Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.980
Filtrar
1.
Curr Opin Anaesthesiol ; 34(3): 345-351, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33935183

RESUMEN

PURPOSE OF REVIEW: Psychiatric illness is common in patients presenting for surgery. Overall health and surgical outcomes are adversely affected by the presence of psychiatric comorbidities. RECENT FINDINGS: As new treatment modalities become available, their perioperative implications need to be evaluated. These implications include drug-drug interactions, hemodynamic effects, bleeding risk, and factors affecting perioperative exacerbation of the underlying psychiatric illness. SUMMARY: From our review of the recent literature we continue to support the continuation of psychoactive agents in the perioperative period, taking into consideration the effects these agents have on concomitant drug use in the perioperative period; and the risks of withholding them at a high-stress time.


Asunto(s)
Anestesiólogos , Trastornos Mentales , Hemorragia , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Atención Perioperativa , Periodo Perioperatorio
2.
Transl Psychiatry ; 11(1): 210, 2021 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-33833219

RESUMEN

Observational studies have suggested bidirectional associations between psychiatric disorders and COVID-19 phenotypes, but results of such studies are inconsistent. Mendelian Randomization (MR) may overcome the limitations of observational studies, e.g., unmeasured confounding and uncertainties about cause and effect. We aimed to elucidate associations between neuropsychiatric disorders and COVID-19 susceptibility and severity. To that end, we applied a two-sample, bidirectional, univariable, and multivariable MR design to genetic data from genome-wide association studies (GWASs) of neuropsychiatric disorders and COVID-19 phenotypes (released in January 2021). In single-variable Generalized Summary MR analysis, the most significant and only Bonferroni-corrected significant result was found for genetic liability to BIP-SCZ (a combined GWAS of bipolar disorder and schizophrenia as cases vs. controls) increasing risk of COVID-19 (OR = 1.17, 95% CI, 1.06-1.28). However, we found a significant, positive genetic correlation between BIP-SCZ and COVID-19 of 0.295 and could not confirm causal or horizontally pleiotropic effects using another method. No genetic liabilities to COVID-19 phenotypes increased the risk of (neuro)psychiatric disorders. In multivariable MR using both neuropsychiatric and a range of other phenotypes, only genetic instruments of BMI remained causally associated with COVID-19. All sensitivity analyses confirmed the results. In conclusion, while genetic liability to bipolar disorder and schizophrenia combined slightly increased COVID-19 susceptibility in one univariable analysis, other MR and multivariable analyses could only confirm genetic underpinnings of BMI to be causally implicated in COVID-19 susceptibility. Thus, using MR we found no consistent proof of genetic liabilities to (neuro)psychiatric disorders contributing to COVID-19 liability or vice versa, which is in line with at least two observational studies. Previously reported positive associations between psychiatric disorders and COVID-19 by others may have resulted from statistical models incompletely capturing BMI as a continuous covariate.


Asunto(s)
/complicaciones , Análisis de la Aleatorización Mendeliana , Trastornos Mentales/complicaciones , /diagnóstico , Estudio de Asociación del Genoma Completo , Humanos , Trastornos Mentales/genética , Factores de Riesgo
3.
Global Health ; 17(1): 44, 2021 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-33832489

RESUMEN

BACKGROUND: The possibility of psychopathological symptoms and related risk factors among normal persons and patients infected during the outbreak of COVID-19 has been widely investigated. The mental health outcomes of the second wave of the pandemic remain unclear, especially those of patients with an infection. Thus, this study aims to explore the prevalence of and related risk factors associated with psychopathological symptoms among patients infected with COVID-19 during the second wave. METHOD: A cross-sectional survey was conducted in five isolated wards of a designated hospital in Beijing, China, from July 1 to July 15, 2020. The Mini International Neuropsychiatric Interview (MINI) was conducted to assess psychiatric disorders, and a series of scales were used to measure self-reported psychopathological symptoms and psychosomatic factors. Multivariate regression analysis was used to analyze the risk factors associated with psychopathological symptoms. RESULTS: Among 119 participants with infections, the prevalence of generalized anxiety symptoms (51.3%), depressive symptoms (41.2%), and posttraumatic stress symptoms (PTSS)/posttraumatic stress disorder (PTSD) symptoms (33.6%) was observed. Loneliness, hope, coping strategies, and history of mental disorders were the shared risk or protective factors across several psychopathological symptoms. The perceived impact of COVID-19 is the specific risk factor associated with state anxiety symptoms. CONCLUSIONS: The prevalence of symptoms of depression, anxiety, and PTSS/PTSD is high among patients with infections during the second wave of the pandemic in Beijing. Clinical doctors must realize that these patients will probably experience depressive disorder, anxiety disorders, and PTSS/PTSD, as well as some neuropsychiatric syndromes. Specific mental health care is urgently required to help patients manage the virus during the second wave of the pandemic.


