Knowledge and Attitude Towards Pharmacological Management of Acute Agitation: A Survey of Psychiatrists, Psychiatry Residents, and Psychiatric Nurses.

OBJECTIVE: The authors compared the current knowledge and attitude of psychiatrists, psychiatry residents, and psychiatric nurses towards the pharmacological management of acute agitation. METHODS: Questionnaires were electronically distributed to all attending psychiatrists, psychiatry residents, and psychiatric nurses who were either employed by the University Department of Psychiatry and Behavioral Sciences or were staff at a 250-bed affiliated Psychiatric Hospital. Where possible, Fisher's exact test was used to compare responses to questions based on designation. RESULTS: Of the 250 questionnaires distributed, 112 were returned (response rate of 44.8%), of which 64 (57.1%) were psychiatric nurses, 27 (24.1%) were attending psychiatrists, and 21 (18.8%) were psychiatry residents. A significantly higher percentage of attending psychiatrists and psychiatric nurses compared to psychiatry residents thought that newer second- generation antipsychotics (SGAs) are not as effective as older first-generation antipsychotics (FGAs) for managing acute agitation (55.6, 48.4, and 9.5% respectively, p = 0.008). The combination of intramuscular haloperidol, lorazepam, and diphenhydramine was the most preferred option chosen by all designations for the psychopharmacological management of severe agitation. Furthermore, a larger percentage of the psychiatric nurses, in comparison to attending psychiatrists, also chose the combination of intramuscular chlorpromazine, lorazepam, and diphenhydramine as an option for managing severe agitation; no psychiatry resident chose this option. CONCLUSION: Knowledge of evidence-based psychopharmacological management of agitation differs among attending psychiatrists, psychiatry residents and psychiatric nurses. Although the management of agitation should be individualized and context specific, monotherapy should be considered first where applicable.

Hospital length of stay in individuals with schizophrenia with and without cocaine-positive urine drug screens at hospital admission.

Despite the high prevalence of cocaine use disorder (CUD) in individuals with schizophrenia, current understanding of the effect of cocaine on psychiatric hospital length of stay (LOS) in individuals with schizophrenia is limited. We therefore retrospectively examined the medical records of 5106 hospital admissions due to exacerbation of schizophrenia. Linear regression and t-test were used to compare LOS between individuals with schizophrenia with cocaine-positive urine drug test results and those with negative test results. Individuals with schizophrenia who were also positive for cocaine had shorter LOS from both unadjusted (geometric mean LOS, 8.07 ± 1.92 vs. 11.83 ± 1.83 days; p < 0.001) and adjusted (ß = 0.69; confidence interval, 0.63-0.76; p < 0.001) analyses. Our results suggest that individuals with schizophrenia who also have comorbid CUD may require shorter inpatient treatment during periods of exacerbation of symptoms. Replication of this finding has relevance in treatment planning and resource allocation for the subpopulation of individuals with schizophrenia who also have stimulant use disorders.

Third-year medical students' understanding, knowledge, and attitudes toward the use of electroconvulsive therapy: a pre-exposure and postexposure survey.

OBJECTIVES: The purpose of this study was to examine the impact of the third-year psychiatric clerkship at the University of Texas on medical students' perception about and attitudes toward electroconvulsive therapy (ECT) and to determine whether direct observation of the procedure by students impacts their attitudes differently than attendance of lectures only. METHODS: All third-year medical students were asked to complete a survey regarding their opinions about ECT before and after their third-year psychiatry rotation, and they were asked whether they received the required didactic ECT training alone or also received adjunctive observation training. RESULTS: The opinions of students in both groups (observed plus didactic vs didactic only) improved significantly from prerotation to postrotation. However, the opinions of those who observed ECT improved more than those who did not. The groups differed on only 1 item before the rotation. CONCLUSIONS: Students in the observed plus didactic group had a more positive response to the items after rotation than did their peers. Given the effectiveness of ECT, it would be beneficial for all students to have exposure to observed ECT during their psychiatric rotation. This study should be replicated in other medical school settings. Future directions will focus on replicating the study but ensuring that students do not self-select into the observation group.

Smoking and BDNF Val66Met polymorphism in male schizophrenia: a case-control study.

