Psychiatric implications of presymptomatic testing for Huntington's disease

Responses of 69 at-risk individuals suggest that potential for psychiatric problems exists for those testing positive for the Huntington Disease gene and for their relatives. Their families were found to have high rates of psychiatric dysfunctions and suicide. Poorly developed social support networks and the psychological defensive strategies of many at-risk people may also contribute to post-test psychiatric morbidity. The active involvement of mental health professionals is emphasized.     

The genetics of childhood psychiatric disorders: a decade of progress

OBJECTIVE: To review the literature over the past decade on the genetics of childhood neuropsychiatric disorders. METHOD: A computerized search was performed for articles published in the past decade, and selected papers were highlighted. RESULTS: The past decade of research has illuminated the complex genetics of early-onset mental disorders. Advances in statistical methodologies and laboratory-based gene-hunting techniques are laying the foundation for a deeper understanding of both the biological and environmental factors that contribute to mental illness. Researchers are on the verge of identifying and characterizing genetic vulnerabilities involved in common childhood psychiatric syndromes. CONCLUSIONS: Although the study of the genetics of childhood psychiatric disorders has advanced significantly over the past decade, considerable work remains. The identification of genes conferring vulnerability to psychiatric illnesses will have the potential to transform the field by providing insight into both biological and environmental determinants that contribute to serious developmental and psychiatric disorders in children and adolescents. These advances promise new understanding and new avenues for prevention and treatment. They will also present physicians and families with significant clinical and ethical challenges.     

Life events in a South Indian population and their association with psychiatric disorder in children

Western research suggests that life events contribute to childhood psychiatric disorder but no studies have examined this in developing countries. During a population-based study of 1,403 8-12 year old children in Kerala, South India, a life events schedule was administered to parents of children with ICD10 psychiatric disorders (n = 72) and controls. Life events were associated with lower social class, greater poverty, less educated parents, worse physical health and psychiatric disorder. Multivariate analysis confirmed the association of life events with psychiatric disorder, independent of indices of social adversity.     

Stress hormone-related psychopathology: pathophysiological and treatment implications.

Stress is commonly associated with a variety of psychiatric conditions, including major depression, and with chronic medical conditions, including diabetes and insulin resistance. Whether stress causes these conditions is uncertain, but plausible mechanisms exist by which such effects might occur. To the extent stress-induced hormonal alterations (e.g., chronically elevated cortisol levels and lowered dehydroepiandrosterone [DHEA] levels) contribute to psychiatric and medical disease states, manipulations that normalize these hormonal aberrations should prove therapeutic. In this review, we discuss mechanisms by which hormonal imbalance (discussed in the frameworks of "allostatic load" and "anabolic balance") might contribute to illness. We then review certain clinical manifestations of such hormonal imbalances and discuss pharmacological and behavioural treatment strategies aimed at normalizing hormonal output and lessening psychiatric and physical pathology.     

Psychiatric comorbidities of episodic and chronic migraine

Migraine is a prevalent disabling neurological disorder associated with a wide range of medical and psychiatric comorbidities. Population- and clinic-based studies suggest that psychiatric comorbidities, particularly mood and anxiety disorders, are more common among persons with chronic migraine than among those with episodic migraine. Additional studies suggest that psychiatric comorbidities may be a risk factor for migraine chronification (i.e., progression from episodic to chronic migraine). It is important to identify and appropriately treat comorbid psychiatric conditions in persons with migraine, as these conditions may contribute to increased migraine-related disability and impact, diminished health-related quality of life, and poor treatment outcomes. Here, we review the current literature on the rates of several psychiatric comorbidities, including depression, anxiety, and post-traumatic stress disorder, among persons with migraine in clinic- and population-based studies. We also review the link between physical, emotional, and substance abuse, psychiatric disorders, and migraine. Finally, we review the data on psychiatric risk factors for migraine chronification and explore theories and evidence underlying the comorbidity between migraine and these psychiatric disorders.     