Asunto(s)
/complicaciones , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Pandemias , Adulto , Beijing , Estudios Transversales , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Prevalencia
4.
Surg Clin North Am ; 101(2): 323-333, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33743972

RESUMEN

Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.


Asunto(s)
Cirugía Bariátrica/métodos , Conducta , Trastornos Mentales/complicaciones , Obesidad Mórbida/cirugía , Cuidados Preoperatorios/métodos , Pérdida de Peso/fisiología , Humanos , Trastornos Mentales/psicología , Obesidad Mórbida/complicaciones , Obesidad Mórbida/psicología
5.
PLoS One ; 16(3): e0248009, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33724987

RESUMEN

INTRODUCTION: Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. METHODS AND FINDINGS: We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab's positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients' autonomy and early heparin treatment were related to lower mortality risk. CONCLUSIONS: We evidenced factors associated with infection's risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.


Asunto(s)
/patología , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/administración & dosificación , /mortalidad , Disnea/etiología , Femenino , Fiebre/etiología , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/patología , Neoplasias/complicaciones , Neoplasias/patología , Casas de Salud , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Tasa de Supervivencia
6.
Psychiatry Res ; 299: 113856, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33740483

RESUMEN

Several observational studies investigated the relationship between pre-diagnosis with mental disorders and COVID-19 outcomes. Thus, we have decided to conduct this meta-analysis to explore this relationship. We complied to the PRISMA guidelines in conducting this meta-analysis. PubMed, ScienceDirect, Google Scholar and medRxiv were searched until the 15th of February, 2021. We used the Random effect model in Meta XL, version 5.3 to pool the included studies. Statistical heterogeneity was assessed using Cochran's Q heterogeneity test and I². This meta-analysis included 634,338 COVID-19 patients from 16 studies. Our findings revealed that pre-diagnosis with mental disorders increased the risk of COVID-19 mortality and severity. This increase in the risk of COVID-19 mortality and severity remained significant in the model that only included the studies that adjusted for confounding variables. Furthermore, higher mortality was noticed in the included studies among schizophrenia, schizotypal and delusional disorders patients compared to mood disorders patients. In this meta-analysis we provided two models which both reported a significant increase in the risk of  COVID-19 severity and mortality among patients with mental disorders, and with the upcoming COVID-19 vaccines, we recommend to give this category the priority in the vaccination campaigns along with medical health providers and elderly.


Asunto(s)
/mortalidad , Trastornos Mentales/complicaciones , Anciano , Humanos , Trastornos Mentales/psicología , Pandemias , Índice de Severidad de la Enfermedad
7.
Clin Psychol Rev ; 85: 102006, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33714167

RESUMEN

The COVID-19 pandemic has and will continue to result in negative mental health outcomes such as depression, anxiety and traumatic stress in people and populations throughout the world. A population mental health perspective informed by clinical psychology, psychiatry and dissemination and implementation science is ideally suited to address the broad, multi-faceted and long-lasting mental health impact of the pandemic. Informed by a systematic review of the burgeoning empirical research on the COVID-19 pandemic and research on prior coronavirus pandemics, we link pandemic risk factors, negative mental health outcomes and appropriate intervention strategies. We describe how social risk factors and pandemic stressors will contribute to negative mental health outcomes, especially among vulnerable populations. We evaluate the scalability of primary, secondary and tertiary interventions according to mental health target, population, modality, intensity and provider type to provide a unified strategy for meeting population mental health needs. Traditional models, in which evidence-based therapies delivered are delivered in-person, by a trained expert, at a specialty care location have proved difficult to scale. The use of non-traditional models, tailoring preventive interventions to populations based on their needs, and ongoing coordinated evaluation of intervention implementation and effectiveness will be critical to refining our efforts to increase reach.


