Organic delusional disorder in psychiatric in-patients: comparison with delusional disorder

Organic delusional disorder (ODD) is rarely diagnosed in psychiatric in-patients, and may be misdiagnosed as delusional disorder (DD) from a similar clinical presentation. The aim of the present study was to investigate the characteristics of ODD and to make a comparison with those of DD patients. Patients who conformed to DSM-III-R criteria for ODD were recruited from an 8-year psychiatric in-patient database. Matching controls were DD patients admitted over the same time period. The prevalence of ODD according to DSM-III-R criteria was 0.4% of total admissions and 2.9% of organic mental disorders. Compared to DD patients, ODD patients less often had a family psychiatric history, and had an older age of onset of psychiatric disorder, longer hospital stays and lower treatment dosage of antipsychotic drugs. It is suggested that a detailed medical history and examination are needed in patients with delusion, especially in patients with a late onset of psychiatric symptoms and no family psychiatric history.     

Suicide among psychiatric in-patients in Stockholm,Sweden

Abstract

The aim of this study was to analyse how sex, age, ethnicity and psychiatric disorders influence the suicide rate and to describe the methods used when committing suicide. The study was designed as a prospective follow-up study from 23 October 1984 to 31 December 1986. The study population was comprised of in-patients in psychiatric care from 23 October 1984 to 23 October 1985 living in the southern part of Stockholm, Sweden. Women had significantly higher standardised mortality ratios (SMR = 33.7. CI -31.6-35.8) of suicide (determined and undetermined) than men (SMR = 21.4, CI = 19.7-23.1), and the SMR of total mortality were 4.0 and 3.8 respectively. The suicide rate was 15.5 per 1000 patients and 2.6 during the hospitalisation period. For men and women aged under 50, suicide accounted for 60% and 75% respectively of the total mortality. Men had a higher (p < 0.0001) hospitalisation rate than women, 1082 and 1004 (per 100.000 and year) respectively. One-third of those who committed suicide died from an overdose and 35% were diagnosed as psychotic. Foreign-born individuals ran a twofold risk of committing suicide compared to Swedes. These findings are imponant and need to be further analysed in studies based on larger population samples.     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t-test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

A comparison of purposeless movements in psychiatric patients treated with antipsychotic drugs, and normal individuals.

Oro-facial dyskinesia and purposeless trunk and limb movements were assessed, using a standard videotape rating technique, in 182 psychiatric patients receiving antipsychotic medication, in a second sample of 43 elderly psychiatric patients also receiving antipsychotic drugs, and 85 normal, drug-naive subjects. In both the first patient sample and the group of normal subjects, oro-facial dyskinesia was more common over 50 years of age. Statistical analysis of the data suggested that drug-induced oro-facial dyskinesia has a characteristic pattern of movement distribution significantly different from that of idiopathic oro-facial dyskinesia. The videotapes of the first patient sample and the normal subjects were viewed by a neurologist who assessed and categorised all movements. Purposeless trunk and limb movements were classified as either normal or abnormal. Normal purposeless movements were significantly more common in the drug-naive subjects. The presence of abnormal movements such as choreiform movements, dystonias and stereotypies and mannerisms was limited, almost exclusively, to the patients.     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t -test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

Retrospective psychiatric assessment of 200 suicides in Budapest

Based on an interview with the closest family member, using the Schedule of Affective Disorders and Schizophrenia--SADS, a retrospective psychiatric assessment and diagnostic classification was carried out on 200 completed suicides. Eighty-one per cent of the victims had a recent psychiatric disorder, in 63% depression. The prevalence of psychiatric illnesses was similar to that of other studies from countries with lower suicide rates.     

Cross-cultural study of religious phenomenology in psychiatric in-patients

Case notes of patients from nine different cultural groups admitted to a London hospital were scrutinized for religious background and religious phenomenology. With the exception of preaching behaviour there were no statistically significant cultural differences, but certain trends were apparent. The pattern of religion in each cultural group could be understood in terms of the historical and geographical origins of these groups. Religious phenomenology was better explained in terms of deep-seated cultural factors rather than current religion.     