Illness behaviour as a determinant of referral to a psychiatric consultation/liaison service

Recognition of psychiatric disturbance and rate of referral to psychiatric units in general hospitals falls far short of the prevalence of psychiatric morbidity in such hospitals. This study has sought to determine whether particular patterns of "illness behaviour" contribute to the decision to refer. A group of patients referred to a psychiatric service was compared to a group of non-referred patients using the General Health Questionnaire (GHQ) as a general measure of morbidity, the Inventory to Diagnose Depression (IDD), the State-Trait Anxiety Inventory (STAI) and the Illness Behaviour Questionnaire (IBQ). The rate of referral to the service was 2.9%. The estimated prevalence of psychiatric morbidity was 30%. Referred patients scored more highly on all measures of morbidity (GHQ, IDD, STAI) and on the IBQ scale Affective Disturbance, and scored lower on the Denial Scale. Data are reported which suggest that patients with a strong somatic focus are less likely to be referred for psychiatric assessment despite the presence of significant psychiatric morbidity. The implications for health care delivery and identification of psychiatric morbidity are discussed.     

Mental Health Telephone Triage: Managing Psychiatric Crisis and Emergency

PURPOSE: The study aims to identify and articulate how mental health telephone triage (MHTT) clinicians manage psychiatric crisis and emergency via the telephone. DESIGN AND METHODS: An observational design was employed in the study. Wireless headsets were used to observe 197 occasions of MHTT. FINDINGS: Clinicians use a range of practical strategies, therapeutic skills, and psychosocial interventions to manage psychiatric crises and emergencies via the telephone. PRACTICE IMPLICATIONS: The evidence base for managing psychiatric crisis/emergency in MHTT is minimal. These findings contribute to the MHTT knowledge base and provide evidence‐based strategies for high‐quality emergency mental health care.     

What Does it Take to Transfer Training?

Abstract

Staff training is a necessary component in psychiatric rehabilitation programs, providing the basis of a skilled and integrated workforce. However, it has been found repeatedly that training is not sufficient to result in an improved quality of care for clients. What is required to make training effective is a parallel emphasis upon the organizational context within which these trained skills are to be applied. The present paper provides a review of the contextual factors that contribute to training effectiveness. A case study of the transfer of staff training (N=10) in psychiatric rehabilitation skills illustrates several of these factors. Conclusions are drawn about the factors that contribute to successful transfer of training, and about future research requirements.     

The intermediate and long-term supports for the suffered places of the Higashi-Nihon Huge earthquake. From the point of view of the community living and psychiatric rehabilitation

The intermediate and long-term supports for suffered places of the Higashi-Nihon Huge Earthquake were discussed from the viewpoint of the community living and psychiatric rehabilitation. It might be useful to prevent from exacerbation of psychiatric disorders that gathering information, communication skills, relation with neighborhood, and joining training for disaster defense, and so on are acquired by persons with psychiatric disorders in the community living. If persons with psychiatric disorders are cared as disabled against disaster without empowering them with these skills, they cannot contribute to new society after disaster and worse estrangement from the society might appear. The Japanese Association of Psychiatric Rehabilitation proposed two models of one-stop service combining psychiatric service, mental health, and welfare from the viewpoint to support the community living; multi-disciplinary outreach team based temporary psychiatric clinic focusing psychiatric services, and comprehensive community living support center focusing mental health and welfare. It depends on demands of the suffered places which model is better adjusted, and hybrid model is possible. The important need to build long-term support system for people of supporting suffered persons from this huge earthquake was mentioned.     

The lived experience of long-term psychiatric hospitalization of four women in Brazil

PROBLEM: What is the experience from long‐term psychiatric hospitalization? How can psychiatric nursing contribute to reduce the emotional suffering and the feeling of social exclusion related to this process? METHODS: This study was conducted on four women committed to long periods of psychiatric hospitalization in Brazil. Data were collected through open interviews and drawings made by the patients, and interpreted according to the theory of social representations. FINDINGS: Reports on the patients refer to a process of social exclusion, emotional suffering, and inadequate treatment in the hospital, leading to no other option but recurrent hospitalization. CONCLUSION: Negative experiences related to long‐term hospitalization could possibly be minimized through adequate assistance provided by psychiatric nursing in open services, as proposed in the recent Brazilian psychiatric reform.     

