Advances in the study on brain-gut axis mechanism of common mental disorders and clinical intervention / 四川精神卫生

There are a large number of microbial communities in human intestine， which play an important role in many physiological processes of the body. It has been found that intestinal microorganisms can act on brain diseases through brain-gut axis mechanism. The purpose of this paper is to summarize the mechanism of intestinal microorganisms in schizophrenia， bipolar disorder and depression， and to provide new ideas for the prevention and treatment of psychiatric disorders.

Sobrecarga del cuidador de pacientes con trastornos mentales en la sala de corta estancia del Hospital Psiquiátrico de Paraguay, año 2018 / Caregiver overload of patients with mental disorders in the short-stay ward of the Psychiatric Hospital of Paraguay, year 2018

Introducción: El cuidador es un individuo que tiene la responsabilidad de satisfacer las necesidades físicas y psicológicas del paciente. El término "sobrecarga del cuidador" se utiliza para describir el costo físico, emocional y financiero de proporcionar dicha atención. Objetivos: El objetivo de este estudio fue determinar los niveles de sobrecarga en cuidadores de pacientes con trastornos mentales en la sala de corta estancia del Hospital Psiquiátrico. Materiales y métodos: Estudio cuantitativo, descriptivo, de corte trasversal, donde se aplicó la Escala de Zarit de Sobrecarga del cuidador en cuidadores de pacientes que acuden a la sala de corta estancia del Hospital Psiquiátrico, Asunción, Paraguay, en total 79 participantes. Resultados: El 74,7% de los cuidadores son mujeres y las edades están comprendidas entre los 21 y 85 años. Sobre la situación de convivencia del cuidador se obtiene que el 39,2% está casado y el 25,3% está soltero. El 43% tiene estudios primarios y el 40,5% realiza tareas domésticas. Sobre la frecuencia de cuidado a los familiares los cuidadores refieren que 79,7% lo realizan permanentemente, el 12,7% algunas horas al día, el 6,3% algunas horas a la semana, y el 1,3% algunos días al mes. Teniendo en cuenta la Escala de Zarit y la clasificación por niveles de sobrecarga se obtiene que el 65,8% no tiene sobrecarga, el 15,2% tiene sobrecarga leve y el 19% tiene sobrecarga intensa. Conclusión: La sobrecarga intensa fue del 19% por lo que es fundamental que los Servicios de Psiquiatría del país puedan ofrecer atención psiquiátrica y psicológica a los familiares y cuidadores de pacientes con diagnóstico de algún trastorno mental.

Introduction: The caregiver is an individual who has the responsibility to meet the physical and psychological needs of the patient. The term "caregiver burden" is used to describe the physical, emotional, and financial cost of providing such care. Objectives: The objective of this study was to determine the levels of overload in caregivers of patients with mental disorders in the short-stay ward of the Psychiatric Hospital. Materials and methods: Quantitative, descriptive, cross-sectional study, where the Zarit Scale of Caregiver Overload was applied to caregivers of patients who attend the short-stay ward of the Psychiatric Hospital, Asunción, Paraguay, with a total of 79 participants. Results: 74.7% of the caregivers are women and the ages are between 21 and 85 years. Regarding the situation of coexistence of the caregiver, it is obtained that 39.2% are married and 25.3% are single. 43% have primary studies and 40.5% do housework. Regarding the frequency of caring for family members, caregivers report that 79.7% do it permanently, 12.7% a few hours a day, 6.3% a few hours a week, and 1.3% a few days a week. month. Taking into account the Zarit Scale and the classification by levels of overload, it is obtained that 65.8% have no overload, 15.2% have mild overload and 19% have intense overload. Conclusion: The intense overload was 19%, so it is essential that the Psychiatric Services of the country can offer psychiatric and psychological care to relatives and caregivers of patients diagnosed with a mental disorder.

Open surgery for urethral foreign body / Tratamiento quirúrgico convencional de cuerpo extraño uretral

Abstract The introduction of foreign bodies in the urethra are uncommon. Given its rarity, the approach to this condition is not standardized but it is highlighted that minimally invasive procedures should be prioritized depending on its feasibility. In the present study, we report a case of a 60-year-old male patient with bipolar disorder and a foreign body impacted in the bulbar urethra with open surgical resolution after a failed endoscopic treatment. We perform an analysis into the diagnostic and therapeutic methods used, with postopera tive results.

Resumen La introducción de cuerpos extraños uretrales es poco frecuente, razón por la cual, la mayoría de las publicaciones disponibles en la literatura son reportes de casos aislados o pequeñas series con gran heteroge neidad. Existen distintas aproximaciones frente a esta afección, desde métodos menos invasivos hasta cirugías abiertas más complejas. Presentamos un caso de cuerpo extraño impactado en uretra bulbar con el objetivo de analizar métodos diagnósticos empleados y aproximaciones terapéuticas concluyendo en la resolución quirúrgica convencional. Se evaluaron resultados postoperatorios.

