[Treatment of clozapine-induced tachycardia with propranolol complicated by psoriasis]. / Behandeling van clozapinegeïnduceerde tachycardie met propranolol gecompliceerd door psoriasis.

A 25-year-old male developed sinus tachycardia after given clozapine for treatment-resistant psychosis in schizophrenia. The tachycardia was treated successfully with propranolol for several weeks. The patient developed skin eruptions, later diagnosed as psoriasis. Propranolol is known to be capable of causing, evoking or aggravating psoriasis. Several other drugs commonly used in psychiatric practice are also known to cause psoriasis. Doctors need to be aware to the possible side effects of such drugs because they can jeopardise the patient's wellbeing and reduce the efficacy of psychiatric treatment.

Substantial skin disorders in psychiatric illness coincide with diabetes and addiction.

BACKGROUND: Dermatological diseases in psychiatric patients are common; however, epidemiological data on this subject are scarce and to our knowledge integral studies of dermatological disease in psychiatric inpatients are not available yet. AIM: The aim of this study was to describe the incidence of dermatological problems in psychiatric inpatients. METHOD: This study evaluates the consultations for new dermatological problems by inpatients of a general psychiatric hospital of over 700 beds during a 6-month period. RESULTS: A total of 255 patients consulted their physician because of a new dermatological problem. Diagnoses (n=360) included skin infections (32%), accidents (7%), decubitus ulcers (7%), complications of medical treatment (3%), auto mutilation (1%) and neoplasms of the skin (1%). Patients with skin infections were likely to have diabetes [odds ratio (OR)=3.6; 95% confidence interval (CI): 1.56-8.40]. Patients with decubitus ulcers were likely to have an addiction problem (OR=6.4; 95% CI: 1.46-28.00). Dermatitis was associated with affective disorder (OR=2.5; 95% CI: 1.12-5.43) but not with psychosis (OR=0.5; 95% CI: 0.23-0.90). Only a poor correlation existed between the length of hospital stay and skin problems. CONCLUSIONS: Dermatological problems are common in hospitalized psychiatric patients. Patients with diabetes mellitus are at high risk for skin infections. There are significant relationships between the psychiatric and the dermatological diagnoses. The length of the admission to a psychiatric hospital does not seem to play a major role in skin diseases.

Skin disorders in chronic psychiatric illness.

BACKGROUND: Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. OBJECTIVE: To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. METHODS: Ninety-one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin. RESULTS: Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40-49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38-39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67-24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34-10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation. CONCLUSIONS: Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.

Screening for somatic disease in elderly psychiatric patients.

An inventory of the indications for laboratory tests, electrocardiography (EKG), and chest x-ray films was compiled in 194 elderly patients admitted to a general psychiatric hospital. Indications were obtained from data on medical history, physical complaints, chronically used medication, and findings of physical examination. The therapeutic benefit of tests was also evaluated. When the therapeutic value of nonindicated tests was assessed, only routine testing for glucose, folic acid, vitamin B12, and testing for urinary tract infection in women seemed useful. Furthermore, routine determination of full blood counts, certain liver enzymes, creatinine or urea, electrolytes, and thyroid-stimulating hormone seemed useful because of the frequency of indications. There were no arguments for performing the other evaluated laboratory tests, EKG, and x-ray films of the chest on a routine basis in these patients.

[Pressure sores in a psychiatric hospital: a report of 10 years of systematic decubitus treatment]. / Doorliggen in een psychiatrisch ziekenhuis: een verslag van tien jaar systematische decubitus-behandeling.

Ten years of systematic treatment of pressure sores in a general psychiatric hospital (1983-1992) are reported on. Most of the patients were aged 65 years or older. The prevalence of pressure sores among them varied between 1.4 and 3.8%, whilst among younger patients the prevalence varied between 0 and 0.8%. Over the reported ten years the seriousness of the wounds decreased and prognoses improved. The percentage of healed patients increased from 56 in 1983 to round about 80 in the last few years. Over the years the number of patients with new pressure sores showed a varying course.

[Nutritional status of elderly patients at admission to a general psychiatric hospital. An inventory]. / De voedingstoestand van oudere patiënten bij opname in een algemeen psychiatrisch ziekenhuis. Een inventarisatie.

The nutritional status of 121 psychiatric patients over the age of 60 years was examined on admission in a general psychiatric hospital. Before admission all patients were living independently. They were admitted directly from their homes. We found that the older psychiatric patient is evidently at risk for malnutrition. A quarter of the males had, according to the Quetelet's index, a low weight. Half of the males and one third of the females had a thiamin-deficiency, whereas half of all patients showed a deficiency of folic acid. Furthermore, in half of the males and one tenth of the females anaemia was diagnosed. Widowers and to a lesser extent also patients with an organic brain disease or psychotic disturbance ran a greater risk of malnutrition in comparison to their fellow patients. A relation between behaviour, measured by the Nosie (Nursing Observation Scale for Inpatient Evaluation) and the nutritional status was not found.

Dyspepsia in chronic psychiatric patients.

INTRODUCTION: We report on dyspeptic complaints among patients hospitalized in the long-stay ward of a general psychiatric hospital. METHODS: A representative sample of the patients was interviewed using a structured questionnaire. RESULTS: Eighty percent of the patients reported one or more symptoms of dyspepsia, and 68 % reported symptoms of reflux-like dyspepsia. CONCLUSION: Significant positive associations were found for dyspepsia complaints and clozapine (OR = 3.4), laxatives (OR = 4.4), and heavy smoking (OR = 2.3).