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1.
BMC Psychiatry ; 24(1): 104, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321443

RESUMO

BACKGROUND: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people's homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness. METHODS: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners' experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is 'successful rehabilitation' defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. DISCUSSION: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services. TRIAL REGISTRATION: ISRCTN17381762 retrospectively registered.


Assuntos
Reabilitação Psiquiátrica , Humanos , Medicina Estatal , Estudos de Coortes , Análise de Custo-Efetividade , Análise Custo-Benefício , Pacientes Internados
2.
Front Psychiatry ; 14: 1227218, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37720899

RESUMO

Introduction: Patients with psychosis can develop sexual dysfunction, which may be related to the disease itself, psychosocial factors, somatic comorbidities, and the use of psychotropic medication. Objective: We aimed to investigate the type and frequency of sexual dysfunction in patients diagnosed with schizophrenia or bipolar disorder in order to assess the side effects of antipsychotics in sexual function. Methods: This is a multicenter, cross-sectional study, involving patients diagnosed with schizophrenia (79.3%) or bipolar disorder (20.7%) treated in the Department of Psychiatry and Community Mental Health Centers from November 2018 to December 2019. Patients were enrolled in the study after signed informed consent. Demographic and clinical data were collected from patients through a semi-structured interview. The Antipsychotics and Sexual Functioning Questionnaire (ASFQ) was administered to assess sexual function. Results: A total of 87 outpatients on antipsychotics were recruited in the study. The mean age was 43.6 years, while the mean duration of the disease was 16.9 years. Overall, only 9.1% of patients spontaneously reported sexual dysfunction. Patients treated with oral first-generation antipsychotics had more difficulties in achieving orgasm and decreased erection capacity. In contrast, patients treated with oral second-generation antipsychotics had decreased ejaculation capacity. Patients on antipsychotic combination therapy were associated with higher rates of sexual anhedonia. Discussion: These results suggest that sexual dysfunction is a side effect of antipsychotic treatment, which was spontaneously rarely reported by patients. It seems essential to obtain a psychosexual clinical history before initiating antipsychotic treatment to evaluate following changes and adopt an individualized strategy to manage sexual dysfunction induced by antipsychotics.

3.
Sex Med ; 9(3): 100334, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33722475

RESUMO

INTRODUCTION: Sexual dysfunction in patients with psychoses may be associated with the psychiatric illness itself (negative symptoms, such as apathy, and avolition), comorbid somatic health, psychosocial factors (stigmatization, discrimination), and the use of psychotropic drugs. In Greece, research into the study of antipsychotic-induced sexual dysfunction is not sufficient. AIM: This study was conducted to translate and validate the Greek version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ) in a sample of patients receiving antipsychotic treatment. METHODS: A "forward-backward translation" method was applied. A pilot study was conducted with 15 outpatients with schizophrenia and bipolar disorder under antipsychotics treatment. Patients also completed the "Subjects' Response to Antipsychotics (SRA)" questionnaire in order to assess the validity of the ASFQ. The ASFQ and the SRA questionnaire were completed twice within 2 weeks. MAIN OUTCOME MEASURES: Reliability (internal consistency and test-retest) and validity were assessed. RESULTS: The Greek translation of ASFQ was reliable, with excellent internal consistency (Cronbach's a = 0.90 for men and 0.95 for women in both measurements). In addition, the Spearman correlation coefficient was 1 (P< .001) in all Likert-type questions in both assessments. Finally, Spearman correlation coefficients between ASFQ and SRA were moderately positive to strongly positive (between 0.25 and 1) in both assessments, demonstrating moderate to high validity. CONCLUSIONS: The Greek version of the ASFQ has proved to be a reliable and valid clinical instrument, hence it can be used in further studies in the Greek population. Angelaki M, Galanis P, Igoumenou A, et al. Translation and Validation of the Greek Version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ). J Sex Med 2021;9:100334.