Caracterización clínica, psicológica y sociofamiliar de la conducta suicida en adolescentes chilenos: análisis de correspondencias múltiples / Clinical, psychological, social, and family characterization of suicidal behavior in Chilean adolescents: a multiple correspondence analysis

Introducción El suicidio es la segunda causa de muerte prematura en personas entre 15 y 29 años, y la tercera en jóvenes entre 15 y 19 años. La adolescencia es un periodo crítico, dado que existe mayor vulnerabilidad para conductas suicidas. La situación en América Latina es crítica, siendo Chile uno de los dos países donde las tasas de suicidio de niños y adolescentes aumentan año tras año. En este estudio se analizan factores de riesgo clínicos, psicológicos y sociofamiliares asociados con la conducta suicida, en una muestra clínica de adolescentes atendidos en el sistema de salud público de la región del Maule. Método El diseño del presente estudio es transversal. En él se utilizó una muestra de 388 adolescentes de 10 a 21 años ingresados al sistema de salud de la Región del Maule. Durante la recogida de información se aplicaron cinco instrumentos de medición (escalas de impulsividad de Barrat, de dificultades de regulación emocional, de depresión, ansiedad y estrés, cuestionario general de búsqueda de ayuda para problemas de salud mental en adolescentes y escala de clasificación de gravedad del suicidio de Columbia). Además se recabó información sociofamiliar y antecedentes relevantes desde las fichas clínicas. Resultados El análisis realizado permitió identificar características distintivas de la conducta suicida adolescente, mediante la descripción de factores clínicos, psicológicos y sociofamiliares evaluados. Conclusión Los adolescentes con historial de intentos de suicidio se caracterizan por presentar ideación suicida, sintomatología ansiosa- depresiva, estrés, insomnio e impulsividad. Asimismo, reportan no tener creencias religiosas, pertenecer a minorías sexuales y haber sido víctima de acoso y/o abuso sexual.

Introduction Suicide is the second leading cause of premature death in people between 15 and 29 years old and the third in young people between 15 and 19 years old. Adolescence is a critical period concerning mental health disorders since there is greater vulnerability to suicidal behaviors. The situation in Latin America is worrying, with Chile being one of the two countries where suicide rates of children and adolescents increase yearly. This study aims to analyze clinical, psychological, family, and social risk factors associated with suicidal behavior in a clinical sample of adolescents treated in the public health system of the Maule region. Methods The study design is cross- sectional. We used a sample of 388 adolescents between 10 and 21 years old admitted to the health system of the Maule Region. The participants were evaluated by applying five measuring instruments (The Barrat Impulsivity Scale, The Difficulties in Emotional Regulation Scale, The Depression, Anxiety and Stress Scale, The General Help-Seeking Questionnaire for mental health problems in adolescents, and The Columbia Suicide Severity Rating Scale) in addition to collecting social and family information and relevant clinical history from the medical records. Results The analysis allowed us to identify distinctive characteristics of adolescent suicidal behavior by describing clinical, psychological, and family social factors. Conclusions Adolescents with a history of suicide attempts are characterized by having suicidal ideation, anxious-depressive symptoms, stress, insomnia, and impulsiveness. Likewise, they report being non-religious, belonging to sexual minorities, and victims of sexual harassment and/or abuse.

Insights into the clinical profile and comorbidities of factitious disorder in a multispeciality setting in southwest Nigeria: A cases series and review

Background: Factitious disorder (FD) is an under-recognized and under-diagnosed mental condition. Healthcare professionals often have challenges to diagnose and treating the disorder. As a result, needless and endless medical resources are recommended to assess and evaluate those affected. FD may present as a physical condition, a psychological disorder, or maybe both depending on the prominent symptoms. However, there is a strong correlation between having FD and psychiatric symptoms. Main Text: FD occurs in early adulthood, with a mean age of onset of 25 years in both genders, although with differing demographic features. The lifetime prevalence of FD imposed on oneself in clinical settings is 1.0%, 0.1% in the overall population (ranging between 0.007% and 8.0%) and occurs more in female health care professionals. FD may make up 0.6%­3.0% of psychiatric referrals, and it accounts for 3-5% of doctor-patient contacts. In actuality, 1-2% of hospital admissions and an average of 6-8% of all psychiatric admissions have been underreported. The study aimed to highlight the signs and symptoms of FD identified in a psychiatry department of a multispecialty center and to increase the awareness of health practitioners. A critical review of the literature was done with an emphasis on psychological symptoms. PubMed, Mendeley, and Google Scholar were thoroughly searched and full-text publications of journals from 2010-2021 were included. Conclusion: FD is a diagnostic puzzle that necessitates adequate, prompt medical attention as well as social support because of the potentially fatal consequence. A stronger patient-therapist relationship can strengthen the patient's conscious self-control to minimize the symptoms; therefore the healthcare provider has to be openminded. For the diagnostic enigma to be removed and for ease of treatment, additional research, increasing awareness among medical professionals and the general public, accurate evaluation, diagnosis, and psychotherapy should be encouraged. These case studies will contribute to the knowledge base of FD and improve the quality of care.