Asunto(s)
/complicaciones , Trastornos Mentales/complicaciones , Trastornos Mentales/psicología , Salud Poblacional/estadística & datos numéricos , Humanos
8.
Cochrane Database Syst Rev ; 2: CD013281, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33591592

RESUMEN

BACKGROUND: The prevalence of type 2 diabetes is increased in individuals with mental disorders. Much of the burden of disease falls on the populations of low- and middle-income countries (LMICs). OBJECTIVES: To assess the effects of pharmacological, behaviour change, and organisational interventions versus active and non-active comparators in the prevention or delay of type 2 diabetes among people with mental illness in LMICs. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase and six other databases, as well as three international trials registries. We also searched conference proceedings and checked the reference lists of relevant systematic reviews. Searches are current up to 20 February 2020. SELECTION CRITERIA: Randomized controlled trials (RCTs) of pharmacological, behavioural or organisational interventions targeting the prevention or delay of type 2 diabetes in adults with mental disorders in LMICs. DATA COLLECTION AND ANALYSIS: Pairs of review authors working independently performed data extraction and risk of bias assessments. We conducted meta-analyses using random-effects models. MAIN RESULTS: One hospital-based RCT with 150 participants (99 participants with schizophrenia) addressed our review's primary outcome of prevention or delay of type 2 diabetes onset. Low-certainty evidence from this study did not show a difference between atypical and typical antipsychotics in the development of diabetes at six weeks (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.03 to 7.05) (among a total 99 participants with schizophrenia, 68 were in atypical and 31 were in typical antipsychotic groups; 55 participants without mental illness were not considered in the analysis). An additional 29 RCTs with 2481 participants assessed one or more of the review's secondary outcomes. All studies were conducted in hospital settings and reported on pharmacological interventions. One study, which we could not include in our meta-analysis, included an intervention with pharmacological and behaviour change components. We identified no studies of organisational interventions. Low- to moderate-certainty evidence suggests there may be no difference between the use of atypical and typical antipsychotics for the outcomes of drop-outs from care (RR 1.31, 95% CI 0.63 to 2.69; two studies with 144 participants), and fasting blood glucose levels (mean difference (MD) 0.05 lower, 95% CI 0.10 to 0.00; two studies with 211 participants). Participants who receive typical antipsychotics may have a lower body mass index (BMI) at follow-up than participants who receive atypical antipsychotics (MD 0.57, 95% CI 0.33 to 0.81; two studies with 141 participants; moderate certainty of evidence), and may have lower total cholesterol levels eight weeks after starting treatment (MD 0.35, 95% CI 0.27 to 0.43; one study with 112 participants). There was moderate certainty evidence suggesting no difference between the use of metformin and placebo for the outcomes of drop-outs from care (RR 1.22, 95% CI 0.09 to 16.35; three studies with 158 participants). There was moderate-to-high certainty evidence of no difference between metformin and placebo for fasting blood glucose levels (endpoint data: MD -0.35, 95% CI -0.60 to -0.11; change from baseline data: MD 0.01, 95% CI -0.21 to 0.22; five studies with 264 participants). There was high certainty evidence that BMI was lower for participants receiving metformin compared with those receiving a placebo (MD -1.37, 95% CI -2.04 to -0.70; five studies with 264 participants; high certainty of evidence). There was no difference between metformin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Low-certainty evidence from one study (48 participants) suggests there may be no difference between the use of melatonin and placebo for the outcome of drop-outs from care (RR 1.00, 95% CI 0.38 to 2.66). Fasting blood glucose is probably reduced more in participants treated with melatonin compared with placebo (endpoint data: MD -0.17, 95% CI -0.35 to 0.01; change from baseline data: MD -0.24, 95% CI -0.39 to -0.09; three studies with 202 participants, moderate-certainty evidence). There was no difference between melatonin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Very low-certainty evidence from one study (25 participants) suggests that drop-outs may be higher in participants treated with a tricyclic antidepressant (TCA) compared with those receiving a selective serotonin reuptake inhibitor (SSRI) (RR 0.34, 95% CI 0.11 to 1.01). It is uncertain if there is no difference in fasting blood glucose levels between these groups (MD -0.39, 95% CI -0.88 to 0.10; three studies with 141 participants, moderate-certainty evidence). It is uncertain if there is no difference in BMI and depression between the TCA and SSRI antidepressant groups. AUTHORS' CONCLUSIONS: Only one study reported data on our primary outcome of interest, providing low-certainty evidence that there may be no difference in risk between atypical and typical antipsychotics for the outcome of developing type 2 diabetes. We are therefore not able to draw conclusions on the prevention of type 2 diabetes in people with mental disorders in LMICs. For studies reporting on secondary outcomes, there was evidence of risk of bias in the results. There is a need for further studies with participants from LMICs with mental disorders, particularly on behaviour change and on organisational interventions targeting prevention of type 2 diabetes in these populations.