4.
Soc Psychiatry Psychiatr Epidemiol ; 56(1): 75-84, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32627061

RESUMO

PURPOSE: In England, community mental health rehabilitation teams play a major role in supporting people with complex mental health needs to progress from inpatient to community settings and from more to less supported accommodation. We aimed to conduct the first study to investigate longitudinal outcomes for users of a community rehabilitation team and identify service user characteristics associated with successful progress along the rehabilitation pathway. METHODS: We used routinely collected clinical outcome data relating to all 193 users of a community rehabilitation team in inner London, transferred to the team between June 2013 and May 2018, with a cut-off data-collection date of 20th June 2019. We estimated the proportion who moved on to more independent accommodation successfully, with no breakdown in the placement. We conducted multivariable Cox proportional hazard regression to investigate associations between service user characteristics at transfer and successful move-on. RESULTS: Overall, 43/193 (23%) service users achieved successful move-on during a median follow-up of 51 months (IQR 32-63). This was more likely for those who were residing in more highly supported accommodation (HR 3.90; 95% CI 2.01-7.54) and those who had better functioning (HR 1.04, 95% CI 1.02-1.06) at transfer, while those with a serious physical health condition were less likely to achieve successful move-on (HR 0.44, 95% CI 0.21-0.95). CONCLUSION: Most supported accommodation services aim to offer time-limited support, but most service users do not progress successfully to more independent accommodation within 4 years. Investment in interventions that improve functioning and physical health may facilitate successful move-on.


Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Mentais , Reabilitação Psiquiátrica , Inglaterra , Humanos , Londres , Transtornos Mentais/terapia , Estudos Prospectivos
5.
J Forensic Leg Med ; 73: 101971, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32658745

RESUMO

The study explored health related quality of life of prisoners with diabetes mellitus (DM).48 male inmates incarcerated in a Greek prison, completed a demographic and clinical traits questionnaire. Prisoners with DM and those with additional health problems had worse physical, mental health and psychological well-being outcomes (p = 0.002, p < 0.001 and p = 0.014 respectively). People with DM in correctional facilities should receive specialized primary health care services either health services within the correctional institution or community liaison. The implementation of services targeting DM should be evaluated with the target of improving offenders' physical and mental health.


Assuntos
Diabetes Mellitus/epidemiologia , Prisioneiros/psicologia , Qualidade de Vida , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Dislipidemias/epidemiologia , Escolaridade , Grécia/epidemiologia , Cardiopatias/epidemiologia , Hepatite/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fumantes/estatística & dados numéricos
6.
Int J Neuropsychopharmacol ; 21(11): 988-996, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30124867

RESUMO

Background: Identification of biomarkers predicting therapeutic outcome of antidepressant treatment is one of the most important tasks in current research because it may transform the lengthy process of finding the right treatment for a given individual with depression. In the current study, we explored the potential of pretreatment pregenual anterior cingulate cortex activity as a putative biomarker of treatment response. Methods: Thirty-two medication-free patients with depression were treated for 6 weeks with a selective serotonin reuptake inhibitor, escitalopram. Before treatment began, patients underwent an fMRI scan testing response to brief, masked, presentations of facial expression depicting sadness and happiness. Results: After 6 weeks of treatment, there were 20 selective serotonin reuptake inhibitor responders and 12 nonresponders. Increased pretreatment pregenual anterior cingulate cortex activity to sad vs happy faces was observed in responders relative to nonresponders. A leave-one-out analysis suggested that activity in the anterior cingulate cortex was able to predict response status at the level of the individual participant. Conclusions: The study supports the notion of pregenual anterior cingulate cortex as a promising predictor of antidepressant response.


