[Somatic morbidity in the mentally ill]. / Somatische Morbidität bei psychisch Kranken.

In addition to psychosocial impairment, patients with severe mental illness (SMI) are exposed to substantial risks with respect to physical health. Their life expectancy is significantly shortened in the range of 1-2 decades. Against this background common medical comorbidities of this important group of patients are discussed (e.g. cardiovascular, respiratory and metabolic disorders) with a focus on those clinical aspects most relevant for everyday psychiatric practice. Potentials for improvement of curative and preventive health care are outlined. Current scientific and clinical knowledge on somatic health of patients with SMI provides evidence of close interactions between physical and mental health. Meeting the challenge of compromised physical health in this particular group of patients might be a relevant topic for further conceptual development of psychiatry, psychotherapy und psychosomatic medicine.

[Psychiatric disorders in elderly patients caused by disturbed calcium metabolism]. / Ausgeprägte Störungen des Kalziumstoffwechsels als Ursache psychischer Störungen bei Alterspatienten.

We report on three patients admitted to psychiatric hospital due to mental disorder in the context of marked pathology of calcium metabolism: a 69 years old male patient with known major depression developed pronounced deterioration of his mental state with distinct hypercalcemia due to parathyroid adenoma, a 90 years old male patient came to treatment with organic affective und delirious symptomatology caused by severe hypercalcemia due to bronchial carcinoma, and a 79 years old female patient was admitted for mixed depressive and anxiety syndrome with profound hypocalcemia and -magnesaemia originating in malabsorption syndrome due to Crohn's disease. Although all patients had received general medical care previously the relevance of their metabolic disorders with regard to their psychopathology had not been ascertained. In all cases treatment of disturbed electrolyte metabolism resulted in an at least temporary improvement of their psychiatric symptomatology. Our case reports referring to elderly patients with multimorbidity underscore the etiological relevance of disturbed calcium metabolism with regard to a broad spectrum of psychiatric syndromes.

General medical interventions in patients with dementia treated in a psychogeriatric unit.

Medical records of 50 consecutive psychogeriatric inpatients with moderate or severe dementia were retrospectively analyzed. Comorbid general medical disorders were diagnosed in 88% of the patients (202 disorders; mean: 4.6/patient). At least one general medical intervention was initiated during hospital treatment in 78% of patients (82 interventions in 39 patients with a mean length of stay of 38.8 days). Interventions were most frequently related to respiratory and urinary tract infections, followed by cardiovascular diseases and metabolic disorders, respectively. In conclusion, psychogeriatric patients with advanced dementia are in need of a substantial amount of general medical care.

Multiinfarct and Alzheimer-type dementia investigated by transcranial Doppler sonography.

Primary degenerative dementia of the Alzheimer type and multiinfarct dementia exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by transcranial Doppler sonography. The pulsatility indices, as angle-independent parameters of peripheral vascular resistence, measured in middle cerebral and basilar arteries of patients with multiinfarct dementia were significantly increased (p less than 0.005) compared with cases of primary degenerative dementia of the Alzheimer type and with healthy age-matched controls.

Psychiatric disorders and diabetes--results from a community study.

In the Upper Bavarian Field Study a total of 1536 persons (15 years and older) were interviewed by research psychiatrists. The prevalence of diabetes (ICD 250) identified by the interviewer and/or the primary care physician was 4.0%. Since the number of diabetics among the younger age groups was relatively low (n = 7) and in order to obtain a more homogeneous study group, only those over the age of 55 were considered in further analysis. Diabetics were compared with a control group of persons with another chronic medical condition of similar clinical severity and a control group without a somatic disorder. The sex- and age-adjusted prevalence of psychiatric disorders identified with the aid of the Clinical Interview Schedule was significantly higher among diabetics (43.1%) and persons with other chronic medical conditions (50.7%) in comparison to the healthy control group (26.2%). The difference was mainly due to mild psychiatric disorders and those suffering from depression. No statistically significant association was found between diabetes and moderate to severe mental disorders, the use of psychotropic drugs and previous psychiatric treatment.

Multiinfarct dementia vs Alzheimer's disease: sonographic criteria.