Instituições residenciais brasileiras para idosos e condições psicológicas e cognitivas de residentes / Brazilian long-term care institutions and psychological and cognitive conditions of residents / Los hogares para ancianos en brasil y las condiciones psicológicas y cognitivas de sus residentes

O aumento da população idosa no Brasil tem feito crescer a demanda por cuidados de longa duração oferecidos por instituições de longa permanência para idosos (Ilpi). A literatura apresenta caracterizações de Ilpi em cidades ou regiões específicas, mas uma visão geral dessas instituições e de seus residentes, especialmente em termos de características psicológicas e cognitivas, pode ajudar psicólogos a compreenderem as necessidades desses idosos e a planejar intervenções. O objetivo desta revisão integrativa é caracterizar Ilpi brasileiras, em termos de condições de funcionamento e de oferta de serviços, bem como de funções psicológicas e cognitivas de seus residentes, com fundamentação na literatura científica. Por meio de buscas nas bases SciELO, PePSIC e Periódicos Capes, foram selecionados nove artigos que caracterizam Ilpi brasileiras e 19 estudos que qualificam as condições psicológicas e cognitivas de residentes. Os artigos caracterizam 41 Ilpi de quatro do país. A maioria dessas instituições eram filantrópicas e recebiam idosos de ambos os sexos (majoritariamente mulheres), com preferência a pessoas independentes para atividades de vida diária. Os ambientes físicos eram compatíveis com a legislação, mas as rotinas eram rígidas e havia pouca oferta de atividades de lazer, o que contribuía para a baixa autonomia dos residentes. Constataram-se quadros reduzidos de funcionários, majoritariamente profissionais de saúde e cuidadores. A depressão foi a condição mais estudada, com prevalência média de 50% em residentes. A prevalência de declínio cognitivo variou entre 45% e 86%. Discute-se a necessidade de profissionais preparados para o trabalho junto a essa população, especialmente psicólogos capazes de intervir sobre o sofrimento psíquico de residentes.(AU)

The growth in Brazil's older population has increased the demand for long-term care provided by long-term care institutions (ILPI) for older adults. Although studies have characterized these institutions and their residents in specific cities or regions, a more general analysis, including psychological and cognitive characteristics, can help psychologists understand the needs of this population and plan interventions. This integrative literature review sought to characterize Brazilian ILPI regarding environmental conditions and service provision, as well as the psychological and cognitive functions of residents. Based on a literature search conducted in the SciELO, PePSIC and Capes databases, we selected nine papers characterizing Brazilian ILPI and 19 studies characterizing the psychological and cognitive conditions of residents. The selected papers analyzed 41 ILPI from four Brazilian regions. Most were philanthropic and received older adults of both genders (mostly women), preferably those independent for performing daily activities. Despite presenting a physical environment compatible with the legislation, all ILPIs had rigid routines and little time for leisure activities, contributing to the residents' low autonomy, and had reduced staff - mostly health professionals and caregivers. Depression had an average prevalence of 50%, while the prevalence of cognitive decline ranged from 45% to 86%. We need professionals prepared to work with this population, especially psychologists capable of intervening on the resident's psychological suffering.(AU)

El aumento de la población adulta mayor en Brasil ha ocasionado una mayor demanda de cuidados que ofrecen los hogares para ancianos (HA). La literatura presenta caracterizaciones de HA en ciudades o regiones específicas, y la visión general de estos establecimientos y sus residentes, especialmente de sus características psicológicas y cognitivas, pueden ayudar a los psicólogos a comprender las necesidades de esta población y a planear intervenciones. Esta revisión integrativa pretende evaluar los HA en Brasil en cuanto a condiciones de funcionalidad y a oferta de servicios, así como la salud psicológica y cognitivas de los residentes. A partir de la búsqueda de los datos en las bases SciELO, PePSIC y Periódicos Capes, se han seleccionado nueve artículos que evaluaban los HA brasileños y 19 estudios que caracterizaban las condiciones psicológicas y cognitivas de los residentes. Los artículos analizaron 41 HA de cuatro regiones del país. La mayoría de estos establecimientos era filantrópica y atendía a los adultos mayores de ambos sexos (la mayoría mujeres), con el requisito de que estuviesen aptos para realizar las actividades diarias. El ambiente físico estaba compatible con la legislación, pero las rutinas eran rígidas y había poca oferta de las actividades de ocio, lo que les aportaba a los residentes muy poca autonomía. Se contaba con un reducido número de trabajadores cuya mayoría era profesionales de la salud y cuidadores. La depresión fue la enfermedad más estudiada, con una prevalencia media del 50%. La prevalencia de disminución cognitiva osciló entre el 45% y el 86%. Esto evidencia la necesidad de capacitar a los profesionales para el trabajo con las personas mayores, en especial los psicólogos capaces de intervenir en el sufrimiento psíquico de los residentes.(AU)