Assuntos
Citalopram/uso terapêutico , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/tratamento farmacológico , Giro do Cíngulo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Adulto , Antidepressivos/uso terapêutico , Depressão/diagnóstico por imagem , Depressão/tratamento farmacológico , Depressão/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Emoções , Expressão Facial , Reconhecimento Facial/fisiologia , Feminino , Giro do Cíngulo/fisiopatologia , Humanos , Masculino , Prognóstico , Escalas de Graduação Psiquiátrica
7.
Eur Psychiatry ; 52: 47-53, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29626758

RESUMO

BACKGROUND AND AIMS: Violent behaviour by forensic psychiatric inpatients is common. We aimed to systematically review the performance of structured risk assessment tools for violence in these settings. METHODS: The nine most commonly used violence risk assessment instruments used in psychiatric hospitals were examined. A systematic search of five databases (CINAHL, Embase, Global Health, PsycINFO and PubMed) was conducted to identify studies examining the predictive accuracy of these tools in forensic psychiatric inpatient settings. Risk assessment instruments were separated into those designed for imminent (within 24 hours) violence prediction and those designed for longer-term prediction. A range of accuracy measures and descriptive variables were extracted. A quality assessment was performed for each eligible study using the QUADAS-2. Summary performance measures (sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio, and area under the curve value) and HSROC curves were produced. In addition, meta-regression analyses investigated study and sample effects on tool performance. RESULTS: Fifty-two eligible publications were identified, of which 43 provided information on tool accuracy in the form of AUC statistics. These provided data on 78 individual samples, with information on 6,840 patients. Of these, 35 samples (3,306 patients from 19 publications) provided data on all performance measures. The median AUC value for the wider group of 78 samples was higher for imminent tools (AUC 0.83; IQR: 0.71-0.85) compared with longer-term tools (AUC 0.68; IQR: 0.62-0.75). Other performance measures indicated variable accuracy for imminent and longer-term tools. Meta-regression indicated that no study or sample-related characteristics were associated with between-study differences in AUCs. INTERPRETATION: The performance of current tools in predicting risk of violence beyond the first few days is variable, and the selection of which tool to use in clinical practice should consider accuracy estimates. For more imminent violence, however, there is evidence in support of brief scalable assessment tools.


Assuntos
Psiquiatria Legal , Hospitais Psiquiátricos , Prisioneiros/psicologia , Medição de Risco/estatística & dados numéricos , Violência/psicologia , Adulto , Agressão/psicologia , Feminino , Humanos , Masculino , Sensibilidade e Especificidade
8.
J Abnorm Psychol ; 126(8): 1066-1076, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29154567

RESUMO

Psychopathy consists of a constellation of affective-interpersonal features including lack of empathy, callousness, manipulativeness and interpersonal charm, impulsiveness and irresponsibility. Despite its theoretical and predictive value in forensic contexts, the relationships between the psychometric dimensions of psychopathy, including its antisocial features, and the construct's neuropsychological characteristics remain uncertain. In this study, 685 personality-disordered prisoners with histories of serious violent or sexual offenses were assessed for psychopathy before completing a computerized and well-validated assessment of the ability to recognize emotional expressions in the face. Prisoners with more of the affective features of psychopathy, and prisoners with more of its antisocial manifestations, showed relatively poor recognition accuracy of fearfulness and disgust. These relationships were independent and modest but were still evident following correction for demographic features (e.g., ethnicity and socioeconomic status), mental illness (e.g., substance and alcohol misuse), personality disorders (other than antisocial personality disorder) and treatment status. By contrast, the associations between these dimensions of psychopathy and emotion recognition were diminished by controlling for cognitive ability. These findings demonstrate that variability in the ability of high-risk personality-disordered prisoners to recognize emotional expressions in the face-in particular, fear and disgust-reflects both the affective and antisocial aspects of psychopathy, and is moderated by cognitive ability. (PsycINFO Database Record


Assuntos
Afeto , Transtorno da Personalidade Antissocial/psicologia , Emoções , Reconhecimento Facial , Prisioneiros/psicologia , Adulto , Transtorno da Personalidade Antissocial/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Comorbidade , Correlação de Dados , Empatia , Humanos , Masculino , Determinação da Personalidade/estatística & dados numéricos , Psicometria
9.
BMC Psychiatry ; 16: 180, 2016 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-27255770

