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3.
Sci Prog ; 105(3): 368504221128775, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36154521

RESUMO

Professor Bajram Preza was a career neurologist with a strong background in research both in neurology and psychiatry. After a period of study in Sarajevo in the immediate post-WWII period, he completed his studies in medicine and a fellowship in neuropsychiatry in Nizhny Novgorod (formerly Gorky). A highly prolific author, he holds the laurels of the first medical dissertation sustained in the University of Tirana (1958) as well as for publishing the first student's textbook on medicine (Semiotics of nervous diseases, 1964) in Albania. He led the Clinic of Neurology in Tirana for more than three decades, while relentlessly lecturing, publishing and editing a diversity of medical papers, translations and original works that have shaped the professional education of entire generations of future Albanian physicians.


Assuntos
Neurologia , Neuropsiquiatria , Psiquiatria , História do Século XX , Humanos , Neurologistas , Neurologia/história , Neuropsiquiatria/história , Organizações , Psiquiatria/educação , Psiquiatria/história
4.
Expert Rev Clin Pharmacol ; 15(9): 1067-1080, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36062480

RESUMO

INTRODUCTION: Ashwagandha (ASW) is the extract of the plant Withania somnifera. It is widely used in complementary, alternative, and integrative medicine (CAIM) but is little discussed in mainstream modern medical literature. AREAS COVERED: We performed a review of potential pharmacotherapeutic properties of ASW. Studies were sourced from relevant online and offline databases. In animal models, ASW displays antioxidant activity. It has GABAergic and other neurotransmitter modulatory effects. It reduces apoptosis and promotes synaptic plasticity. It improves cognition and reverses induced cognitive deficits. It attenuates indices of stress. In human subjects, ASW enhances adaptogenesis in healthy adults. It modestly benefits generalized anxiety disorder and obsessive-compulsive disorder, and symptom severity in schizophrenia, substance use disorders, and attention deficit hyperactivity disorder. It improves sleep quality. EXPERT OPINION: ASW may confer modest benefit in certain neuropsychiatric conditions. Its benefits may arise from induction of neuroplasticity, antioxidant and anti-inflammatory effects, and modulation of GABA and glutamate, as well as other neurotransmitters. The antioxidant and anti-inflammatory actions may also benefit neurodegenerative states. Reports of clinical benefit with ASW must be interpreted with caution, given the paucity of randomized clinical trials (RCTs). Greater methodological rigor is necessary before clinical recommendations on ASW can be confidently made.


ASW is an extract of the Indian winter review and meta-analysis of four RCTs reported scientific studies on the use of ASW in animal and human subjects in order to identify potential clinical uses in modern medicine.Our review finds that ASW has antioxidant and anti-inflammatory action. It also modulates the effects of several neurotransmitters in the brain. It attenuates laboratory and clinical indices of stress. These mechanisms may benefit mental illnesses such as anxiety, depression, obsessive-compulsive disorder, schizophrenia, attention deficit hyperactivity disorder, and addictive disorders. ASW improves exercise capacity in healthy adults. It also appears to improve sleep quality. In addition, ASW may also improve cognitive functioning post-brain injury and in those at risk of dementia. There is evidence from animal models that ASW may also be of benefit in cancer, stroke, and induced organ damage.These studies, while suggesting a wide range of potential clinical applications for ASW, must be viewed with caution because the clinical data are based on small numbers of patients treated for a relatively short period of time. Many clinical trials that found benefits with ASW were one-off studies that have not been replicated. Larger and more methodologically stringent clinical trials are required before ASW can be confidently recommended for clinical use. Because ASW is a herbal extract and because the efficacy of its many constituents is not known, it is not possible to generalize conclusions to all extracts, whether standardized or not.


Assuntos
Neuropsiquiatria , Withania , Adulto , Animais , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Glutamatos , Humanos , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Ácido gama-Aminobutírico
5.
Psychiatr Danub ; 34(Suppl 8): 164-169, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36170723