Set-Up Madness: A Review

@#Psychosis can be defined as a mental disorder in which a person’s thoughts, affective response, ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired to grossly interfere with his or her capacity to deal with reality. The classical characteristics of psychosis are impaired reality testing, hallucinations, delusions, and illusions. While factitious disorder and malingering are usually acknowledged as contrived psychiatric conditions for acquisition of interior or exterior profits, respectively, another alternative, also, exists that though is not manufactured individually, is enforced peripherally. Such cases, which are usually referred by the judge’s ruling, for evaluation and treatment, are more important than comparable simulated or genuine mental conditions, because incorrect diagnosis, or careless, cagily, and guarded validation of preliminary diagnosis that has been issued in the authorized or emergency department, can seriously endanger the individual’s civil rights, while it should not be overlooked that incorrect diagnosis is a kind of malpractice that may harm an individual awfully. In the present article the clinical picture of the said situation, in addition to some case histories, and recommendable hints for differential diagnosis between different types of psychoses, has been discussed.

Regulação molecular do ritmo circadiano e transtornos psiquiátricos: uma revisão sistemática / Molecular regulation of circadian rhythm and psychiatric disorders: a systematic review

RESUMO Objetivo O artigo possui como objetivo investigar os genes relógio que estão mais associados com os transtornos psiquiátricos, as funções e localizações desses genes, assim como investigar o principal transtorno, método e modelo considerados nas análises. O trabalho busca resumir os achados e discutir o impacto dessas pesquisas no conhecimento científico. Métodos Esta revisão utilizou-se de uma metodologia sistemática (Prospero; ID 152031) e seguiu as diretrizes PRISMA. A busca dos estudos foi realizada nas bases de dados PubMed/MEDLINE e Scientific Eletronic Library Online e foram utilizados os termos do Medical Subject Headings Terms . Foram selecionados estudos quantitativos com resultados conclusivos referentes à associação de transtornos psiquiátricos com a regulação molecular do ritmo circadiano. As informações úteis foram extraídas e utilizadas para a elaboração de gráficos e tabelas. Resultados Foram incluídos 24 artigos em nosso estudo. Observou-se que o transtorno bipolar consistiu no transtorno psiquiátrico mais abordado (40% dos estudos); a nacionalidade polonesa dos participantes também se destacou em 39% dos trabalhos. Adicionalmente, o gene PER foi o mais estudado (25%) e o córtex cerebral foi a principal região em que os genes relógio avaliados se expressam (34%). A PCR comum mostrou ser o método mais utilizado (38%) e o metabolismo da serotonina mostrou ser a principal função desempenhada pelos produtos gênicos (16%). Conclusões Em conjunto, os resultados sugerem que o transtorno bipolar consiste no distúrbio psiquiátrico mais prevalente entre as pesquisas relacionadas aos genes circadianos, expressos principalmente no córtex cerebral de humanos, em especial o gene PER .

ABSTRACT Objective The article aims to investigate the clock genes that are most associated with psychiatric disorders, the functions, and locations of these genes, as well as to investigate the main disorder, method and model in the analyzes. The paper seeks to summarize the findings and discuss the impact of this research on scientific knowledge. Methods This review used a systematic methodology (Prospero; ID 152031) and followed the PRISMA guidelines. The studies were searched in the PubMed/MEDLINE and Scientific Electronic Library Online databases and the terms of the Medical Subject Headings Terms were used. Quantitative studies with conclusive results regarding the association of psychiatric disorders with the molecular regulation of circadian rhythm were selected. The useful information was extracted and used for the elaboration of graphs and tables. Results We included 24 articles in our study. Bipolar disorder was the most commonly addressed psychiatric disorder (40% of studies); The participants' Polish nationality also stood out in 39% of the works. Additionally, the PER gene was the most studied (25%) and the cerebral cortex was the main region in which the evaluated clock genes express themselves (34%). Finally, common PCR was the most used method (38%) and serotonin metabolism was the main function performed by gene products (16%). Conclusions Taken together, the results suggest that bipolar disorder is the most prevalent psychiatric disorder among research related to circadian genes, expressed mainly in the cerebral cortex of humans, especially the PER gene.