RESUMO

BACKGROUND: Borderline personality disorder (BPD) is characterised by difficulties with impulse control and affective dysregulation. It is unclear whether BPD contributes to the perpetration of violence or whether this is explained by comorbidity. We explored independent associations between categorical and dimensional representations of BPD and violence in the general population, and differential associations from individual BPD criteria. METHODS: We used a representative combined sample of 14,753 men and women from two British national surveys of adults (≥16 years). BPD was assessed using the Structured Clinical Interview II- Questionnaire. We measured self-reported violent behaviour in the past 5 years, including severity, victims and locations of incidents. Associations for binary, dimensional and trait-level exposures were performed using weighted logistic regression, adjusted for demography and comorbid psychopathology. RESULTS: Categorical diagnosis of BPD was associated only with intimate partner violence (IPV). Associations with serious violence leading to injuries and repetitive violence were better explained by comorbid substance misuse, anxiety and antisocial personality disorder (ASPD). However, anger and impulsivity BPD items were independently associated with most violent outcomes including severity, repetition and injury; suicidal behaviours and affective instability were not associated with violence. Both trait-level and severity-dimensional analyses showed that BPD symptoms might impact males and females differently in terms of violence. CONCLUSIONS: For individuals diagnosed BPD, violence is better explained by comorbidity. However, BPD individual traits show different pathways to violence at the population level. Gender differences in BPD traits and their severity indicate distinct, underlying mechanisms towards violence. BPD and traits should be evaluated in perpetrators of IPV.


Assuntos
Transtorno da Personalidade Borderline/epidemiologia , Comportamento Impulsivo , Violência/estatística & dados numéricos , Adulto , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Borderline/psicologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Maus-Tratos Conjugais/estatística & dados numéricos , Inquéritos e Questionários , Violência/psicologia , Adulto Jovem
10.
Int J Law Psychiatry ; 47: 171-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27167215

RESUMO

OBJECTIVES: Τo explore the psychopathology of the Greek male prisoner population and the relationship between psychiatric disorders and the criminal history of the subjects. METHODS: The Iowa Structured Psychiatric Interview and the Personality Disorders Questionnaire were administered. The prevalence of the most common mental disorders was analyzed separately and in relation to the criminal history. SPSS was used for the statistical analysis. RESULTS: A total of 495 male prisoners were interviewed. Overall, 223 (45.06%) were diagnosed with a psychiatric disorder. Non-violent crimes were the most prevalent reason for imprisonment (40.7%). One-third (30.3%) of the sample was convicted with drug-related crimes, and 28.0% with violent crimes. DISCUSSION: The prevalence of mental disorders in Greek prisoners was higher than in the general population. Personality disorder was the most common type of mental disorder and the only psychiatric diagnosis related to violent crime. This highlights the need for screening for mental disorders and the need for therapeutic provision within the prison setting.


Assuntos
Comportamento Criminoso , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Prisioneiros/legislação & jurisprudência , Prisioneiros/psicologia , Internação Compulsória de Doente Mental/legislação & jurisprudência , Estudos Transversais , Grécia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Entrevista Psicológica , Masculino , Programas de Rastreamento , Transtornos Mentais/psicologia , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/psicologia , Prisioneiros/estatística & dados numéricos , Psicopatologia , Inquéritos e Questionários , Violência/psicologia , Violência/estatística & dados numéricos
11.
BJPsych Open ; 1(2): 149-157, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27703740