RESUMO

BACKGROUND: The COVID-19 pandemic brought challenges to governments, healthcare systems (including, mental healthcare services), clinicians and researchers in the EU and worldwide. A range of neurological (e.g., brain fog, encephalitis, myalgia) and psychiatric (e.g., affective disorders, delirium, cognitive disturbances) complications of a novel nature have been observed in patients during the acute phase of illness, which often persist as a Long-COVID state for months after the primary recovery. The pandemic has progressed to a psychodemic and syndemic, affecting communities with social distress, panic, fears, increased home violence, and protest movements that derive from conspiracy theories and hostile attitudes towards vaccination and lockdown measures. In response to this complex scenario of major social changes, universities must face the need to equip the new generation of doctors with novel special skills. SUBJECTS AND METHODS: The study course (50 hours duration; 20 lectures, three webinars, three e-discussion forums, five local seminars, two social events, three intermediate assessments and a final test for certification; bilingual Russian/English hybrid format, information materials, video-content, interactive web-page and social media) was developed by the team of the International Centre for Education and Research in Neuropsychiatry (ICERN), and is unique for the EU. The course integrates the most relevant data on SARS-Cov-2-related neuropsychiatry, and COVID-19' pandemic impact on mental health and society, including assignment of the vulnerable groups of students and healthcare professionals. The major topics covered during the course are (i) Novel virus, (ii) Brain, (iii) Society. The project takes place originally in Samara State Medical University. The ICERN Faculty includes academic staff from France, Hungary, Italy, Russia, Switzerland, invited speakers from the WHO Regional Office for Europe and World Psychiatric Association (EU Zones) members, some of them employed at ICERN by remote work contracts. The format of the educational process for students is hybrid suggesting both remote and face-to-face events. Distant learning participants and EU lecturers are to attend on-line via zoom platform, whereas local participants and staff work face-to-face in the ICERN video-conference room. The course is addressed to a broad audience of doctors, undergraduate and postgraduate students, and researchers from EU wishing to upgrade their knowledge in the pandemic-associated neuropsychiatry. RESULTS: The evaluation process supposes three intermediate assessments and a final test for certification. On-line assessment is to be performed at the project web-page - 10 randomly selected questions with scoring from 1 to 10 each. The Pass Score is 70-100. At the end of the course all the participants receive certificates of Samara State Medical University according to the ERASMUS policy book, as planned in 2021. CONCLUSIONS: We formatted this course as essential for the target audience to improve their resources of professional adaptability in the field of neuropsychiatry and mental healthcare management during challenging times. The ICERN course in pandemic-related neuropsychiatry is essential for early career health professionals and targets the principles of "academia without borders" in the context of international medical knowledge exchange. In the conditions of the changing social situation this educational content is necessary for the young doctors to acquire the add-on skills on flexibility to switch toward new professional approaches in the times of need. The long-term outcomes in pandemic-related neuropsychiatry are still to be seen, though the first feedback on the course content is already promising for the academic community.


Assuntos
COVID-19 , Neuropsiquiatria , Encéfalo , COVID-19/complicações , Controle de Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2
6.
Hist Psychiatry ; 33(3): 350-363, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35979864

RESUMO

This article analyses the origins and formation of medical and social discourses on neurosis in colonial Korea. With the introduction of Western medicine after the Opening of Korea in 1876, neurasthenia and hysteria began to be understood as neurotic diseases, and their importance was further highlighted during the colonial period of 1910-45. The article also addresses the role of neuropsychiatry in forming discourses on neurosis. In medical communities during the colonial period, the main source of these discourses gradually shifted from internal medicine to neuropsychiatry. In particular, Korean neuropsychiatrists distinguished between neurosis and psychosis as a way to reinforce their authority. Neuropsychiatrists tried to explain the temperamental and environmental factors of neurosis from a psychoanalytic standpoint.


Assuntos
Transtornos Neuróticos , Transtornos Psicóticos , Humanos , Histeria , Neurastenia/diagnóstico , Neuropsiquiatria , Transtornos Neuróticos/diagnóstico , Psicanálise , Transtornos Psicóticos/diagnóstico , República da Coreia
7.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 15(3): 167-175, jul. - sept. 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-207932

RESUMO

Introduction: Incidence rates of dementia-related neuropsychiatric symptoms (NPS) are not known and this hampers the assessment of their population burden. The objective of this study was to obtain an approximate estimate of the population incidence and prevalence of both dementia and NPS.Methods: Given the dynamic nature of the population with dementia, a retrospective study was conducted within the database of the Basque Health Service (real-world data) at the beginning and end of 2019. Validated random forest models were used to identify separately depressive and psychotic clusters according to their presence in the electronic health records of all patients diagnosed with dementia.Results: Among the 631,949 individuals over 60 years registered, 28,563 were diagnosed with dementia, of whom 15,828 (55.4%) showed psychotic symptoms and 19,461 (68.1%) depressive symptoms. The incidence of dementia in 2019 was 6.8/1000 person-years. Most incident cases of depressive (72.3%) and psychotic (51.9%) NPS occurred in cases of incident dementia. The risk of depressive-type NPS grows with years since dementia diagnosis, living in a nursing home, and female sex, but falls with older age. In the psychotic cluster model, the effects of male sex, and older age are inverted, both increasing the probability of this type of symptoms.Conclusions: The stigmatization factor conditions the social and attitudinal environment, delaying the diagnosis of dementia, preventing patients from receiving adequate care and exacerbating families’ suffering. This study evidences the synergy between big data and real-world data for psychiatric epidemiological research. (AU)