Prevalence of Intestinal Parasitosis among Mentally Ill Persons in Neuropsychiatric Hospital, Calabar, Nigeria

Aim:The prevalence of intestinal parasitosis in relation to mental illness among inpatients of Federal Neuropsychiatric Hospital, Calabar was investigated with a view to improving the quality of their medical care. Study Design: This was cross sectional study. Ethical approval and patients’ informed consent were sought and obtained before collection and processing of samples.Place and Duration of Study: Federal Neuropsychiatric Hospital, Calabar, between February and August, 2016.Methodology: We included 246 (126 patients, 120 apparently healthy) subjects. Intestinal parasites were detected by direct stool microscopy and formol ether concentration technique and the cellophane anal swab method for Enterobius vermicularis.Chi square analysis was used to compare percentages.Results: The prevalence of intestinal parasitosis among the 126 studied patients was 49.2% compared to 11.7% recorded among the 120 apparently healthy (control) subjects examined (P < 0.0001). There was no significant association between intestinal parasites prevalence and gender in test as well as control subjects 60.0% v. 45.1%, respectively, p = 0.2022) and 14.3% v. 8.8%, respectively, P = 0.3113). Subjects with chronic mental cases insignificantly harbored more intestinal parasites than those with acute cases (53.8% v. 47.1%, respectively; P = 0.5699). Parasites detected in the study were Hookworm 34.6%, Entamoeba histolytica/dispar25%, Ascaris lumbricoides17.3%, Trichuris trichiura9.6%, Enterobius vermicularis5.8%, Giardia intestinalis3.8%, Taenia species and Schistosoma mansoni1.9% each. Hookworm ranked highest 34.6% among the parasites encountered in the test subjects while Ascaris lumbricoides33.3% took the lead in the control group. People diagnosed with Variance Psychosis disorder recorded highest infection rate (68.4%) while those with substance abuse had the least (28.0%). Conclusion: Intestinal parasitosis may possibly play aetiologic or enhancement role in mental ill health. For effective management of the mental challenge, periodic parasitic investigations and appropriate therapy before and after admittance should be effected in all psychiatric institutions

Depression among tuberculosis patients attending a DOTS centre in a rural area of Delhi: A cross-sectional study

Background: Studies have shown that the prevalence of psychiatric disorders, particularly depression, is high among tuberculosis (TB) patients, and may adversely affect treatment compliance. A person suffering from TB can develop depression in due course of time owing to a number of factors, namely the long duration of treatment for TB, stigmatization faced by the patient due to the disease and lack of family support to name a few. Objectives: The present study aimed to determine the prevalence of depression and its correlates among TB patients enrolled at a Directly Observed Treatment Short-course (DOTS) center in a rural area of Delhi. Methods: The study was a DOTS center-based, cross-sectional study, among 106 patients of pulmonary and extrapulmonary TB, above 18 years of age. An interviewer-administered questionnaire in Hindi was used to collect basic sociodemographic data and the Patient Health Questionnaire (PHQ)-9 was used for detecting depression. Those with a score of 10 or more were considered to be suffering from depression. Data analysis was done using SPSS licensed version 20. Chi-square was used to test for association between qualitative variables, and a P < 0.05 was considered statistically significant. Results: A total of 106 patients participated in the study, of which 61 (57.5%) were males. The median age was 30 years (inter-quartile range 24� years). Depression was found to be present in 25 (23.6%) participants. A higher proportion of patients with depression were unemployed currently, and also belonged to middle or lower class (P < 0.05). Depression was not found to be associated with religion, gender, marital status, HIV status, presence of diabetes, DOTS category nor with the phase of treatment. Conclusion: Depression among TB patients is common, affecting almost one in four TB patients. Physicians and DOTS providers should have a high index of suspicion for depression when assessing TB patients.

Prevalence of Neoplasms among Former Adolescent Psychiatric Inpatients

OBJECTIVE: To examine the association between psychiatric disorders and neoplasms. METHODS: A follow-up study of a population-based cohort of patients admitted for psychiatric care between the ages 13–17 years. The cases were patients with a follow-up diagnosis of neoplasm. The K-SADS-PL interview was used to assess DSM-IV based psychiatric diagnoses at adolescence. The treatment episodes due to neoplasms and related psychiatric disorders were extracted from the National Health Care Registers. RESULTS: Of the original cohort, 6.3% of subjects had a neoplasm diagnosis. Male cases were characterized as taking snuff and females as having a fear of becoming obese. 75% of cases had smoked regularly and 47% suffered from substance misuse disorder already in adolescence. At a mean age of 22 years, the diagnoses of skin or soft tissue neoplasms were prevailing, three being malignant neoplasms of the skin, mouth or colon. Non-psychotic disorders were comorbid both two years before (26%) and after (33%) the neoplasm diagnosis. CONCLUSION: Focus on psychiatric symptoms of patients with neoplasms may enhance their treatment outcome and quality of life.