Diagnostic characteristics of inpatients in a Western African psychiatric hospital

Little is known about psychiatric patients and psychiatric service delivery in non-Western developing countries. Therefore, this naturalistic pilot study aimed at analysing and describing the patient population treated in the Tanka Tanka Psychiatric Hospital, the mental health inpatient facility of The Gambia. Most patients were male and exhibited a wide age range of over 40 years. There were also indicators that the hospital population consisted of two distinguished groups: a large group of chronically ill patients and a smaller group of psychiatric patients with very acute symptoms. Psychotic/mood disorders and substance dependence/abuse were the most common diagnoses. In many patients problematic cannabis use was prevalent. Such research can contribute to better understand the needs of psychiatric patients, and help to develop continuously improved service delivery and optimise therapeutic options.     

Interferon alpha (IFNalpha) and psychiatric syndromes: a review

Interferon alpha (IFNalpha) is used for the treatment of several disorders, such as chronic hepatitis or malignant melanoma. During the therapy, IFNalpha may cause severe neuropsychiatric syndromes including depression with suicidal ideation, paranoid psychoses, or confusional states. The reasons and management of these side effects are widely unknown. Our aim is to review research evidence for the contribution of IFNalpha for the etiopathology of psychiatric syndromes. Therefore, research findings of neuropsychiatric syndromes induced by IFNalpha treatment, the putative mechanisms underlying those syndromes, and their treatment are-reviewed. Furthermore, neuropsychiatric syndromes in diseases with high IFNalpha levels such as systemic lupus erythematosus (SLE) are discussed. Finally, the question is addressed whether IFNalpha may contribute to the etiopathology of endogenous psychiatric disorders. IFNalpha may cause psychiatric syndromes in a subset of treated patients. The underlying pathogenetic mechanisms include various effects on neuroendocrine, cytokine, and neurotransmitter systems. Research data on the role of IFNalpha in the pathogenesis of endogenous psychiatric disorders are conflicting. Future research should improve our understanding of the role of IFNalpha for the etiopathology of psychiatric syndromes and has an impact on treatment of IFNalpha-induced psychiatric syndromes.     

Kinematic movement analyses and their application in psychiatry

There is a long tradition to develop valid instruments for the exact assessment of psycho-motor dysfunctions in psychiatry. However, progress is hampered by the complexity of emotionally driven movements in psychiatric patients. Methods used up to now either remains unspecific due to only qualitative measurements or focus on the neurophysiological aspects too much. Thus, the results accomplished so far are only very general unspecific concerning different groups of psychiatric patients. In this paper, two own methods are presented which are aimed to avoid the two poles above mentioned. Kinematic analyses of facial expressions as well as handwriting movements provide quantitative and quite specific informations about psycho-motor dysfunctions of psychiatric patients and the effects of psychotropic substances. Thus, these methods are well suitable for relating them to other neurobiological parameters in order to contribute to the pathophysiological understanding of psycho-motor symptoms in psychiatric patients.     

The Psychiatric Family Nurse Practitioner: A Collaborator in Family Practice

The potential of the psychiatric family nurse practitioner (Psych.F.N.P.) to contribute to family practice through physical care and mental health care exists in the here and now. This role is a synthesis of 2 advanced practice roles, the psychiatric clinical nurse specialist (Psych.C.N.S.) and family nurse practitioner (F.N.P.), both of which continue to have great utility independently. This synthesis is a practical application of concepts that have evolved to meet the changing patterns of health care delivery. At this time, dual certification as a Psych.C.N.S. and F.N.P. best reflects the broad practice expertise of the psychiatric family nurse practitioner. The experienced psychiatric family nurse practitioner provides direct care for both physical and psychological needs of patients in a family practice setting.     

