RESUMO
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.
Assuntos
Doença Crônica/psicologia , Doença Crônica/terapia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Medicina Baseada em Evidências , Alemanha , Humanos , Transtornos Mentais/diagnóstico , Resultado do TratamentoRESUMO
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.
Assuntos
Hipercalcemia/metabolismo , Hipercalcemia/psicologia , Transtornos Mentais/etiologia , Transtornos Mentais/metabolismo , Adenoma/complicações , Adenoma/metabolismo , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/metabolismo , Transtornos de Ansiedade/psicologia , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/metabolismo , Cálcio/sangue , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/metabolismo , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/metabolismo , Neoplasias das Paratireoides/psicologia , Escalas de Graduação PsiquiátricaRESUMO
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.
Assuntos
Doenças Cardiovasculares/epidemiologia , Demência/epidemiologia , Infecções/epidemiologia , Doenças Metabólicas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Alemanha/epidemiologia , Serviços de Saúde para Idosos/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Prevalência , Medição de Risco , Fatores de RiscoAssuntos
Amnésia/diagnóstico , Disfunção Cognitiva/diagnóstico , Delusões/diagnóstico , Demência/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Amnésia/psicologia , Amnésia/terapia , Encéfalo/patologia , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapia , Delusões/psicologia , Delusões/terapia , Demência/psicologia , Demência/terapia , Feminino , Medicina Geral , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeAssuntos
Transtornos Mentais/complicações , Transtornos Mentais/terapia , Injúria Renal Aguda/complicações , Injúria Renal Aguda/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Depressão Pós-Parto , Complicações do Diabetes/terapia , Coma Diabético/complicações , Evolução Fatal , Feminino , Nível de Saúde , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/psicologia , Cooperação do Paciente , Transtornos da Personalidade/complicações , Transtornos da Personalidade/psicologia , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Esquizofrenia/complicações , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/terapia , Tentativa de SuicídioRESUMO
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.
Assuntos
Doença de Alzheimer/diagnóstico , Circulação Cerebrovascular , Demência por Múltiplos Infartos/diagnóstico , Ecoencefalografia , Idoso , Velocidade do Fluxo Sanguíneo , Isquemia Encefálica/diagnóstico , Humanos , Interpretação de Imagem Assistida por Computador , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Complicações do Diabetes , Transtornos Mentais/complicações , Adolescente , Adulto , Idoso , Comorbidade , Transtorno Depressivo/complicações , Diabetes Mellitus/epidemiologia , Feminino , Alemanha Ocidental , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Psicotrópicos/uso terapêuticoAssuntos
Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Haloperidol/efeitos adversos , Embolia Pulmonar/etiologia , Restrição Física/efeitos adversos , Idoso , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Evolução Fatal , Feminino , Haloperidol/uso terapêutico , Parada Cardíaca/etiologia , Insuficiência Cardíaca/etiologia , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Lorazepam/efeitos adversos , Lorazepam/farmacologia , Olanzapina , Guias de Prática Clínica como Assunto , Artéria Pulmonar/patologia , Embolia Pulmonar/patologia , Embolia Pulmonar/prevenção & controle , Esquizofrenia Paranoide/tratamento farmacológico , Esquizofrenia Paranoide/terapia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controleRESUMO
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.
Assuntos
Doença de Alzheimer/diagnóstico por imagem , Demência por Múltiplos Infartos/diagnóstico por imagem , Idoso , Doença de Alzheimer/fisiopatologia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/fisiopatologia , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Demência por Múltiplos Infartos/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Pulsátil , Ultrassonografia Doppler TranscranianaAssuntos
Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Antipsicóticos/efeitos adversos , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Comorbidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/mortalidade , Humanos , Transtornos Mentais/mortalidade , Doenças Respiratórias/complicações , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/mortalidadeRESUMO
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.
Assuntos
Psiquiatria Geriátrica/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Transtornos Psicóticos Afetivos/complicações , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/complicações , Feminino , Hospitais Gerais/estatística & dados numéricos , Humanos , Pneumopatias/complicações , Masculino , Transtornos Neurocognitivos/complicações , Estudos RetrospectivosAssuntos
Transtorno Bipolar/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/induzido quimicamente , Carbonato de Lítio/efeitos adversos , Síndrome Nefrótica/induzido quimicamente , Feminino , Humanos , Carbonato de Lítio/uso terapêutico , Pessoa de Meia-Idade , Proteinúria/diagnóstico , Proteinúria/etiologiaRESUMO
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.
Assuntos
Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Equipe de Assistência ao Paciente/organização & administração , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/terapia , Alemanha , Humanos , Transtornos Mentais/psicologia , Transtornos Psicofisiológicos/psicologiaRESUMO
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.