Burden of Psychiatric Disorders among Pediatric and Young Adults with Inflammatory Bowel Disease: A Population-Based Analysis / 대한소아소화기영양학회지

PURPOSE: There is increasing prevalence of psychiatric disorders among inflammatory bowel Disease (IBD) population. Further, presence of psychiatric disorders has been shown as an independent predictor of quality of life among patients with IBD. We intended to explore the prevalence of various psychiatric disorders among pediatric and young adult population with IBD as a population-based analysis. METHODS: We did a retrospective case control analysis using a deidentified cloud-based database including health care data across 26 health care networks comprising of more than 360 hospitals across USA. Data collected across different hospitals were classified and stored according to Systematized Nomenclature of Medicine-Clinical Terms. We preidentified 10 psychiatric disorders and the queried the database for the presence of at least one of the ten psychiatric disorders among IBD patients between 5 and 24 years of age and compared with controls. RESULTS: Total of 11,316,450 patients in the age group between 5 and 24 years and the number of patients with a diagnosis of IBD, Crohn's disease or ulcerative colitis were 58,020. The prevalence of psychiatric disorders was 21.6% among IBD mainly comprising of depression and anxiety disorder. Multiple logistic regression analysis showed, IBD is 5 times more likely associated with psychiatric disorders than controls, p<0.001). We showed a steady increasing trend in the incidence of psychiatric disorders among IBD patients (2% in 2006 to 15% in 2017). CONCLUSION: Largest population-based analysis demonstrated an increased prevalence of psychiatric disorders among IBD patients. Our study emphasizes the need for psychological and mental health services to be incorporated as a part of the routine IBD clinic.

The Effectiveness on Prevention of Rehospitalization with Long-Term Psychosocial Interventions for Patients with Major Psychiatric Disorders / 대한정신분열병학회지

OBJECTIVES: This study aimed to elucidate the effectiveness of long-term psychosocial intervention in reducing the disabling period of patients with major psychiatric disorders by their rehospitalization rate. METHODS: Of the 210 patients with major psychiatric disorders received psychosocial interventions in a Mental Health and Welfare Center, 192 patients (147 with schizophrenia spectrum disorders, 45 with mood disorders) who received interventions more than 6 months were selected. Review of case management records was conducted to obtain information. RESULTS: The number and length of hospitalization and the hospital days per year significantly decreased after psychosocial intervention. Additional analysis of 102 patients followed up for more than 5 years suggested that the effectiveness of the intervention persisted for a sufficient period. However, no significant difference was observed in the number of rehospitalization in 45 patients with mood disorders, though the length of hospitalization significantly decreased. In addition, the hospital days per year of 21 patients with mood disorder followed up for more than 5 years also showed no significant decrease. CONCLUSION: Long-term psychosocial intervention had a significant effect on reducing the number and length of hospitalization for patients with major psychiatric disorder and the effectiveness maintained for more than 5 years.

To Find Out Psychiatric Morbidity in Dermatological Outpatient

Background: Psychiatric problems  in skin outpatient department are very common. This study evaluates various psychiatric manifestation in skin out patients and its impact on day to day living of patients. About 40% of skin out door patients had a minor psychiatric problem e.g. Depression, Anxiety, Adjustment disorder etc. Patients with psychiatric problems were more psychosocial problems like less socialization, avoidance, job and marital problems etc. Methods: This study was conducted at dermatology outpatient department at civil hospital Ahmadabad. 200 consecutive dermatology out patients above age 15 were studied. All patients were requested to fill in general health questionnaire Guajarati version. Patient has to tick mark one out of the four alternative response. Those who could not read, interviewer read out the questionnaire and recorded the patient’s responses. Results: Sleep disturbance was present in 83% of patients. More than quarter of patients reported marital problem after onset of skin lesion. Avoiding people, stopped going out, more time in grooming and stopped hobbies were less common. Work loss and job impairment were present in 16% and 8.5% patients respectively. Conclusion: Out of 200 dermatology out patients 81 (40.5%) had psychiatric morbidity on clinical interview. Adjustment disorder, depression, anxiety disorders were most common diagnosis. Psychotic disorders were found was found in 3 patients.  Patients with psychiatric morbidity were older than patients without psychiatric morbidity.

