008). Suicidal patients scored higher in the vascular and the respiratory sections of CIRS. Our results support reported findings of higher rates of illness among suicidal elderly patients. The CIRS may be considered an additional tool in assessing risk for suicide in elderly psychiatric subjects.
Asunto(s)
Costo de Enfermedad , Trastorno Depresivo/psicología , Pacientes Internos/psicología , Intento de Suicidio/psicología , Factores de Edad , Anciano , Trastorno Depresivo/complicaciones , Femenino , Humanos , Masculino , Índice de Severidad de la EnfermedadRESUMEN
Most data imply that dopaminergic transmission is essential for proper hypothalamic-mediated core temperature regulation. Altered central dopaminergic transmission is suggested to be involved in the pathophysiology of schizophrenia. Thus, hypothetically, schizophrenia patients might be at increased risk of developing thermoregulatory dysregulation manifested by alterations in core temperature, as well as in peripheral tissue, the temperature of which has been shown to correlate with core temperature (e.g. cornea). Previous small pilot studies of ours showed that schizophrenia patients may exhibit corneal temperature abnormalities. Hence, we assessed corneal temperature in a controlled sample of drug-free ( n =11) and medicated ( n =28) schizophrenia patients compared to healthy comparison subjects ( n =9), using a FLIR thermal imaging camera. Drug-free schizophrenia patients exhibited significantly higher corneal temperature compared to healthy subjects, typical antipsychotic drug (APD)-treated patients ( n =16) and atypical APD-treated patients ( n =12) (37.08+/-1.46 degrees C vs. 33.37+/-2.51 degrees C, 31.08+/-1.43 degrees C and 31.67+/-0.44 degrees C respectively, p <0.0001; p <0.001 vs. each group separately). The healthy comparison subjects and the atypical APD-treated patients exhibited comparable corneal temperatures and these two groups exhibited higher corneal temperatures compared to the typical APD-treated patients ( p <0.01 and p =0.051 respectively). In conclusion, this study indicates that drug-free schizophrenia patients exhibit substantially higher corneal temperature compared to healthy comparison subjects or medicated patients, and that APDs may decrease corneal temperature either to normal (atypical APD) or to subnormal (typical APD) values. The relevance of these phenomena to the pathophysiology of schizophrenia, the biological mechanism underlying drug-induced corneal temperature alterations, the possible role of temperature-lowering drugs (neuroleptics or non-neuroleptics) on schizophrenic psychosis as well as the role of corneal temperature as a tool to evaluate adherence to APD treatment merit further investigation via larger samples of both medicated and drug-free schizophrenia patients compared to matched controlled subjects.
Asunto(s)
Temperatura Corporal/fisiología , Córnea/fisiopatología , Esquizofrenia/fisiopatología , Adulto , Antipsicóticos/uso terapéutico , Antagonistas Colinérgicos/uso terapéutico , Quimioterapia Combinada , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Esquizofrenia/tratamiento farmacológico , Psicología del EsquizofrénicoRESUMEN
OBJECTIVE: Falls are an everyday risk for the elderly and their etiology is multifactorial. Because there are little data focusing on falls among elderly psychiatric inpatients, we aimed to retrospectively assess the characteristics of inpatients that had sustained a fall during hospitalization. METHODS: Over 4 years, all adverse-event reports of falls were reviewed. Inclusion criteria were age >65 years and intact cognition. The control group consisted of the previous and next admission of an elderly patient to the same ward. Anticholinergic score was calculated for each patient. RESULTS: Of 414 admissions of elderly patients, 34 (8.2%) patients had had a fall. The control group (n = 68) did not differ in mean age, distribution of diagnoses, or use of benzodiazepines, antidepressants, or antipsychotics. Two variables were significantly associated with falls: female gender (68% vs. 39%, p < .05) and anticholinergic burden score (ABS) (mean: 3.7 vs. 2.1, p < .05). CONCLUSIONS: Our results support reported findings of higher rates of falls among elderly women and suggest that ABS may be a risk factor for falls.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Antagonistas Colinérgicos/efectos adversos , Costo de Enfermedad , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Anciano , Femenino , Hospitalización , Humanos , Masculino , Trastornos Mentales/rehabilitación , Estudios Retrospectivos , Factores de RiesgoRESUMEN
This study compared cardiac autonomic modulation in physically healthy patients with major depressive disorder to that in mentally healthy heart transplant recipients and physically and mentally healthy comparison subjects by using a nonlinear measure and a conventional measure of heart rate variability. No significant differences in cardiac autonomic modulation were noted between the depressive group and the transplant recipients, but both of those groups had significantly lower mean values for heart rate variability measures relative to the healthy comparison subjects. The results support the hypothesis that cardiac autonomic imbalance (reduced vagal modulation) to the extent of cardiac neuropathy is present in depression.