Introducción: Se desconocen las tasas de incidencia de los síntomas neuropsiquiátricos (SN) asociados a la demencia, lo cual dificulta la evaluación de su carga para la población. El objetivo de este estudio fue obtener una estimación aproximada de la incidencia y prevalencia en la población tanto de la demencia como de los SN.Métodos: Dada la naturaleza dinámica de la población con demencia, se realizó un estudio dentro de la base de datos del Servicio Vasco de Salud (datos del mundo real) a comienzos y finales de 2019. Se utilizaron modelos de bosques aleatorios validados para identificar por separado los clústeres depresivos y psicóticos, con arreglo a su presencia en los registros sanitarios electrónicos de todos los pacientes con diagnóstico de demencia.Resultados: Entre los 631.949 individuos mayores de 60 años registrados, 28.563 fueron diagnosticados de demencia, de los cuales 15.828 (55,4%) mostraron síntomas psicóticos y 19.461 (68,1%) síntomas depresivos. La incidencia de la demencia en 2019 fue de 6,8/1.000 personas-años. Muchos de los casos incidentes de SN depresivos (72,3%) y psicóticos (51,9%) se produjeron en casos de demencia incidente. El riesgo de SN de tipo depresivo se incrementa con factores tales como los años transcurridos desde que se diagnostica la demencia, la residencia en un sanatorio, y el sexo femenino, pero desciende con la edad avanzada. En el modelo de clúster psicótico, los efectos del sexo masculino y la edad avanzada se invierten, incrementando ambos la probabilidad de este tipo de síntomas.Conclusiones: El factor de estigmatización condiciona el entorno social y actitudinal, demorando el diagnóstico de la demencia, impidiendo que los pacientes reciban los cuidados adecuados, y exacerbando el sufrimiento de las familias. Este estudio evidencia la sinergia entre los grandes datos y los datos del mundo real para la investigación epidemiológica psiquiátrica. (AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Demência/epidemiologia , Demência/diagnóstico , Prevalência , Neuropsiquiatria , Estudos Retrospectivos , Estudos Transversais
8.
Neuropsychopharmacol Rep ; 42(3): 315-322, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35697664

RESUMO

BACKGROUND: Disruptions in biological rhythm (BR) are considered a factor in the spread of many chronic diseases such as hypertension, diabetes, and depression. It has been shown that imbalance in BR disrupts the body's physiological timings; therefore, it is essential to have a tool for BR evaluation. METHODS: A cross-sectional study was conducted on a sample of 403 Jordanian participants (200 depressed people and 203 control groups). Classical test theory (CTT) was used to evaluate the psychometric properties of the Arabic version of BRIAN. We aimed to validate the Arabic version of Biological Rhythms Interview Assessment in Neuropsychiatry (BRIAN) by investigating its internal consistency and validity, assessing its factor structure, and exploring its relationships with depression and sleep disorders. RESULTS: The internal consistency (α) was 0.91. The concurrent validity was supported by the severity of depression and sleep disorders (r = 0.87, r = 0.83, p < 0.001). The BRIAN's ability to differentiate between depressed people and the control group supported its discriminant validity (t = 21.2, p = 0.001). With a sensitivity of 75 and a specificity of 95.57, BRIAN revealed good accuracy in distinguishing between depressed and non-depressed persons at cutoff 44. The exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) analyses supported its proposed three-factor solutions. CONCLUSIONS: The results demonstrated that the BRIAN-A has acceptable validity in detecting BR and could be useful in examining the impact of circadian disturbance on the Arabic population.