Approach to the patient with Klinefelter syndrome combined with neuropsychological abnormality / 中华内分泌代谢杂志

Klinefelter syndrome(KS) is the most common sex chromosome disorder in males,which is caused by the presence of the extra X chromosome that maybe inherited from mother or father. Approximately 80% karyotype of the cases is 47,XXY. KS is characterized by small firm testes, hypergonadotropic hypogonadism, infertility,gynaecomastia, increased height. However, cognitive disabilities and psychiatric disorders are rarely diagnosed in KS because they lack screening in related aspects. At the present, the pathogenesis of cognitive disabilities and increased risk of psychiatric diseases in KS have not been delineated. In this article,we report two cases of KS,and review their clinical manifestations,diagnosis,and treatments.

Psychosocial Factors Influence the Functional Gastrointestinal Disorder among Psychiatric Patients / 정신신체의학

OBJECTIVES: This study aimed to investigate the psychosocial characteristics of functional gastrointestinal disorder (FGID) in patients with psychiatric disorders. METHODS: This study was conducted with 144 outpatients visiting the psychiatric clinic at a university hospital. FGIDs were screened according to the Rome III questionnaire-Korean version. Demographic factors were investigated, and psychosocial factors were evaluated using the Hospital Anxiety Depression Scale, Patient Health Questionnaire-15, Childhood Trauma Questionnaire-Korean, and State-Trait Anger Expression Inventory. Chi-squared test and student's t-test were used as statistical analysis methods. RESULTS: There were differences in education level between two groups divided according to FGID status (χ²=10.139, p=0.017). Comparing the psychiatric disorder by FGID group, irritable bowel syndrome (IBS) group showed significant differences (χ²=11.408, p=0.022). According to FGID status, IBS group showed significant differences for anxiety (t=−3.106, p=0.002), depressive symptom (t=−2.105, p=0.037), somatic symptom (t=−3.565, p < 0.001), trait anger (t=−3.683, p < 0.001), anger-in (t=−2.463, p=0.015), and anger-out (t=− 2.355, p=0.020). Functional dyspepsia group showed significant differences for anxiety (t=−4.893, p < 0.001), depressive symptom (t=−3.459, p < 0.001), somatic symptom (t=−7.906, p < 0.001), trait-anger (t=−4.148, p < 0.001), state-anger (t=−2.181, p=0.031), anger-in (t=−2.684, p=0.008), and anger-out (t=−3.005, p=0.003). Nonerosive reflux disease group showed significant differences for anxiety (t=−4.286, p < 0.001), depressive symptom (t=−3.402, p < 0.001), somatic symptom (t=−7.162, p < 0.001), trait anger (t=−2.994, p=0.003), state anger (t=−2.259, p=0.025), anger-in (t=−2.772, p=0.006), and anger-out (t=−2.958, p=0.004). CONCLUSIONS: Patients with psychiatric disorders had a high prevalence of FGID, and various psychosocial factors contributed to such differences. Therefore, the psychiatric approach can offer better understandings and treatments to patients with FGID.

Effects of Tianeptine on Adult Rats Following Prenatal Stress

OBJECTIVE: Exposing a pregnant female to stress during the critical period of embryonic fetal brain development increases the risk of psychiatric disorders in the offspring. The objective of this study was to investigate the effect of antidepressant tianeptine on prenatally stressed (PNS) rats. METHODS: In this study, a repeated variable stress paradigm was applied to pregnant rats during the last week of gestation. To investigate the effects of antidepressant tianeptine on PNS rats, behavioral and protein expression analyses were performed. Forced swim test, open field test, and social interaction test were performed to determine changes in PNS rats compared to non-stressed offspring. Haloperidol was used as a positive control as an antipsychotic drug based on previous studies. RESULTS: Behavioral changes were restored after treatment with tianeptine or haloperidol. Western blot and immunohistochemical analyses of the prefrontal cortex revealed downregulation of several neurodevelopmental proteins in PNS rats. After treatment with tianeptine or haloperidol, their expression levels were increased. CONCLUSION: Downregulation of several proteins in PNS rats might have caused subsequent behavioral changes in PNS rats. After tianeptine or haloperidol treatment, behavioral changes in PNS rats were restored. Therefore, tianeptine might decrease incidence of prenatal stress related-psychiatric disorders such as depression and schizophrenia.

