Substance use disorders among psychotic patients admitted to inpatient psychiatric care

Previous epidemiological and clinical studies have shown high rates of substance use disorders in patients with psychotic disorders. There are few studies from the Scandinavian countries. The aim of this study was to investigate the rate of substance use disorders in a group of Norwegian psychotic inpatients from a specific catchment area. Sixty patients, aged 18–40 years, were interviewed through standardized methods: the Addiction Severity Index (EuropASI) and the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I). Urine toxicology screens confirmed patients’ self-report of recent substance use. The lifetime rate of substance use disorders was 70% when all psychotic disorders were included and 62.5% when substance-induced psychotic disorders were excluded. Fifty percent of all the patients studied had current substance use disorders. The majority of substance use disorders were dependence disorders. Alcohol, amphetamine and cannabis were the dominant substances. The level of comorbidity found in this study is comparable with that found in American studies, despite lower prevalence of substance use in the Norwegian population. The high rate of substance use disorders in psychotic inpatients has implications for the treatment and the organization of psychiatric care for these patients.     

Occurrence of psychosis in patients with epilepsy randomized to tiagabine or placebo treatment

PURPOSE: Patients with drug-resistant epilepsy have a higher incidence of psychiatric problems and possibly greater intolerance to antiepileptic drugs (AEDs) than do other patients with epilepsy. Concern has been raised that gamma-aminobutyric acid (GABA)ergic drugs may be associated with treatment-emergent psychosis. Tiagabine (TGB; Gabitril), a new AED that blocks synaptic GABA uptake, was developed in trials of drug-resistant patients with epilepsy. We conducted ad hoc analyses of adverse events, drug intolerance, and treatment response to evaluate the association between TGB treatment and psychosis and whether psychiatric history might be predictive of tolerance or effectiveness of this GABAergic drug. METHODS: Data were analyzed from two multicenter, randomized, double-blind, placebo-controlled trials of add-on TGB therapy (32 or 56 mg daily) in 554 adolescents and adults with complex partial seizures (CPSs). After an 8- or 12-week baseline phase, double-blind treatment consisted of a 4-week titration period (with TGB dose gradually increased to 32 or 56 mg daily) and an 8- or 12-week fixed-dose period. Adverse events commonly associated with psychosis were evaluated. Treatment intolerance and effectiveness (> or =50% reduction in CPS rate) were compared among patients with and without psychiatric histories. RESULTS: Psychotic symptoms (hallucinations) were observed in three (0.8%) of 356 TGB-treated patients and none of 198 placebo-treated patients (p = 0.556, NS). Statistical analysis showed no interaction between psychiatric history and drug intolerance or treatment outcome. CONCLUSIONS: TGB administration appears to carry no significant increased risk of treatment-emergent psychosis. Psychiatric history was not predictive of the tolerance or effectiveness of the drug.     

山东省精神疾病流行病学调查(1984年与1994年)

目的将１９８４与１９９４年山东省各类精神疾病两次横断面抽样调查的患病率及其分布特征进行比较。方法两次调查在同一框架区内统一抽样，分别调查１１８９９８人和８４７６７人（分别占全省总人口的１．５‰和１．１‰）；调查流程及各种筛选和诊断工具相同。结果１９８４与１９９４年山东省精神疾病的终生患病率分别为９．７６‰和１３．２４‰，时点患病率分别为９．１３‰和１２．２１‰；≥１５岁人口时点患病率分别为１１．２４‰和１３．９８‰；酒依赖、神经症、躯体疾病所致精神障碍和其它精神障碍的患病率明显上升。结论１０年间山东省精神疾病患病率有所上升，与社会、经济、文化发展密切相关的某些精神疾病患病率升高较明显     

住院精神障碍患者抗精神病药物一日处方调查

目的 了解我院住院精神障碍患者抗精神病药物的使用情况及其用药规律.方法 采用一日法对本院住院精神疾病患者的抗精神药物应用状况进行调查.结果 (1)住院精神疾病种类构成发生了一些变化;(2)两药联用与单药治疗并重;(3)药物以利培酮处方量第一;(4)St精神病药物的使用剂量基本都在推荐的安全剂量之内.结论 目前本院药物使用以非典型抗精神药物为主,抗精神病药物使用合理.     

A randomized clinical trial of supported employment for inner-city patients with severe mental disorders.

BACKGROUND: This experiment evaluated the effectiveness of 2 approaches to vocational services for persons with severe mental disorders: (1) individual placement and support (IPS), in which employment specialists within the mental health center help patients to obtain competitive jobs and provide ongoing support, and (2) enhanced vocational rehabilitation (EVR), in which stepwise vocational services are delivered by rehabilitation agencies. METHODS: One hundred fifty-two unemployed, inner-city patients with severe mental disorders who expressed interest in competitive employment were randomly assigned to IPS or EVR and followed up for 18 months. Following diagnostic assessment, participants were assessed with standardized measures of work, income, self-esteem, quality of life, symptoms, and hospitalization at baseline and at 6-, 12-, and 18-month follow-up evaluations. Employment was tracked monthly and job satisfaction every 2 months. RESULTS: During the 18-month study, participants in the IPS program were more likely to become competitively employed (60.8% vs 9.2%) and to work at least 20 hours per week in a competitive job (45.9% vs 5.3%), whereas EVR participants had a higher rate of participation in sheltered employment (71.1% vs 10.8%). Total earnings, job satisfaction, and nonvocational outcomes were similarly improved for both groups. CONCLUSION: The IPS model of supported employment is more effective than standard, stepwise EVR approaches for achieving competitive employment, even for inner-city patients with poor work histories and multiple problems.     