Asunto(s)
Antipsicóticos/uso terapéutico , Países en Desarrollo , Diabetes Mellitus Tipo 2/prevención & control , Esquizofrenia/tratamiento farmacológico , Adulto , Anciano , Antidepresivos Tricíclicos/uso terapéutico , Antioxidantes/uso terapéutico , Glucemia/análisis , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/complicaciones , Ayuno/sangre , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Melatonina/uso terapéutico , Trastornos Mentales/complicaciones , Metformina/uso terapéutico , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Placebos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Esquizofrenia/complicaciones , Inhibidores de la Captación de Serotonina/uso terapéutico
9.
Epilepsy Behav ; 117: 107857, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33636528

RESUMEN

AIMS: The aim of this study was to estimate the prevalence of physical and psychological comorbidities in patients with epilepsy in Germany in order to better understand the complex clinical picture and its consequences. METHODS: This retrospective cohort study included adult individuals with a diagnosis of epilepsy between January 2018 and December 2018 (index date). Patients with epilepsy were matched 1:1 with patients without epilepsy by age, sex, and physician. The study outcomes included the associations between epilepsy and different physical and mental disorders documented within 365 days after the index date as well as multimorbidity defined as at least two, three, four, and five different diagnoses. The present study used multivariate logistic regression models with all study disorders as dependent variables and epilepsy as an impact variable. RESULTS: After 1:1 matching, the present study included 7942 patients with and 7942 patients without epilepsy (mean age: 58.0 years; 49.7% female). Epilepsy was significantly positively associated with nine disorders, and the strongest associations were with mental retardation (Odds Ratio (OR): 21.11 (95% Confidence Intervals (CI): 12.52-35.59)), cerebrovascular diseases (OR: 3.14 (95% CI: 2.80-3.55)), and dementia (OR: 1.72 (95% CI: 1.47-2.01)). Epilepsy was associated with significantly increased odds of multimorbidity. CONCLUSION: In summary, individuals with epilepsy have an increased prevalence of comorbidities that increase with age. Further research should be undertaken in this area, including the etiology of comorbidities.


Asunto(s)
Epilepsia , Trastornos Mentales , Adulto , Comorbilidad , Epilepsia/complicaciones , Epilepsia/epidemiología , Femenino , Alemania/epidemiología , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Salud Mental , Persona de Mediana Edad , Estudios Retrospectivos
10.
JAMA Netw Open ; 4(1): e2033448, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33439264