RESUMO

BACKGROUND: Violence among released prisoners with psychosis is an important public health problem. It is unclear whether treatment in prison can influence criminal behaviour subsequent to release. AIMS: To investigate whether treatment in prison can delay time to reoffending. METHOD: Our sample consisted of 1717 adult prisoners in England and Wales convicted of a serious violent or sexual offence. We used Cox regression to investigate the effects of treatment received in prison on associations between mental illness and time to first reconviction following release. RESULTS: Prisoners with current symptoms of schizophrenia reoffended quicker following release. Nevertheless, treatment with medication significantly delayed time to violence (18% reduction). Treatment for substance dependence delayed violent and non-violent reoffending among prisoners with drug-induced psychosis. CONCLUSIONS: Identifying prisoners with psychosis and administering treatment in prison have important protective effects against reoffending. Repeated screening with improved accuracy in identification is necessary to prevent cases being missed. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

12.
Schizophr Bull ; 41(2): 391-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25031222

RESUMO

Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis-∆(9)-tetrahydrocannabinol (THC)-causes paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying paranoia. A randomized, placebo-controlled, between-groups test of the effects of intravenous THC was conducted. A total of 121 individuals with paranoid ideation were randomized to receive placebo, THC, or THC preceded by a cognitive awareness condition. Paranoia was assessed extensively via a real social situation, an immersive virtual reality experiment, and standard self-report and interviewer measures. Putative causal factors were assessed. Principal components analysis was used to create a composite paranoia score and composite causal variables to be tested in a mediation analysis. THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity. The increase in negative affect and in anomalous experiences fully accounted for the increase in paranoia. Working memory changes did not lead to paranoia. Making participants aware of the effects of THC had little impact. In this largest study of intravenous THC, it was definitively demonstrated that the drug triggers paranoid thoughts in vulnerable individuals. The most likely mechanism of action causing paranoia was the generation of negative affect and anomalous experiences.


Assuntos
Afeto/efeitos dos fármacos , Agonistas de Receptores de Canabinoides/efeitos adversos , Dronabinol/efeitos adversos , Transtornos Paranoides/induzido quimicamente , Administração Intravenosa , Adulto , Agonistas de Receptores de Canabinoides/administração & dosagem , Dronabinol/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Paranoides/fisiopatologia , Adulto Jovem
13.
BMC Psychiatry ; 14: 332, 2014 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-25476202

RESUMO

BACKGROUND: Measures of research productivity are increasingly used to determine how research should be evaluated and funding decisions made. In psychiatry, citation patterns within and between countries are not known, and whether these differ by choice of citation metric. METHOD: In this study, we examined publication characteristics and citation practices in articles published in 50 Web of Science indexed psychiatric and relevant clinical neurosciences journals, between January 2004 and December 2009 comprising 51,072 records that produced 375,962 citations. We compared citation patterns, including self-citations, between countries using standard x(2) tests. RESULTS: We found that most publications came from the USA, with Germany being second and UK third in productivity. USA articles received most citations and the highest citation rate with an average 11.5 citations per article. The UK received the second highest absolute number of citations, but came fourth by citation rate (9.7 citations/article), after the Netherlands (11.4 citations/article) and Canada (9.8 citations/article). Within the USA, Harvard University published most articles and these articles were the most cited, on average 20.0 citations per paper. In Europe, UK institutions published and were cited most often. The Institute of Psychiatry/Kings College London was the leading institution in terms of number of published records and overall citations, while Oxford University had the highest citation rate (18.5 citations/record). There were no differences between the self-citation practices of American and European researchers. Articles that examined some aspect of treatment in psychiatry were the most published. In terms of diagnosis, papers about schizophrenia-spectrum disorders were the most published and the most cited. CONCLUSIONS: We found large differences between and within countries in terms of their research productivity in psychiatry and clinical neuroscience. In addition, the ranking of countries and institutions differed widely by whether productivity was assessed by total research records published, overall citations these received, or citations per paper. The choice of measures of scientific output could be important in determining how research output translates into decisions about resource allocation.