Bioenergetic exercises in inpatient treatment of Turkish immigrants with chronic somatoform disorders: a randomized, controlled study

OBJECTIVE: The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders. METHOD: In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed. RESULTS: According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales. CONCLUSIONS: BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.     

2016年-2020年成都市严重精神障碍患者管理治疗分析

目的 对2016年-2020年成都市严重精神障碍患者管理治疗情况进行分析,以期为相关部门制定决策及完善精神卫生服务体系提供参考。方法 提取2016年1月1日-2020年12月31日成都市22个区(市)县国家严重精神障碍信息系统相关数据,对严重精神障碍患者的报告患病率、管理率、规范管理率、服药率、规律服药率以及病情稳定率等指标进行逐年分析。结果 截至2020年底,成都市登记在册的严重精神障碍患者共71 899例,报告患病率为0.34%,规范管理率为95.53%,规律服药率为72.50%。2016年-2020年,除报告患病率(χ²=269.566,P<0.01)之外,管理率(χ²=384.030,P<0.01)、规范管理率(χ²=309.742,P<0.01)、服药率(χ²=414.252,P<0.01)、规律服药率(χ²=316.172,P<0.01)和病情稳定率(χ²=288.335,P<0.01)均有随年度增加而增高的...     

奥氮平与氟哌啶醇治疗脑血管病伴发精神障碍的疗效分析

目的比较奥氮平和氟哌啶醇治疗脑血管病伴发精神障碍的疗效和安全性。方法将79例未经系统治疗的病人随机分为氟哌啶醇和奥氮平组,进行双盲对照治疗研究。采用简明精神病症状量表（BPRS）、疗效总评量表（CGI-SI）和不良反应量表（TESS）分别评定其严重程度、疗效和不良反应。结果2周后奥氮平组BPRS总分、活动过多因子分别显著下降（P〈0．05或P〈0．01）,氟哌啶醇组BPRS总分及其他因子分4周后开始下降;8周后2组总体疗效比较无显著性差异（P〉0.05）;奥氮平组的不良反应为头晕和嗜睡;氟哌啶醇组较多,包括锥体外系反应、心动过速、头晕、流涎等。结论奥氮平和氟哌啶醇在临床上治疗脑血管病伴发精神障碍均有效,但前者起效更快,不良反应较少。     

The wishes of outpatients with severe mental disorders to discuss spiritual and religious issues in their psychiatric care

Objective. In a previous multisite comparative study of spiritual and religious coping (S/R) among outpatients with schizophrenia; S/R were adaptive for 80% of patients; harmful for 13%; and marginal for 7%. This importance was underestimated by clinicians. We created an interfaith therapeutic group to address such topics. The aim of the study is to assess patients’ wish to address S/R issues in their psychiatric care. Method. Psychiatrists asked consecutive outpatients about their wish; with who they shared S/R concerns; and their interest to enroll in the “Spiritual and Recovery Group”. Results. Among the 147 patients included less than half shared their spiritual concerns with other people. A quarter wished to address S/R issues in their care; 24/147 already shared those issues with a religious professional; half of them wished also to share them with their psychiatrist. Among the 21 patients who participated in an in-depth spiritual assessment 16 patients were directed to the S/R group and 5 patients were directed to groups addressing other therapeutic objectives. Conclusion. For one patient out of ten, S/R issues were of a clinical significance warranting integration into psychiatric treatment. This study shows that patients’ views are in accordance with former research, putting forward psychiatrists’ stance on this issue.     

43例被关锁重性精神疾病患者解锁治疗前后对照分析

目的 比较被关锁的重性精神疾病患者解锁前后的症状、社会功能及其家庭经济负担的变化.方法 对43例被关锁的重性精神疾病患者(精神分裂症和双相障碍)于解锁前、解锁后6个月分别采用阳性与阴性症状量表(PANSS)或Bech-Rafaelsen躁狂量表(BRMS)评定临床效果,采用社会功能缺陷量表(SDSS)评定社会功能,采用＜解锁患者信息采集表＞和＜解锁患者家庭经济学指标调查表＞进行患者家庭经济学指标比较.结果 解锁前、解锁治疗6个月时PANSS总分、BRMS总分、SDSS总分、家庭经济学指标评定结果比较,差异有显著性(P＜0.01).结论 解锁治疗显著改善了被关锁重性精神疾病患者的精神症状和社会功能,减轻了患者家庭的经济负担,提高了患者及其家属的生活质量.     

Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm,functional impairment,and educational and clinical outcomes

Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12–18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05–0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2–208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.

