Subject(s)
Motivation , Paroxetine/therapeutic use , Selective Serotonin Reuptake Inhibitors/therapeutic use , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/psychology , Hemiplegia/etiology , Hemiplegia/psychology , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/psychology , SyndromeABSTRACT
Assessment of capacity to give informed consent in the general hospital setting usually rests on a clinical judgment made of a patient's understanding and appreciation of his or her illness, a process limited by its subjective nature, interexaminer variability, and relative deficiency of quantitative instruments available to provide collateral information. Inasmuch as identification of associated variables could strengthen this process, this study examines the association of cognitive functions to the capacity to give informed consent. Over a one-year period, 65 patients were evaluated independent of medical or psychiatric diagnoses. The study population consisted of medical and neurology inpatients seen for neuropsychiatric evaluation. All evaluations included assessment of capacity to give informed consent as it related to the reason for the admission to the hospital, followed by administration of the Hopkins Competency Assessment Test, the Mini-Mental Status Examination, the Trail-Making Test, Parts A and B, and the Executive Interview. Of 65 patients, 34 were excluded based on preset criteria. The remaining patients were assigned to either a "competent" or "noncompetent" group based on clinical evaluation. Number of patients, gender, and handedness distributions between groups were similar. The groups did not differ significantly in terms of age or education. Significant between-group differences were found on an empirical measure of competency, a general mental state measure, and on measures of attentional and executive cognitive functions. An analysis of classification rates indicated that a measure of executive cognitive functioning (Executive Interview) had the best sensitivity and specificity in correctly classifying competent and noncompetent patients. The results of this study support the association between the capacity to give informed consent in the hospital setting and measures of cognitive functioning, suggesting that utilization of cognitive function measures may strengthen the competency assessment process.
Subject(s)
Cognition Disorders/diagnosis , Informed Consent , Inpatients , Mental Competency , Neuropsychological Tests/standards , Adult , Evaluation Studies as Topic , Female , Humans , Inpatients/classification , Inpatients/psychology , Male , Middle Aged , Pilot Projects , Sensitivity and SpecificitySubject(s)
Aggression/drug effects , Buspirone/therapeutic use , Dementia/drug therapy , Age Factors , Aged , Aged, 80 and over , Dementia/psychology , Humans , MaleABSTRACT
The phenomenological features of 35 obsessive-compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.
Subject(s)
Obsessive-Compulsive Disorder/diagnosis , Tic Disorders/diagnosis , Tourette Syndrome/diagnosis , Adult , Female , Humans , Male , Obsessive-Compulsive Disorder/classification , Obsessive-Compulsive Disorder/psychology , Personality Inventory , Tic Disorders/classification , Tic Disorders/psychology , Tourette Syndrome/classification , Tourette Syndrome/psychologyABSTRACT
The abnormal neuronal excitability underlying seizure disorders may alter behavior. Behavioral alterations associated with epilepsy can occur during the ictal period, especially in patients who suffer partial seizures of temporal or frontal lobe origin, or during the interictal period in the setting of chronic temporolimbic seizure discharges. We use case descriptions to illustrate behavioral presentations of epilepsy that resemble primary psychiatric illnesses, including schizophrenic psychoses, mood disorders, panic disorder, and dissociative disorders. The varied secondary psychiatric syndromes produced by epilepsy are elucidated by a consideration of normal functions of temporal and frontolimbic structures. The clinical pictures provide clues to the causes of primary psychiatric disorders.
Subject(s)
Epilepsy/psychology , Neurocognitive Disorders/psychology , Adult , Diagnosis, Differential , Epilepsy/diagnosis , Epilepsy, Frontal Lobe/diagnosis , Epilepsy, Frontal Lobe/psychology , Epilepsy, Post-Traumatic/diagnosis , Epilepsy, Post-Traumatic/psychology , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/psychology , Female , Humans , Male , Middle Aged , Neurocognitive Disorders/diagnosis , Schizophrenia/diagnosis , Schizophrenic PsychologyABSTRACT
The authors found that buspirone added to the treatment of 33 patients with obsessive-compulsive disorder who were refractory to the serotonin reuptake inhibitor fluvoxamine was no better than placebo in reducing obsessive-compulsive, depressive, or anxiety symptoms. This finding suggests that addition of buspirone to ongoing fluvoxamine therapy is not an effective treatment strategy for most patients with obsessive-compulsive disorder.