Sexual dysfunctions in a group of psychiatric in-patients

41 mentally ill patients with sexual dysfunctions were examined by means of a semistructured interview. In this interview we tried to assess quality, intensity and duration of the sexual dysfunctions. In addition to this we developed a self-rating-scale in order to assess the patients' possibilities to talk about their sexual problems with a therapist. These attitudes were related to the attitudes of the staff towards the same issue. We found out that the dysfunctions had lasted for 11.0 years on average and that 58.8 % of the patients hadn't made any attempts for specific therapeutic steps so far. Patients with sexual dysfunctions such as erectile impotence were more interested in having additional talks about their sexual problems than patients with sexual disturbances such as libido loss. They were also more inclined to see psychiatric medication as a cause for their sexual problems. In addition to this, the complete group of the examined patients considered as to be less important that the therapist was of the same sex than the staff, particularly if the interviewer was not of the same sex. Our results confirm the thesis, that it is worth paying more attention to sexual dysfunctions of mentally ill patients, necessary therapeutic steps should be taken if possible. A positive effect of this probably seems to be a better compliance.     

Oral health of psychiatric in-patients in Hong Kong

BACKGROUND: Poor oral health has been reported among various psychiatric populations. Little is known regarding the oral health among psychiatric patients in Asia. AIMS: To examine the oral health status of a group of Chinese psychiatric in-patients in a long-term rehabilitation facility. METHODS: A dental survey using the WHO standardised dental evaluation form was conducted in adult psychiatric patients in a rehabilitation programme. A qualified dentist examined all consenting patients. RESULTS: Ninety-one patients (64.8% male; mean age: 44.7 +/- 9.9 years; mean length of illness: 20.3 +/- 11.5 years) were included in the study, the majority (80.2%) diagnosed with schizophrenia. Malocclusion was found in 79.1% of patients. The mean number of missing teeth was 9.5 +/- 8.9. Bleeding on probing, calculus, shallow and deep pockets were found in 7.1%, 71.8%, 72.9% and 28.2% of patients, respectively. Dental caries were found in 75.3% of dentate patients. The mean number of caries per patient was 5.5 +/- 6.1. Fifty-four per cent of patients needed dental extraction and 78.8% required conservative dental treatment. Older age and length of illness were significantly associated with poor dental health. CONCLUSIONS: Oral health status of chronic psychiatric patients seems to be considerably worse than that of the general population. Mental health professionals should pay more attention to preventive oral health habits of psychiatric patients.     

Violence in psychiatric in-patients: review and clinical implications

The literature on violence by psychiatric patients is reviewed. Emphasis is given to recent papers relevant to clinical management. Most studies are cross-sectional. The Maudsley/Bethlem Violent Incidents Register is used to provide longitudinal data over a period in excess of 20 years. In acute units most violent actions are carried out by patients suffering from schizophrenia, personality disorder and alcohol or substance abuse. In longer stay units violence tends to be associated with either intractable schizophrenia or with organic syndromes-particularly mental impairment. Most in-patient violence is minor and repetitive. Patients at risk are usually easily identifiable by a past history of violence or aggression. Most psychiatric patients are non-violent, but a small proportion of patients account for a large number of incidents. Violence by psychotic patients is particularly likely to occur in the period leading up to and immediately following admission, when the patient is acutely disturbed. The prevention of violence is largely a matter of good psychiatric and nursing care for patients at risk. Much of the violence committed by recently admitted psychotic patients could be prevented if after care facilities were more effective in preventing non-compliance and relapse.     

Computerized self-assessment in psychiatric in-patients: acceptability,feasibility and influence of computer attitude

In recent years various approaches using computerized assessments and tests in psychiatry have been published. In our study, the acceptability and feasibility of computerized self-assessments and attitude to computers were examined in psychiatric in-patients, using an improved interactive schedule, the Interactive Self-Assessment Scale (ISAS), based on the Windows? operating system. In general we found a good level of acceptability and feasibility of the computerized self-assessment. Our results confirm the influence of attitude to computers on acceptability, and indicate a lack of self-confidence in interacting with computers, accompanied by a less positive attitude to computers than reported by healthy subjects and psychiatric out-patients. Computerized self-assessment is suitable for psychiatric in-patients. Nevertheless, further research is necessary in order to improve attitude to computers and the patient-computer interaction.