Catatonia in the medically ill: Differences and parallels in etiology, phenomenology and management.

OBJECTIVE: Catatonia is a disorder characterized by psychomotor symptoms. The etiology, symptomatology, response and outcome of catatonia in the medically ill has not been vigorously studied. Those who have catatonia associated with another mental disorder versus. catatonic disorder due to another medical condition may differ. The aim of this study is to study the causes, phenomenology and outcomes of medically ill patients with catatonia and explore differences among those who have catatonia associated with psychiatric illness vs. systemic medical illness. METHOD: We studied the incidence of catatonic symptoms in medically hospitalized patients to identify any apparent differences in clinical manifestations due to distinctive etiologies. Specifically, we assessed if there are differences between those who had catatonia associated with another mental disorder versus those with catatonic disorder due to another medical condition in their phenomenology, management and likelihood of response to treatment. RESULTS: Of our 40 patients, 18 patients (45%) had catatonia associated with another mental disorder, 17 (42.5%) had catatonic disorder due to another medical condition, and in 5 patients (12.5%) the cause of catatonia was not identified. The most common catatonic symptoms regardless of etiology in our medically ill were mutism, followed by rigidity, and immobility. Bipolar disorder, schizophrenia, major depressive disorder, metabolic abnormalities, anti NMDAR encephalitis were the most frequent causes of catatonia in our medically ill patients. Compared to subjects with catatonic disorder due to another medical condition, those with catatonia associated with another mental disorder had more frequent mannerisms (Chi-square = 4.27; p = 0.039), waxy flexibility (Chi-square = 11.0; p < 0.01), and impulsivity (Chi-square = 4.12, p = 0.042). Nonsignificant trends were noted for posturing (Chi-square = 3.74, p = 0.053), perseveration (Chi-square = 3.37, p = 0.067), and stereotypy (Chi-square = 2.91, p = 0.088) also being more frequent in catatonia associated with a psychiatric cause. DISCUSSION: Our data supports phenomenological differences between medical and psychiatric causes of catatonia in the medically ill.

Stress, health, noise exposures, and injuries among electronic waste recycling workers in Ghana.

BACKGROUND: Electronic waste (e-waste) recycling workers in low and middle-income countries have the potential for occupational injuries due to the nature of their work at informal e-waste sites. However, limited research exists on stress, noise, occupational injuries, and health risks associated with this work environment. This study evaluated injury experience, noise exposures, and stress risk factors among e-waste workers at the large recycling site in the Agbogbloshie market, Accra, Ghana. METHODS: Participants completed a survey addressing their work, health status, stress, exposures to several occupational hazards (including noise), use of personal protective equipment at work, and injury experience. A subset of participants also completed personal noise dosimetry measurements. Poisson regression was used to evaluate the association between the number of injuries experienced by participants and various factors evaluated in the survey. RESULTS: Forty-six male e-waste workers completed the survey, and 26 completed a noise dosimetry measurement. Participants experienced an average of 9.9 ± 9.6 injuries per person in the previous 6 months (range: 1-40). The majority of injuries were lacerations (65.2%), and the most common injury location was the hand (45.7%). Use of personal protective equipment was rare. The mean time-weighted average noise level was 78.8 ± 5.9 dBA. Higher perceived stress, greater age, poorer health status, not using gloves, and involvement in dismantling activities were associated with an increased number of injuries. After controlling for each of these risk factors, perceived stress level and perceived noise exposure were associated with a significantly greater number of injuries. CONCLUSIONS: Our study identified a large number of injuries among informal e-waste recyclers, and we found that higher levels of perceived stress and perceived noise were associated with an increased number of occupational injuries, even after controlling for other injury risk factors.

Heart Rate, Stress, and Occupational Noise Exposure among Electronic Waste Recycling Workers.

Electronic waste (e-waste) is a growing occupational and environmental health issue around the globe. E-waste recycling is a green industry of emerging importance, especially in low-and middle-income countries where much of this recycling work is performed, and where many people's livelihoods depend on this work. The occupational health hazards of e-waste recycling have not been adequately explored. We performed a cross-sectional study of noise exposures, heart rate, and perceived stress among e-waste recycling workers at a large e-waste site in Accra, Ghana. We interviewed 57 workers and continuously monitored their individual noise exposures and heart rates for up to 24 h. More than 40% of workers had noise exposures that exceeded recommended occupational (85 dBA) and community (70 dBA) noise exposure limits, and self-reported hearing difficulties were common. Workers also had moderate to high levels of perceived stress as measured via Cohen's Perceived Stress Scale, and reported a variety of symptoms that could indicate cardiovascular disease. Noise exposures were moderately and significantly correlated with heart rate (Spearman's ρ 0.46, p < 0.001). A mixed effects linear regression model indicated that a 1 dB increase in noise exposure was associated with a 0.17 increase in heart rate (p-value = 0.01) even after controlling for work activities, age, smoking, perceived stress, and unfavorable physical working conditions. These findings suggest that occupational and non-occupational noise exposure is associated with elevations in average heart rate, which may in turn predict potential cardiovascular damage.