     

Hospital vs. outreach treatment of patients with mental retardation and psychiatric disorders: a controlled study

The aim of this study was to investigate the effectiveness of specialized hospital treatment vs. outreach treatment of patients with mental retardation and serious mental illness. A total of 50 patients were randomly assigned to either the hospital treatment (n=25) or the outreach treatment group (n=25). The outcome measures included psychiatric symptoms, family burden, costs and hospital admissions. At most observation points (up to 28 weeks) and at all endpoints the two groups were equivalent with regard to psychiatric symptoms. The burden on carers did not increase significantly during the outreach treatment. Treatment costs were lower for the outreach treatment. Of the 25 patients who received outreach treatment, four had to be admitted to the specialized hospital. Aggressive behaviour, social competence and number of previous psychiatric hospitalizations were found to be predictors of treatment outcome. It is concluded that outreach treatment represents an effective and efficient alternative to hospital treatment for patients with mental retardation and psychiatric disorders.     

重型颅脑损伤患者精神障碍的临床分析

目的 探讨重型颅脑损伤后精神障碍的发生率、表现形式及影响因素。方法 以深圳市1999年10月1日至2000年9月30日因交通事故所致重型颅脑损伤的183例幸存者为研究对象,在颅脑损伤治疗后（平均6个月）,由2名精神科副主任医师根据中国精神疾病分类方案与诊断标准第2版修订本对这些伤者的精神状态进行评估。结果 （1）在183例中,罹患各类精神障碍者共165例,发生率为90．2％,其中智能障碍者为142例（77．6％）。（2）在183例,中度及其以上智力损伤者为29例（15．8％）。（3）有智力损伤组的脑干损伤、颅内血肿及≥3个脑叶损伤的比例高于无智力损伤组（P＜0．01）;伴有精神障碍组的平均年龄（P＜0．05）、脑干损伤（P＜0．05）及≥3个脑中损伤（P＜0．01）的比例高于无精神病性障碍组;有人格改变组额叶损伤、开颅清除血肿并减压治疗的比例高于无人格改变组（P＜0．01）。结论 重型颅脑损伤后精神障碍的发生率较高,应引起有关临床学科的重视。     

郑州市严重精神障碍患者服药依从性的影响因素

目的 调查郑州市严重精神障碍患者服药依从情况并分析其影响因素,为制定严重精神障碍防治措施提供参考。方法 于2021年3月-6月,采用分层多阶段整群抽样方法,从国家严重精神障碍信息系统中郑州市所有在册患者中选取342人为研究对象。采用自编问卷收集患者一般人口学资料,并调查其服药情况及影响因素,比较服药依从组与服药不依从组服药影响因素的差异,采用Logistic回归分析探讨服药依从性的影响因素。结果 共320例患者纳入最终分析,其中服药依从者245人（76.56%）。服药依从组与服药不依从组在居住地、职业以及门诊慢性病报销办理情况方面差异均有统计学意义（χ2=14.015、7.502、13.106,P<0.05或0.01）。服药影响因素问卷评分方面,两组自知力缺失、病耻感以及药物相关因素因子评分差异均有统计学意义（Z=7.588、2.379、2.893,P<0.05或0.01）。已办理门诊慢性病报销是服药依从的保护因素（OR=2.727,95%CI:1.320～5.634,P<0.01）,居住地为农村（OR=0.465,95%CI:0.221～0.977,P<0.0...     

Mortality in persons with mental disorders is substantially overestimated using inpatient psychiatric diagnoses

Mental disorders are associated with premature mortality, and the magnitudes of risk have commonly been estimated using hospital data. However, psychiatric patients who are hospitalized have more severe illness and do not adequately represent mental disorders in the general population. We conducted a national cohort study using outpatient and inpatient diagnoses for the entire Swedish adult population (N = 7,253,516) to examine the extent to which mortality risks are overestimated using inpatient diagnoses only. Outcomes were all-cause and suicide mortality during 8 years of follow-up (2001–2008). There were 377,339 (5.2%) persons with any inpatient psychiatric diagnosis, vs. 680,596 (9.4%) with any inpatient or outpatient diagnosis, hence 44.6% of diagnoses were missed using inpatient data only. When including and accounting for prevalent psychiatric cases, all-cause mortality risk among persons with any mental disorder was overestimated by 15.3% using only inpatient diagnoses (adjusted hazard ratio [aHR], 5.89; 95% CI, 5.85–5.92) vs. both inpatient and outpatient diagnoses (aHR, 5.11; 95% CI, 5.08–5.14). Suicide risk was overestimated by 18.5% (aHRs, 23.91 vs. 20.18), but this varied widely by specific disorders, from 4.4% for substance use to 49.1% for anxiety disorders. The sole use of inpatient diagnoses resulted in even greater overestimation of all-cause or suicide mortality risks when prevalent cases were unidentified (∼20–30%) or excluded (∼25–40%). However, different methods for handling prevalent cases resulted in only modest variation in risk estimates when using both inpatient and outpatient diagnoses. These findings have important implications for the interpretation of hospital-based studies and the design of future studies.