Some recent studies show an association between a functional polymorphism of BDNF gene (Val66Met) and the susceptibility to nicotine dependence and we hypothesized that this polymorphism was associated with smoking in both schizophrenia patients and healthy controls. The BDNF Val66Met gene polymorphism was genotyped in 690 chronic male schizophrenia patients (smoker/nonsmoker = 522/169) and 628 male controls (smoker/nonsmoker = 322/306) using a case-control design. Nicotine dependence (ND) was assessed by the cigarettes smoked per day (CPD), the Heaviness of Smoking Index (HSI), and the Fagerstrom Test for ND (FTND). Patients also were rated on the Positive and Negative Syndrome Scale (PANSS). The results showed no significant differences in BDNF Val66Met genotype and allele distributions between the patients and healthy controls or between smokers and nonsmokers in either patients or healthy controls alone. In patient groups, however, the smokers with the Met allele had significantly higher HSI scores (Met/Met: 2.8 ± 1.7 vs. Met/Val: 2.2 ± 1.7 vs. Val/Val: 2.0 ± 1.6, p < 0.01) and a trend toward a significantly higher FTND score (p = 0.09) than those with the Val/Val genotype. In addition, the smokers showed significantly lower PANSS negative symptom and total scores, longer duration of illness and more hospitalizations (all p < 0.05). In the control group, the smokers with the Met allele started smoking significantly earlier than those with the Val/Val genotype (both p < 0.05). These results suggest that the BDNF Val66Met polymorphism may affect a smoker's response to nicotine in both schizophrenia and healthy controls from a Chinese Han population, but with differential effects in different aspects of smoking behaviors.

Increasing the rate of return of resident rotation evaluations by their attending physicians in an in-patient psychiatric facility.

OBJECTIVE: Psychiatrist's evaluations of residents are the primary means of determining whether the residents are ready to be promoted. However, the return rate for evaluations is quite low. The purpose of this study was to increase the return rates. METHODS: Feedback from two surveys and open discussion was utilized to develop and implement a system for increasing completion rates. Completion rates before and after the intervention were compared. RESULTS: The survey revealed that the initial evaluation form was too complex and not readily available. In addition, participants indicated that reminders would be helpful for increasing compliance. Completion rates were 48% and 80% for the 4 months prior and after the intervention, respectively. CONCLUSION: Addressing the problem and implementing suggested strategies increased completion rates significantly. However, it is unclear which strategy was most associated with the change. Future directions will focus on determining whether gains will be maintained and what would be necessary to obtain 100% compliance rates.

Mixed versus manic bipolar disorder: a comparison of demographic, symptomatic, and treatment differences.

This study compared patients diagnosed with Mixed versus Manic Bipolar disorder across the domains of demographic, symptom, and treatment variables. The sample included 152 patients who were admitted to an acute care psychiatric facility within an index period, whose discharge diagnosis was either Bipolar Disorder, Manic Episode (n = 109) or Bipolar Disorder, Mixed Episode (n = 43). No significant differences were found in age, race, episode number, or length of stay. There was a trend toward females being diagnosed with a Mixed Episode and males a Manic Episode. Group differences were found on physician and nurse symptom ratings, with the manic group receiving higher ratings on resistance, psychosis, and conceptual disorganization and the mixed receiving higher scores on depression and anxiety. On self-report measures, the mixed group endorsed greater severity than did the manic group. The mixed group was more likely to be prescribed antidepressants at discharge; however there were no significant differences across other medication. These differences are discussed.

Is schizoaffective disorder a stable diagnostic category: a retrospective examination.

Debate continues about whether clear nosologic boundaries can be drawn between schizoaffective disorder (SA), schizophrenia (SP), and bipolar disorder (BPD). This study attempted to clarify these boundaries. A retrospective review of the records of adult psychiatric inpatients with DSM-IV diagnoses of SA (n = 96), SP (n = 245), and BPD (n = 203) was conducted. Patients were assessed at admission and discharge using standardized rating scales (completed by physicians and nurses) and self-report inventories. Differential improvement over time also was examined. Significant differences were found for gender, legal status at admission, age, LOS, episode number, and ethnicity. Overall, SA was rated by clinicians as intermediate between SP and BPD, although SA rated themselves as the most severe. SA was similar to SP on positive symptoms, intermediate on negative symptoms, and similar to BPD on mood- and distress-related symptoms. Independent of diagnosis, differences in change scores from admission to discharge were related to severity level at admission. Although several differences were found in symptom severity across domains, no syndrome was identifiable associated with the diagnosis of SA and the diagnosis was unstable over time, thereby bringing into question the validity of SA as a diagnostic entity.