Comparison of MRI and CT Findings in Evaluation of Head Injury: A Prospective Observational Study

Head trauma can have immediate transient symptoms, or lead to chronic signs and symptoms. The apparent seriousness of head injury can be misleading. Minor trauma can result in serious problems. In treating traumatic brain injury, viewing images of the brain, particularly injured areas, is crucial for planning treatment. Images of the brain may be obtained through computed tomography (CT) or MRI. These techniques permit imaging of the brain for both diagnosis of injury and choosing therapeutic interventions. Method Fifty patients presented with head injury referred for CT scan and MRI of all the age group were included in the study. Nonenhanced CT scan of brain was performed on a dual slice (multislice) high speed GE machine. A slice thickness of 5 mm was used in all studies. MRI scan of brain was performed on a general electrical permanent 0.2 TESLA Signa Profile-i SR42 machine. Results Most of the patients (52%) were between the age group of 19 and 49 years. Subarachnoid haemorrhage, cranial fractures, cerebral contusion, and diffuse axonal injury were common head injuries. Subdural hematoma was seeen in all cases in FLAIR sequences. Sensitivity of T2WI was less as compared to T1WI and FLAIR sequences. FLAIR is more sensitive than CT in detecting subdural hematoma. FLAIR sequence picked up all subarachnoid haemorrhage cases followed by GRE and T1WI. T2 is not a routine sequence in detecting subarachnoid haemorrhage. MR (FLAIR) is more useful than CT in detecting subarachnoid haemorrhage. Temporal lobe was common site for contusions followed by frontal, parietal, and occipital lobe. Grey-white matter junction was the most common site followed by corpus callosum. MRI is more sensitive than CT in detecting nonhaemorrhagic contusions. FLAIR, T2WI are more sensitive than T1WI and CT in detecting nonhaemorrhagic contusions. Posterior cerebral artery territory infarcts were common. Encephalomalacia and gliosis are more common in frontal lobe followed by temporal lobe. Conclusion FLAIR sequence picked up subarachnoid haemorrhage in all cases followed by GRE and T1WI. MRI was more sensitive in detecting contusions than CT. Grey-white matter junction was the most common site of diffuse axonal injury followed by corpus callosum. Nonhaemorrhagic DAI were common. MRI is more sensitive than CT in detecting haemorrhagic and nonhaemorrhagic DAI. FLAIR, T2WI are more sensitive than T1WI and CT in detecting nonhaemorrhagic contusions. GRE and FLAIR are more sensitive than T1WI and CT in detecting brainstem injuries.

Behavioral Variant Frontotemporal Dementia Phenocopy Syndrome / 정신신체의학

OBJECTIVES: The aim of this study was to draw attention toward so called ‘behavioral variant frontotemporal dementia(bvFTD) phenocopy syndrome’, which is difficult to discriminate with the primary psychiatric disorders, showing poor response to conventional therapeutic drugs, leading to higher risk to misdiagnoses and legal problems. Furthermore, the author insisted that our interest and study on them must be continued. METHODS: English articles published during 2000 thru 2016 had been searched by internet with the combination of words such as ‘frontotemporal’, ‘phenocopy’ and ‘behavioral’, and reviewed. Besides, two clinical vignettes were described. RESULTS: Precise diagnosis is important because patients' behavioral symptoms can influence on their families and community. However, disease-modifying treatment for bvFTD are not developed until now, and recent therapeutic drugs are only good for specific symptoms, while deterioration progresses in spite of proper psychiatric management. The possible bvFTD patients are not progressed into probable bvFTD clinically, showing no decline of cogntive and social function, no decrease of activity function, longer survival time, and normal neuroimaging for several years. CONCLUSIONS: Rather than expected, there are much more patients having clinical symptoms, course and diagnostic findings including neuroimaging, which are atypical to classical frontotemporal dementia and primary psychiatric disorders. If our knowledge and discriminating ability is improved, discovery rate of that cases will be increased. However, the identity of these atypical features are not clarified until now, it must be further actively investigated.

Riesgo de suicidio posterior a una cirugía bariátrica / Risk of subsequent suicide to bariatric surgery

Con el aumento de la población con obesidad y la poca efectividad del tratamiento médico y los cambios de estilos de vida, la cirugía bariátrica ha surgido como la intervención más efectiva para la pérdida de peso.Recientemente se han obtenido resultados que relacionan positivamente el aumento de riesgo de auto daño y riesgo de suicidio en pacientes posterior a una cirugía bariátrica. Este aumento del riesgo puede ser causado por trastornos psiquiátricos presentes previo a la cirugía relacionados con la obesidad, exacerbados por el estrés que representa el compromiso sobre cambios en la dieta, estilos de vida y los resultados quirúrgicos. Además existen cambios neurohormonales y farmacocinéticos que ocurren posterior a la intervención que podrían hacer más susceptible al paciente a trastornos del estado de ánimo e intoxicaciones. Dado que la mayoría de los pacientes sometidos a una cirugía bariátrica que presentan lesiones por autodaño tienen algún diagnóstico psiquiátrico previo a la cirugía se hace necesario una valoración adecuada para el diagnóstico prequirúrgico y seguimiento posterior cercano.

Obesity is a cronic disease which has increased in the last decades, and with it, new treatments for weigth loss like the bariatric surgery. There is evidence of increase risk of self-harm and suicide in patients with bariatric surgery, which draws attention to the diagnosis of psychiatric pathology in this patients.