Assuntos
Pesquisa Biomédica/tendências , Fator de Impacto de Revistas , Publicações Periódicas como Assunto/tendências , Psiquiatria/tendências , Pesquisa Biomédica/métodos , Canadá , Geografia , Alemanha , Humanos , Países Baixos , Psiquiatria/métodos , Reino Unido , Estados Unidos
15.
Practitioner ; 256(1747): 13-6, 2, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22720454

RESUMO

Vascular dementia (VaD) is common. Pure vascular disease may account for 5-20% of all cases of dementia, while mixed dementia, Alzheimer's disease (AD) with VaD, occurs at least as frequently. There is no specific treatment or cure for VaD, but its proximity to other conditions may make it amenable to interventions at various stages. The causes of VaD are multifactorial and involve neuronal networks needed for memory and cognition, executive function and behaviour. Hypertensive angiopathy is the major known causative factor for VaD. Recent research suggests that VaD and AD occupy ends of the same spectrum and share common risk factors. As VaD is closely related to cardiovascular disease, modifying cardiovascular risk factors may assist in its prevention. Hypertension in midlife increases the risk of all-cause dementia. Regular screening of high-risk individuals could help to detect dementia early on enabling appropriate preventive intervention. Medication for hypertension, diabetes, and hypercholesterolaemia is recommended. Behavioural treatments include enhancing and encouraging cognitive and physical activity, social engagement, smoking cessation and healthy diet, including alcohol reduction. Comorbid depression is common in older people with dementia and treating this can improve cognition. Typically, patients are in their late sixties or early seventies, and may present after a cerebrovascular event. The onset is usually more acute than that of AD. Typical signs and symptoms are gait disturbance, unsteadiness and falls, urinary symptoms not explained by urological disease, pseudobulbar palsy and personality and mood changes. Insight is preserved until late in the disease and seizures or other manifestations of cerebral ischaemic accidents are not infrequent. VaD is characterised by stepwise deterioration with periods of partial recovery that can last months between periods of deterioration and cognitive decline.


Assuntos
Demência Vascular/diagnóstico , Demência Vascular/terapia , Idoso , Demência Vascular/etiologia , Humanos
16.
Heart Asia ; 4(1): 44-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-27326027

RESUMO

OBJECTIVES: The aim of this study was to investigate whether depressive symptoms are related to the risk factors for sudden death in patients with hypertrophic cardiomyopathy (HCM). DESIGN: 121 patients diagnosed as having HCM were assessed for depressive symptomatology using the Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale (CES-D) and followed up for a period of 2 years. For the interview, the authors used the Structured Clinical Interview for DSM-III/DSM-III-R. A multidimensional longitudinal study was carried out with both somatic and psychological symptoms and signs taken into consideration. SPSS was used for the statistical analysis. RESULTS: (1) Patients with HCM are more depressed than the general population. (2) There is no positive correlation between the occurrence of depressive symptoms and the risk factors for sudden death in patients with HCM. (3) Patients at high risk for sudden death are not more depressed than the others. (4) Time from diagnosis of the cardiac disease is not related to the presence and severity of depressive symptoms. CONCLUSIONS: Patients with HCM are more depressed than the general population. The authors suggest that depressive symptoms and risk factors for sudden death in these patients are not related. It is important to screen for mood disorders in this patient population in order to provide an early diagnosis and treatment of the psychiatric disease.

17.
BMJ Case Rep ; 20092009.
Artigo em Inglês | MEDLINE | ID: mdl-22171235

RESUMO

A case is presented of a man who has been detained in secure psychiatric hospitals for the majority of his life. Although his index offence was minor he has a long history of violence. The patient has collected a vast number of diagnoses over the years. His treatment demonstrates a role for clozapine in ameliorating violent behaviour and aggression. We conceptualise this as being linked to the properties of this drug. From the patient's history we believe that reserpine may have had a similar effect to clozapine regarding mental state and reduction of violent behaviour. This case illustrates the consequences of inaccurate diagnosis and therefore the provision of adequate treatment. It highlights that the continuity of care and the communication of information is essential for the patient's quality of life. It also illustrates how the use of certain antipsychotics may prove essential in the control of violence so that institutionalisation can be prevented.

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