RESUMEN

Importance: Excess risk of physical disease and mortality has been observed among individuals with psychiatric conditions, suggesting that ameliorating mental disorders might also be associated with ameliorating the later onset of physical disability and early mortality. However, the temporal association between mental disorders and physical diseases remains unclear, as many studies have relied on retrospective recall, used cross-sectional designs or prospective designs with limited follow-up periods, or given inadequate consideration to preexisting physical illnesses. Objective: To examine whether mental disorders are associated with subsequent physical diseases and mortality across 3 decades of observation. Design, Setting, and Participants: This population-based cohort study used data from the New Zealand Integrated Data Infrastructure, a collection of nationwide administrative data sources linked at the individual level, to identify mental disorders, physical diseases, and deaths recorded between July 1, 1988, and June 30, 2018, in the population of New Zealand. All individuals born in New Zealand between January 1, 1928, and December 31, 1978, who resided in the country at any time during the 30-year observation period were included in the analysis. Data were analyzed from July 2019 to November 2020. Exposures: Nationwide administrative records of mental disorder diagnoses made in public hospitals. Main Outcomes and Measures: Chronic physical disease diagnoses made in public hospitals, deaths, and health care use. Results: The study population comprised 2 349 897 individuals (1 191 981 men [50.7%]; age range at baseline, 10-60 years). Individuals with a mental disorder developed subsequent physical diseases at younger ages (hazard ratio [HR], 2.33; 95% CI, 2.30-2.36) and died at younger ages (HR, 3.80; 95% CI, 3.72-3.89) than those without a mental disorder. These associations remained across sex and age and after accounting for preexisting physical diseases. Associations were observed across different types of mental disorders and self-harm behavior (relative risks, 1.78-2.43; P < .001 for all comparisons). Mental disorders were associated with the onset of physical diseases and the accumulation of physical disease diagnoses (incidence rate ratio [IRR], 2.00; 95% CI, 1.98-2.03), a higher number of hospitalizations (IRR, 2.43; 95% CI, 2.39-2.48), longer hospital stays for treatment (IRR, 2.70; 95% CI, 2.62-2.79), and higher associated health care costs (b = 0.115; 95% CI, 0.112-0.118). Conclusions and Relevance: In this study, mental disorders were likely to begin and peak in young adulthood, and they antedated physical diseases and early mortality in the population. These findings suggest that ameliorating mental disorders may have implications for improving the length and quality of life and for reducing the health care costs associated with physical diseases.


Asunto(s)
Enfermedad Crónica/epidemiología , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Adolescente , Adulto , Niño , Enfermedad Crónica/mortalidad , Femenino , Humanos , Longevidad , Estudios Longitudinales , Masculino , Trastornos Mentales/mortalidad , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Calidad de Vida
11.
Mol Neurobiol ; 58(5): 1905-1916, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33404981

RESUMEN

Since December 2019, the world has been experiencing the challenge of facing coronavirus disease-19 (COVID-19), a severe infectious disease caused by the new coronavirus, SARS-CoV-2. The individuals with the most severe symptoms and the highest risk of death are the elderly and those with chronic illness. Among chronic conditions, those with a certain degree of chronic inflammation may predispose to a more severe evolution of COVID-19. Elderly with psychiatric disorders can present a persistent inflammatory state, a characteristic of the age's immunological senescence, but the disorder can accentuate that. Social isolation is still the safest way to avoid contamination. However, isolated older people may have or worsen mental health conditions due to isolation and health concerns. In this scenario, a SARS-CoV-2 infection may progress to more severe disease. Conversely, COVID-19 can predispose or aggravate psychiatric disorders, as it induces a cytokine storm, causing systemic hyper inflammation. It may damage the blood-brain barrier, resulting in inflammation in the central nervous system. Besides, SARS-CoV-2 is likely to reach and trigger an inflammatory process directly in the nervous system. This review makes an update about research on the mental health of the elderly during the pandemic. Also, it discusses the vulnerability of these individuals in the face of stress and in the case of contracting COVID-19, considering mainly the stress's hormonal and inflammatory mechanisms. Finally, the review points out possible care and attention strategies and entertainment and activities that can reduce the damage to mental and physical health and improve the elderly's quality of life. Graphical abstract Isolation and concerns about COVID-19 may harm elderly mental health. Immunosenescence and pandemic stress increase the risk of psychiatric disorders. Stress and disorders may potentiate the elderly's inflammation and COVID-19 symptoms. SARS-CoV-2 hyperinflammation is a risk factor for elderly psychiatric disorders.


Asunto(s)
/psicología , Trastornos Mentales/psicología , Salud Mental , Calidad de Vida/psicología , Aislamiento Social/psicología , Anciano , Anciano de 80 o más Años , Humanos , Trastornos Mentales/complicaciones , Pandemias
12.
J Clin Neurosci ; 84: 42-45, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33485597

RESUMEN

Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p < 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p < 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p < 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p < 0.001).