Primary degenerative dementia of the Alzheimer type (DAT) and multiinfarct dementia (MID) exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by means of transcranial Doppler sonography. The pulsatility indices, as angle-independent parameters of peripheral vascular resistance, measured in middle cerebral and basilar arteries of patients with MID, were significantly increased (P < 0.005) with respect to cases of primary DAT and to healthy age-matched controls. Approximately 75% of all MID patients exhibited small-vessel disease rather than thromboembolism from the extracranial arteries and the heart, as judged by extracranial and transcranial Doppler sonographies, computerized cerebral tomographies, EEGs, and, if necessary, 2-D echocardiographies.

[Transfer of patients between a unit of geriatric psychiatry and general hospitals: a one-year analysis]. / Verlegungen zwischen Gerontopsychiatrie und Allgemeinkrankenhaus: Analyse der Daten eines Jahres.

BACKGROUND AND OBJECTIVE: Patients with psychogeriatric disorders normally are affected by comorbid medical illnesses. In this context the question where to set therapeutic priorities often arises. With regard to that issue frequency of and indications for patient transfer from general hospital to a psychogeriatric unit and vice versa were evaluated in this study. PATIENTS AND METHODS: Retrospective analysis of all admissions during one year in a geriatric psychiatry department of a regional hospital for psychiatry and neurology. RESULTS: 1005 episodes of treatment were analysed: 65.9 % female patients, mean age 76.7 + or - 9.3 years, mean length of stay 37.2 + or - 25.1 days; main diagnoses: organic mental disorders 50.9 %, affective disorders 30.8 %, others 18.3 %. In 330 cases patients were transferred, either from general hospital to the psychogeriatric unit (n = 164) or vice versa (n = 100), or transfer took place back and forth (n = 66). In the overall 166 transfers to general hospitals acute general medical conditions were the most frequent causes (62.7 %), with cardiovascular and respiratory diseases representing the most common diagnoses (24.1 and 13.3 % of all transfers, respectively). CONCLUSION: Although the results presented here originate from one single region and thus cannot be taken as representative for Germany as a whole they indicate a considerable overlap of the clientele of general hospitals and psychogeriatric units. In view of expected demographic changes which presumably will result in a growing proportion of persons with (psycho)geriatric disorders, cooperation between general hospitals, psychogeriatric departments and outpatient treatment has to be intensified with high priority.

[An interdisciplinary unit for major psychiatric/somatic comorbidity: concept and 22 years of experience]. / Interdisziplinäre Station für psychisch Kranke mit erheblichen somatischen Komorbiditäten: Konzept und Erfahrungen von 1985-2007.

In this article we describe in detail a specialised facility geared toward caring for patients presenting with major psychiatric and somatic comorbidity. Located in a psychiatric hospital, an important feature of the treatment offered in this unit is that psychiatric/psychotherapeutic and somatic care are provided by the same team members. Working in this unit places high demands on the medical team, which must be competent in both fields, especially during emergency situations. Due to the severity of the patients' symptomatology, the unit requires more staff than regular psychiatric wards. Frequent psychiatric diagnoses necessitating the transfer of patients to this ward include delirium associated with internal/neurologic disorders or occurring postoperatively, and affective syndromes and dementia due to general medical conditions. Somatic disorders frequently requiring treatment in this ward include acute cardiovascular syndromes, liver or renal failure, infections, and conditions arising postoperatively or following trauma.

[Hallucinogen-induced psychological disorders]. / Halluzinogen-induzierte psychische Störungen.

OBJECTIVE: The purpose of this article is to provide an overview of the current research on hallucinogen induced psychiatric disorders. In addition to LSD and psilocybin hallucinogens of biologic origin are increasingly used by adolescents and young adults. METHODS: Relevant literature and related articles were identified by means of a computerized MEDLINE search including the years 1997 - 2007. As keywords "hallucinogen induced psychosis", "hallucinogen induced flashback", "hallucinogen persisting perception disorder (HPPD)" were used. Finally, 64 journal articles and books out of 103 were included in the review. RESULTS: Acute psychotic syndromes in adolescents are rarely due to intoxications with hallucinogenic drugs. However, clinical relevance of flashback phenomena as post-hallucinogenic psychiatric disorder has to be disputed. Because of the high popularity of biogenic hallucinogens and LSD knowledge of intoxications and resulting psychiatric disorders as well as medical complications and therapeutical approaches are clinically important. Especially intoxications with drugs of herbal origin like tropanalcaloids play an important role in emergency situations.