The culture and history of psychiatric stigma in early modern and modern Western societies: a review of recent literature

This report continues a review of literature pertaining to psychiatric stigma in Western societies. It concentrates on the early modern and modern periods. The general role played by the medical profession in these two periods with respect to those suffering from psychiatric illness is emphasized. In the initial phase, its largely scientific academic perspective was prominent, and the church's influence continued but became less important. In general, it was during these two periods that the state became increasingly influential in policies involving the institutionalization of marginal populations, including the mad and insane. Many "revisionist" historians have criticized the role played by the emerging psychiatric profession in this whole process and these writings are reviewed. Overall, a complex assortment of factors are seen to contribute to an accentuation of psychiatric stigma that had its roots in the classical and medieval periods.     

Seeing the unexpected: how sex differences in stress responses may provide a new perspective on the manifestation of psychiatric disorders

In this report, the authors propose that underlying sex differences in the biobehavioral response to stress may contribute to the variance in prevalence of some psychiatric disorders based on sex. The authors begin with a discussion of stress physiology and review a new theory on sex differences in stress responses (ie, the “tend-and-befriend” response), which may provide a recent framework for considering sex differences in the manifestation of some psychiatric illnesses. The authors then move to a discussion of major depression and attention deficit hyperactivity disorder as examples of how sex differences in stress responses may influence the behavioral symptoms of psychiatric disorders that are more often diagnosed in one sex compared with another. The authors conclude with a brief discussion of the implications of this new perspective on treatment approaches and encourage further inquiry into the importance of sex-based differences in the behavioral manifestation of some psychiatric illnesses.     

Neuroradiologic Evidence of Pre‐Synaptic and Post‐Synaptic Nigrostriatal Dopaminergic Dysfunction in Idiopathic Basal Ganglia Calcification: A Case Report

Idiopathic basal ganglia calcification (IBGC) is a neuropathological condition known to manifest as motor disturbance, cognitive impairment, and psychiatric symptoms. The pathophysiology of the psychiatric symptoms of IBGC, however, remains controversial. A previous biochemical study suggested that dopaminergic impairment is involved in IBGC. We thus hypothesized that dopaminergic dysfunction might be related with the psychiatric manifestations of IBGC. We used positron emission tomography to measure glucose metabolism and dopaminergic function in the basal ganglia of an IBGC patient with psychiatric symptoms. The results showed that widespread hypometabolism was evident in the frontal, temporal, and parietal cortices while the decline in dopaminergic function was severe in the bilateral striatum. The functional decline of the dopamine system in the calcified area of the bilateral striatum and the disruption of cortico‐subcortical circuits may contribute to clinical manifestations of IBGC in our patient.     

Electronic records in psychiatry

Electronic patient records are very slowly being introduced into French hospitals. It is therefore necessary to consider the factors which contribute to or, on the contrary, hinder the implementation of this tool in a public psychiatric institution.     

Neuropsychological and symptom predictors of aggression on the psychiatric inpatient service

Neuropsychological assessment of executive dysfunction may identify psychiatric patients who may be at high risk for aggressive behavior because impairment of the prefrontal cortex has been indicated as a possible anatomical correlate of aggression. No consensus, however, has been reached on the extent that executive dysfunction contributes to the formation of psychopathology and to aggressive behavior in psychiatric inpatients. We hypothesized a mediating model wherein patients' executive-functioning deficits contribute to the formation of psychopathological symptoms, which then underlies aggressive behavior. To test this model, we examined the relationship between executive functioning, psychiatric symptomatology, and aggressive behavior in 85 psychiatric inpatients presenting over an acute hospital admission using structure equation modeling techniques. The results revealed that psychiatric inpatients' executive function impairment significantly predicted the formation of psychiatric symptomatology, which in turn significantly contributed to the manifestation of aggressive behavior. Executive dysfunction also directly predicted inpatient aggressive behavior. Combining the indirect and direct effects, 59% of our inpatient aggression measure factor variance was accounted for by our measures of executive dysfunction and clinical symptom severity. These findings suggest that neurocognitive deficits underlie both psychiatric symptom formation and aggression. Patients with executive dysfunction may not possess the behavioral inhibition skills needed to cope with the presence of symptoms and other stressful events that accompany acute psychosis and hospitalization that may result, consequently, in increased manifestations of aggressive behavior.     

Prevalence and correlates of aggressive behavior in psychiatric inpatient populations

Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.