Asunto(s)
Procedimientos Quirúrgicos Electivos/efectos adversos , Trastornos Mentales/complicaciones , Procedimientos Ortopédicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/psicología , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos
13.
BMC Psychiatry ; 21(1): 67, 2021 01 30.
Artículo en Inglés | MEDLINE | ID: mdl-33516194

RESUMEN

BACKGROUND: The purpose of this study was to examine if satisfaction with care differs among older trauma patients with and without preexisting mental illness (PMI+/PMI-). METHODS: Data from two level I trauma centers were examined from 11/2016 through 12/2017. Trauma patients ≥55 years were included and satisfaction of those who had a diagnosis of mental illness prior to the trauma admission (PMI+) to those without a diagnosis (PMI-) (n = 299; 62 PMI+ and 237 PMI-) were compared. Enrolled patients completed the Family Satisfaction with Advanced Care Cancer Scale Patient Survey (FAMCARE-P13) prior to discharge. Associations between mental illness status and patient baseline characteristics, overall mean satisfaction, and mean satisfaction by question were compared. Generalized linear models adjusted for differences in patient satisfaction by mental illness status. Analyses were stratified by hospital to account for the interaction between hospital and mental illness status. RESULTS: Compared to PMI- patients, PMI+ patients were more likely to be younger, female, have multiple comorbidities, and to report lower overall satisfaction with care. Among PMI+ patients, the most common diagnoses were depression and anxiety. After adjustment, PMI+ was associated with lower patient satisfaction at hospital 1; after examining individual questions lower satisfaction was associated with information provided on procedures and questions surrounding "Physical care." Conversely, PMI+ did not affect satisfaction at hospital 2 after adjustment. CONCLUSIONS: At hospital 1, room for improvement was identified in providing information about prognosis and procedures, symptom management, and continuity of care. Reexamining practices for older PMI+ trauma patients is warranted.


Asunto(s)
Trastornos Mentales , Satisfacción del Paciente , Estudios Transversales , Femenino , Hospitalización , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/terapia , Cuidados Paliativos
15.
J Nerv Ment Dis ; 209(2): 92-99, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33502140

RESUMEN

ABSTRACT: Mental health clients with serious mental illness in urban settings experience multiple chronic stresses related to poverty, unemployment, discrimination, homelessness, incarceration, hospitalization, posttraumatic stress disorder, pain syndromes, traumatic brain injury, and other problems. Substance use disorder exacerbates these difficulties. This study examined the efficacy of algorithm-driven substance use disorder treatments for 305 inner-city mental health clients with multiple challenges. Researchers assessed substance use quarterly using a combination of standardized self-reports and case manager ratings. Of the 305 multiply impaired clients who began treatment, 200 (66%) completed 2 years of treatment. One fourth (n = 53) of the completers were responders who developed abstinence and improved community function; one half (n = 97) were partial responders, who reduced substance use but did not become abstinent; and one fourth (n = 50) were nonresponders. Evidence-based interventions for substance use disorder can be effective for multiply impaired, inner-city clients, but numerous complications may hinder recovery.


Asunto(s)
Trastornos Mentales/complicaciones , Trastornos Relacionados con Sustancias/terapia , Adulto , Anciano , Algoritmos , Femenino , Humanos , Entrevista Psicológica , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Áreas de Pobreza , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/diagnóstico , Resultado del Tratamiento , Adulto Joven
16.
Qual Life Res ; 30(4): 1165-1172, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33387289