Assuntos
Neuropsiquiatria , Transtornos do Sono-Vigília , Estudos Transversais , Humanos , Periodicidade , Reprodutibilidade dos Testes , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia
9.
Semin Neurol ; 42(2): 78-79, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35675819
11.
Semin Neurol ; 42(2): 88-106, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35477181

RESUMO

Neuropsychiatry is a clinical neuroscience specialty focused on the evaluation and treatment of patients who present with symptoms at the intersection of neurology and psychiatry. Neuropsychiatrists assess and manage the cognitive, affective, behavioral, and perceptual manifestations of disorders of the central nervous system. Although fellowship training in behavioral neurology-neuropsychiatry exists in the United States and several other countries internationally, the need for neuropsychiatric expertise greatly outweighs the number of specialists in practice or training. This article serves as a primer for both neurologists and psychiatrists seeking to improve or refresh their knowledge of the neuropsychiatric assessment, including detailing aspects of the history-taking, physical exam, psychometric testing, and associated diagnostic work-up. In doing so, we urge the next generation of neurologists and psychiatrists to take on both the opportunity and challenge to work at the intersection of both clinical neuroscience specialties using an integrated neuropsychiatric perspective.


Assuntos
Transtornos Mentais , Neurologia , Neuropsiquiatria , Neurociências , Psiquiatria , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Neurologia/educação , Neuropsiquiatria/educação , Neurociências/educação , Psiquiatria/educação , Estados Unidos
12.
Riv Psichiatr ; 57(2): 106-114, 2022.
Artigo em Italiano | MEDLINE | ID: mdl-35426430

RESUMO

Neuropsychiatry mainly deals with processes of the mind related to neurological diseases. Only secondarily, it deal with depressive and anxiety syndromes, as reactions to the presence of an acute, chronic, or degenerative neurological disease. This review illustrate the most frequent neuropsychiatric disorders in the context of the main neurological diseases, focusing on secondary psychic reactions to the development of neurological diseases. The main purpose of this paper is therefore to amplify the sensitivity of psychiatric colleagues towards these clinical conditions in order to create a communication channel with fellow neurologists and neuroradiologists that is not limited to simple counseling.


Assuntos
Transtornos Mentais , Neuropsiquiatria , Ansiedade , Transtornos de Ansiedade , Encéfalo , Humanos
13.
Cogn Neuropsychiatry ; 27(4): 289-295, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35253617

RESUMO

INTRODUCTION: Alwyn Lishman appreciated that if we are to understand the psychological consequences of cerebral disorder we must study the interaction between organic disease and psychological processes. METHODS: We have reviewed Lishman's two major publications on the neuropsychiatry of head injury, published in 1968 and 1988, and considered their conclusions in the light of current knowledge. RESULTS: In his 1968 paper on the psychiatric sequelae of open head injuries sustained in World War II Lishman demonstrated associations between the type of psychiatric sequelae and the location of the injury. He also found that those with "somatic complaints", such as fatigue or sensitivity to light, showed less evidence of organic injury. In his 1988 paper, he attempted to explain why a mild head injury may be followed by long-lasting symptoms. He suggested that in the absence of complications early, organic, symptoms (physiogenesis) should recover quickly. However, this healthy recovery could be jeopardised by psychological factors (psychogenesis), resulting in long-lasting symptoms. This model of physiogenesis and psychogenesis remains relevant today. CONCLUSIONS: The ideas Lishman developed in these two papers were the basis for his huge contribution to the field of neuropsychiatry, and remain relevant today.


Assuntos
Lesões Encefálicas Traumáticas , Traumatismos Craniocerebrais , Neuropsiquiatria , Traumatismos Craniocerebrais/complicações , Humanos , Masculino
14.
Psiquiatr. biol. (Internet) ; 29(1)enero 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-207636

RESUMO

La paratonía es una alteración del tono motor, de interés en neuropsiquiatría por su presencia en la semiología de la demencia y la catatonía. En la paratonía, la resistencia a la manipulación pasiva es errática y depende de la intensidad del movimiento impuesto. Habitualmente se divide en un subtipo oposicionista (gegenhalten) y un subtipo facilitador (mitgehen). Desde el campo de las demencias, se han realizado esfuerzos para establecer una definición de consenso de la paratonía y para describir diferentes maniobras exploratorias, lo que contrasta con la indefinición y heterogeneidad conceptual que se encuentra en la literatura psiquiátrica alrededor de este término, que aún así, aparece en múltiples escalas y criterios diagnósticos de catatonía. Esto supone un problema en el contexto de las dificultades generales para definir y operacionalizar los signos característicos de la catatonía y la creación de instrumentos de evaluación aceptados universalmente. En el presente artículo se revisa la literatura científica de la paratonía con el objetivo de plasmar este problema, así como fomentar que los avances en su estudio desde otros campos puedan servir como referencia para su estudio en psiquiatría. (AU)