RESUMEN

PURPOSE: Individuals post-stroke might have high levels of post-stroke fatigue (PSF) which might affect their quality of life. This study aimed to investigate the prevalence of post-stroke fatigue in Jordan and to comprehensively identify its possible associated factors. METHODS: A cross-sectional design was implemented through one-hour face-to-face assessment sessions. The modified fatigue impact scale, 12-item Short-Form Health Survey, Montreal Cognitive Assessment, Motor Assessment Log, Upper Extremity Fugl Meyer assessment, Nine Hole Peg Test, 10 Meter Walk Testing, active and passive goniometry, Hand-held dynamometry, and modified Ashworth scale were used as outcome measures. Prevalence of post-stroke fatigue and levels of quality of life were reported using descriptive analyses. Multiple variable linear regression analysis was used to identify PSF associated factors of post-stroke fatigue. P < 0.05 was considered significant for all statistical tests. RESULTS: 153 individuals with stroke participated in the study. A total of 117 participants (69.9%, 95% CI = 62.0-77.1%) were fatigued. Fatigue was significantly predicted by mental component of quality of life (ß -0.42 [95% CI -0.53--0.31]; p < 0.001), cognition (ß -0.69 [95% CI -1.08--0.29], p = 0.001), weekly sport hours (ß -0.94 [95% CI -1.73--0.14], p = 0.022), and shoulder abduction spasticity (ß -1.81 [95% CI -3.38--0.24], p = 0.024. The model explained 51% of the variation in the fatigue (F = 29.006, p < 0.001). CONCLUSION: Jordanian individuals with stroke have a high prevalence of fatigue. Mental related quality of life was significantly associated with PSF levels. Other factors significantly associated with PSF included cognition status, sport participation, and spasticity. Healthcare practitioners working in neurorehabilitation should take PSF and its significant correlates into consideration when treating individuals with stroke.


Asunto(s)
Fatiga/etiología , Trastornos Mentales/complicaciones , Salud Mental/normas , Calidad de Vida/psicología , Accidente Cerebrovascular/complicaciones , Adulto , Anciano , Estudios Transversales , Fatiga/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/psicología
17.
Harv Rev Psychiatry ; 29(1): 81-89, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33417376

RESUMEN

ABSTRACT: This article outlines a four-part strategy for future research in mental health and complementary disciplines that will broaden understanding of mass shootings and multi-victim gun homicides. First, researchers must abandon the starting assumption that acts of mass violence are driven primarily by diagnosable psychopathology in isolated "lone wolf" individuals. The destructive motivations must be situated, instead, within larger social structures and cultural scripts. Second, mental health professionals and scholars must carefully scrutinize any apparent correlation of violence with mental illness for evidence of racial bias in the official systems that define, measure, and record psychiatric diagnoses, as well as those that enforce laws and impose criminal justice sanctions. Third, to better understand the role of firearm access in the occurrence and lethality of mass shootings, research should be guided by an overarching framework that incorporates social, cultural, legal, and political, but also psychological, aspects of private gun ownership in the United States. Fourth, effective policies and interventions to reduce the incidence of mass shootings over time-and to prevent serious acts of violence more generally-will require an expanded body of well-funded interdisciplinary research that is informed and implemented through the sustained engagement of researchers with affected communities and other stakeholders in gun violence prevention. Emerging evidence that the coronavirus pandemic has produced a sharp increase both in civilian gun sales and in the social and psychological determinants of injurious behavior adds special urgency to this agenda.


Asunto(s)
Incidentes con Víctimas en Masa/psicología , Trastornos Mentales/psicología , /complicaciones , /psicología , Correlación de Datos , Estudios Transversales , Carencia Cultural , Violencia con Armas/prevención & control , Violencia con Armas/psicología , Homicidio/prevención & control , Homicidio/psicología , Homicidio/estadística & datos numéricos , Humanos , Incidentes con Víctimas en Masa/prevención & control , Incidentes con Víctimas en Masa/estadística & datos numéricos , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Psicopatología , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos
18.
Artículo en Inglés | MEDLINE | ID: mdl-32730915