Paratonia is motor tone disturbance, of interest in neuropsychiatry due to its involvement in the semiology of dementia and catatonia. In paratonia, resistance to passive manipulation is erratic and depends on the intensity of the imposed movement. It is usually divided into an oppositional subtype (gegenhalten) and a facilitatory subtype (mitgehen). Efforts have been made in the field of dementia to establish a consensus definition of paratonia and to describe different exploratory manoeuvres. This contrasts with the conceptual ambiguity and heterogeneity found in the psychiatric literature regarding this term, which still appears in multiple scales and diagnostic criteria for catatonia. This is a problem given the general difficulties in defining and operationalising the characteristic signs of catatonia and in the creation of universally accepted assessment instruments. This article provides a review of scientific literature on paratonia to describe this problem, and encourage advances made in its research by other fields that could serve as a reference for its study in psychiatry. (AU)


Assuntos
Humanos , Catatonia , Demência , Rigidez Muscular , Neuropsiquiatria
15.
Psiquiatr. biol. (Internet) ; 29(1)enero 2022. tab
Artigo em Inglês | IBECS | ID: ibc-207640

RESUMO

Anti-Ma-2 encephalitis is a rare autoimmune condition which can display a wide range of neuropsychiatric symptoms. It is usually paraneoplastic as 96% of the cases are linked to the presence of a tumor, mainly testicular or pulmonary. Many of these patients can usually be misdiagnosed psychiatrically months before the proper diagnosis is set. Diagnostic battery tests must be exhaustive and treatment includes several lines of medications and treatment of the primary tumor, which determines severe but better prognosis than the rest of autoimmune encephalitic processes. Herein, we present a paradigmatic and almost unique clinical case of a 51-year-old man who was affected of this condition, suffering from left hemichorea, cerebellar and limbic symptoms. The symptomatology had been refractory to several treatment lines and no hidden tumor was detected. The case is accompanied by a narrative concise review of this condition. The wide range of symptomatology displayed, often preceding tumor diagnosis and its severe prognosis make essential to suspect these autoimmune entities when facing neuropsychiatric unusual and complex clinical pictures. Only two previous cases of Anti-Ma 2 encephalitis have been described before with these clinical manifestations, one in Iran and the other one in Germany. (AU)


La encefalitis Anti Ma-2 es una situación autoinmune rara que puede mostrar una amplia gama de síntomas neuropsiquiátricos, que son normalmente paraneoplásicos, ya que el 96% de los casos está vinculado a la presencia de un tumor, principalmente testicular o pulmonar. Normalmente muchos de estos pacientes reciben un diagnóstico psiquiátrico erróneo meses antes de que el diagnóstico adecuado sea establecido. La batería de pruebas diagnósticas debe ser exhaustiva, debiéndose incluir diversas líneas farmacológicas y el tratamiento del tumor primario, que determina un pronóstico grave aunque mejor que el resto de procesos de encefalitis autoinmunes. Presentamos aquí un caso paradigmático y casi único de un varón de 51 años afectado de esta situación, que padecía hemicorea izquierda, y síntomas cerebelares y límbicos. La sintomatología había sido refractaria a diversas líneas de tratamiento, no habiéndose detectado ningún tumor. El caso se acompaña de una revisión concisa narrativa de esta situación. La amplia gama de sintomatología exhibida que precede a menudo al diagnóstico del tumor, así como la gravedad de su pronóstico, hacen que sea fundamental sospechar estas entidades autoinmunes a la hora de enfrentarse a cuadros clínicos neuropsiquiátricos inusuales y complejos. Solo se han descrito anteriormente dos casos de encefalitis Anti-Ma 2 previos a estas manifestaciones clínicas: uno en Irán y otro en Alemania. (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Encefalite , Neuropsiquiatria , Prognóstico , Pacientes
19.
Inf. psiquiátr ; (246): 9-21, 1er trimestre 2022. graf
Artigo em Inglês | IBECS | ID: ibc-208055

RESUMO

The psychiatric syndromes derived from acquired brain injury are the behaviouralconsequences of the combination of cognitive,emotional and volitional sequelae. Theirimpact on the quality of life of patients andrelatives is far greater tan the impact ofmotor or sensory deficit. The descriptionof these behavioural presentations and anattempt to understand the formation of thesymptoms will be undertaken. Changes inawareness, empathy, emotional recognitionand regulation are important mediating factors.Behavioural changes mainly take theform of disinhibition or apathy. Psychoticsyndromes, major depression or bipolar disordersare rare. Some delusional ideas respondto changes in the perception of noveltyor to changes in body perception. (AU)