RESUMEN

In December 2019, the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) infection was reported. In only few weeks it has caused a global pandemic, with mortality reaching 3.4%, mostly due to a severe pneumonia. However, the impact of SARS-CoV-2 virus on the central nervous system (CNS) and mental health outcomes remains unclear. Previous studies have demonstrated the presence of other types of coronaviruses in the brain, especially in the brainstem. There is evidence that the novel coronavirus can penetrate CNS through the olfactory or circulatory route as well as it can have an indirect impact on the brain by causing cytokine storm. There are also first reports of neurological signs in patients infected by the SARS-Cov-2. They show that COVID-19 patients have neurologic manifestations like acute cerebrovascular disease, conscious disturbance, taste and olfactory disturbances. In addition, there are studies showing that certain psychopathological symptoms might appear in infected patients, including those related to mood and psychotic disorders as well as post-traumatic stress disorder. Accumulating evidence also indicates that the pandemic might have a great impact on mental health from the global perspective, with medical workers being particularly vulnerable. In this article, we provide a review of studies investigating the impact of the SARS-CoV-2 on the CNS and mental health outcomes. We describe neurobiology of the virus, highlighting the relevance to mental disorders. Furthermore, this article summarizes the impact of the SARS-CoV-2 from the public health perspective. Finally, we present a critical appraisal of evidence and indicate future directions for studies in this field.


Asunto(s)
Infecciones por Coronavirus/psicología , Trastornos Mentales/psicología , Salud Mental , Neumonía Viral/psicología , Betacoronavirus , Encéfalo/virología , Infecciones por Coronavirus/complicaciones , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/etiología , Enfermedades del Sistema Nervioso/etiología , Pandemias , Neumonía Viral/complicaciones , Resultado del Tratamiento
19.
Med Clin North Am ; 105(1): 175-186, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33246517

RESUMEN

Unintentional weight loss is a common clinical problem with a broad differential diagnosis that is clinically important because of the associated risks of morbidity and mortality. Community-dwelling adults are often diagnosed with malignancy, nonmalignant gastrointestinal disorders, and psychiatric disorders as the cause of unintentional weight loss, whereas institutionalized older adults are diagnosed most often with psychiatric disorders. Up to a quarter of patients do not have a diagnosis after comprehensive workup, and close follow-up is warranted. Treatment involves management of underlying causes.


Asunto(s)
Pérdida de Peso , Envejecimiento/fisiología , Enfermedades Cardiovasculares/complicaciones , Enfermedad Crónica , Enfermedades Transmisibles/complicaciones , Diagnóstico Diferencial , Suplementos Dietéticos , Enfermedades del Sistema Endocrino/complicaciones , Enfermedades Gastrointestinales/complicaciones , Humanos , Anamnesis , Trastornos Mentales/complicaciones , Neoplasias/complicaciones , Examen Físico , Enfermedades Respiratorias/complicaciones , Enfermedades Reumáticas/complicaciones , Pérdida de Peso/fisiología
20.
Int J Mol Sci ; 22(1)2020 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-33375447

RESUMEN

Neurological disorders including depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, autism and epilepsy are associated with an increased incidence of cardiovascular disorders and susceptibility to heart failure. The underlying molecular mechanisms that link neurological disorders and adverse cardiac function are poorly understood. Further, a lack of progress is likely due to a paucity of studies that investigate the relationship between neurological disorders and cardiac electrical activity in health and disease. Therefore, there is an important need to understand the spatiotemporal behavior of neurocardiac mechanisms. This can be advanced through the identification and validation of neurological and cardiac signaling pathways that may be adversely regulated. In this review we highlight how dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, autonomic nervous system (ANS) activity and inflammation, predispose to psychiatric disorders and cardiac dysfunction. Moreover, antipsychotic and antidepressant medications increase the risk for adverse cardiac events, mostly through the block of the human ether-a-go-go-related gene (hERG), which plays a critical role in cardiac repolarization. Therefore, understanding how neurological disorders lead to adverse cardiac ion channel remodeling is likely to have significant implications for the development of effective therapeutic interventions and helps improve the rational development of targeted therapeutics with significant clinical implications.


Asunto(s)
Antipsicóticos/efectos adversos , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/metabolismo , Canales Iónicos/efectos de los fármacos , Trastornos Mentales/tratamiento farmacológico , Antipsicóticos/uso terapéutico , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/metabolismo , Canales de Potasio Éter-A-Go-Go/antagonistas & inhibidores , Canales de Potasio Éter-A-Go-Go/efectos de los fármacos , Canales de Potasio Éter-A-Go-Go/metabolismo , Humanos , Canales Iónicos/antagonistas & inhibidores , Canales Iónicos/metabolismo , Trastornos Mentales/complicaciones , Factores de Riesgo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...