Los síndromes psiquiátricos y los cambios conductuales que se derivan del daño cerebralson las consecuencias de la combinaciónde las alteraciones volitivas, emocionales ycognitivas. El impacto en la calidad de vidade los pacientes y de sus familiares es significativamentemayor que el impacto de las secuelasmotoras o sensoriales. En este artículose aborda la descripción de estos trastornosneuropsiquiátricos y se propone un acercamientoa la comprensión de cómo se gestan.Los cambios en conciencia de situación, empatía,reconocimiento y regulación emocionalson factores mediadores importantes enla formación de los síntomas. Los cambiosconductuales se presentan principalmente enforma de apatía o desinhibición. Los síndromespsicóticos, los trastornos bipolares o ladepresión mayor son muy poco frecuentes.Por otro lado, las ideas delirantes respondena cambios en la percepción de la novedad/familiaridad de los estímulos o a cambios enla percepción del cuerpo que ocurren tras lesionesdel hemisferio derecho. (AU)


Assuntos
Humanos , Neuropsiquiatria/classificação , Neuropsiquiatria/tendências , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/terapia , Transtorno da Conduta , Apatia , Inibição Psicológica
20.
J Patient Saf ; 18(1): e343-e350, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34951611

RESUMO

BACKGROUND OBJECTIVES: Adverse drug events (ADEs) present the greatest risk of harm to patients in hospitals, especially those receiving neuropsychiatric treatment. The objective of the present record-based study was to test the appropriateness of the neuropsychiatry trigger tool (NPTT) to identify and measure harm due to adverse events (AEs). METHODS: A total of 1324 clinical case notes of discharged patients from 2017 to 2018 with a hospital stay >24 hours to <70 days were examined. RESULTS: One hundred forty-four (10.88%) patients experienced 166 AEs. A total of 854 triggers (range, 1-12 triggers per patient) were identified in 296 (22.36%) and 39 (2.94%) patients presented with triggers at admission. The overall AE rate per 1000 patient days was 12.73 (intensive care unit, 21; inpatient department, 11.54). Triggers at admission were altered sensorium and abnormal behavior followed by headache, ataxia, and aspiration pneumonia. A small number of triggers accounted for most AEs (laxative, rising liver function test (LFT), hypokalemia, hyponatremia, health care-associated infections, intubation, abnormal behavior/sensorium, hepatic encephalopathy, antiemetics), although type of AE reported differed by level of care. Most AEs caused minor harm, and relatively fewer patients experienced temporary harm requiring intervention (110; 8.29%), permanent harm (45; 3.39%), harm requiring initial/prolonged hospitalization (10; 0.75%), interventions to sustain life (24; 1.81%), and death (109; 8%). The higher the number of AEs, the longer was the length of stay (average increased from 9.32 to 17.33 days). The NPTT identified 30 times more AEs compared with 5 AEs reported by voluntary method. Medication-related ADEs were found in 130 (90%) of 144 patients who experienced AEs. Antitubercular drugs caused most ameliorable AEs (visual disturbance, drug-induced vomiting, deranged LFT, constipation). Care is needed in attributing harm because some triggers (abnormal sensorium/behavior, intubation, headache/dizziness, laxatives) may overlap with neurological illnesses (cerebrovascular accident [CVA]/meningitis/stroke). If the triggers are identified early, harm/discomfort to the patients can be reduced. The NPTT can be used in patient safety improvement projects. Harm occurred in 296 (22.28%) patients (temporary, 120 [9%]; permanent, 178 [13%]). Adverse events prolonged hospital stay (14.29 days) compared with 9.32 days in patients without AEs. CONCLUSIONS: A higher number of triggers per patient (≥5), trigger nature (intubation, cardiac arrest/shock), or the presenting illness (CVA/neuroinfections/status epilepticus/prolonged seizures) were correlated with the highest harm, that is, death. Because some triggers (abnormal sensorium/behavior, headache/dizziness, laxatives, intubation) may overlap with neurological illness (CVA/meningitis/stroke), care is needed in attributing harm. The NPTT identified 30 times more AEs compared with 5 AEs reported by voluntary method. Antitubercular drugs caused ameliorable AEs (visual disturbance, drug-induced vomiting, deranged LFT, constipation) and, if identified early, can reduce harm/discomfort to the patients.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neuropsiquiatria , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hospitalização , Humanos , Segurança do Paciente , Estudos Retrospectivos
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