Efficacy of n-3 polyunsaturated fatty acid enriched enteral nutrient solution in relieving oxidative stress in patients with severe psychophysiologic disorders

It is not unusual for patients with severe motor and intellectual disabilities to present with eating and swallowing disorders, and such patients often require long term enteral nutrition. These patients tend to receive all their nutrients in the form of a single nutrient solution that is administered over a long period, and there are concerns about the impact of the composition of these nutrient formulas on patient health. Therefore, it is very important that adequate care be taken when selecting a nutrient formula for patients of this type. In the present study we administered two types of enteral nutrient solutions and examined the effect of the differences in nutrient composition on the degree of oxidative stress experienced by human patients. Subjects were 5 patients (mean age: 27.2 years; male/female ratio: 4:1) with severe motor and intellectual disabilities who were incapable of oral feeding, and who were receiving long term enteral nutrition. The subjects were administered a standard elemental diet for 2 months, and this was followed by administration of an n-3 polyunsaturated fatty acid enriched enteral nutrient solution for three months. Results showed that the n-3 polyunsaturated fatty acid enriched diet improved serum concentrations of trace elements, protein synthesis, and the balance between n-6 polyunsaturated fatty acids and n-3 polyunsaturated fatty acids, which are essential fatty acids. At the same time oxidative stress was reduced, and serum IgE levels declined significantly. Patients with severe psychophysiological disorders often suffer from repeated bouts of pneumonia due to immune system suppression, and there are reports that such patients are subject to increased allergic diathesis. The present results indicated that the in vivo membrane damage induced by oxidative stress may be closely related to the onset of these disorders. The results also suggested that in addition to attaining an adequate understanding of the effect of each of the various nutrients in enteral nutrient formulas, it will also be important to consider not only trace elements but also fatty acid composition in the nutritional management of patients with such disorders.     

83例酒精所致精神障碍的随访研究

目的:研究酒精所致精神障碍的愈后结局。方法:对83例住院酒精所致精神障碍病人出院8年后,采用问卷对其综合状况进行纵向追踪调查。结果:出院后复饮率为82.3%,平均每日饮酒量比过去降低(P<0.01),嗜酒者晚年躯体状况较差,部分人向酒中毒性脑病发展,患者8年后死亡率较高(30.6%)。结论:无节制饮酒对人的精神、躯体损害明显,患者晚期结局较差,应引起社会各界高度重视。     

有精神病性症状老年期抑郁症临床分析

目的:分析有精神病性症状老年期抑郁症患者的临床特征。方法:将109例老年期抑郁症首发患者根据是否存在精神病性症状分为有精神病性症状组(A组)15例和无精神病性症状组(B组)94例,并对临床资料进行比较分析。结果:A组自杀行为发生率为53.3%,显著高于B组的24.5%,差异有统计学意义(P<0.05),自杀行为的相对危险度为3.53。妄想内容以罪恶妄想40.0%、被害妄想13.3%、疑病妄想6.7%为多见,其中伴有幻听40.0%;A组联合抗精神病药物治疗为20.0%,高于B组的2.1%(P=0.018)。两组近期治疗效果差异无统计学意义(P>0.05)。结论:首发老年期抑郁症是否伴有精神病性症状者,在自杀行为、治疗方法上存在差异。     

The impact of caregiving on caregivers of older persons and its associated factors: a cross-sectional study

INTRODUCTION:Many older people rely on caregivers for support. Caring for older people can pose significant burdens for caregivers yet may also have positive effects. This study aimed to assess the impact on the caregivers and to determine factors associated with caregivers who were burdened.METHODS:This was a cross-sectional study of 385 caregivers of older people who attended a community clinic in Malaysia. Convenience sampling was employed during the study period on caregivers who were aged ≥ 21 years and provided ≥ 4 hours of unpaid support per week. Participants were asked to complete a self-administered questionnaire, which included the Carers of Older People in Europe (COPE) index and the EASYCare Standard 2010 independence score. The COPE index was used to assess the impact of caregiving. A highly burdened caregiver was defined as one whose scores for all three COPE subscales were positive for burden. Care recipients’ independence was assessed using the independence score of the EASYCare Standard 2010 questionnaire. Multiple logistic regression was used to determine the factors associated with caregiver burden.RESULTS:73 (19.0%) caregivers were burdened, of whom two were highly burdened. Caregivers’ median scores on the positive value, negative impact and quality of support scales were 13.0, 9.0 and 12.0, respectively. Care recipients’ median independence score was 18.0. Ethnicity and education levels were found to be associated with caregiver burden.CONCLUSION:Most caregivers gained satisfaction and felt supported in caregiving. Ethnicity and education level were associated with a caregiver being burdened.     

Hospitalization for mental illness: evaluation of admission trends from 1941 to 1971.

A study of the diagnostic composition of the inpatient population of Ontario and Canadian psychiatric facilities has shown an important change in hospital-treated illness over the period 1941-71. Patients with nonpsychotic disorders accounted for 54% of all admissions to Ontario public mental hospitals in 1971, compared with only 8% in 1941. The trend was similar for both first admissions and proportion of readmissions, and was similar for psychiatric units of general hospitals. In contrast, the overall rate of first admission for psychotic disorders to inpatient facilities remained remarkably constant over time, as did the proportion of readmissions among all admissions. The findings dispel the notion that the increasing proportion of readmissions is due largely to a rapid turnover of former long-stay psychotic patients (the "revolving-door phenomenon"). The findings could not be attributed to a changing prevalence of types of psychiatric illness, increased availability of psychiatric inpatient facilities or comprehensive medical insurance.     

神经精神症状问卷中文版的信度和效度

目的 评估神经精神症状问卷中文版(Chinese version of the neuropsychiatric inventory,CNPI)的信度和效度.方法 对2004年至2008年间到上海交通大学医学院附属精神卫生中心就诊的219例阿尔茨海默病(AD)患者的照料者进行CNPI的测试,每例被测试者在4周后均进行重测.应用SPSS11.0统计软件进行信效度分析.结果 CNPI症状分问卷Cronbach α系数为0.69,CNPI苦恼分问卷Cronbach α系数为0.72.重测相关系数在0.66～0.98之间(P<0.001),其中症状分问卷总分相关系数为0.96(P<0.001),苦恼分问卷总分相关系数为0.94(P<0.001);对症状分问卷12个条目进行主轴因子分析产生5个公因子,累积解释变异量为67.0%;对苦恼分问卷12个条目进行主轴因子分析也产生5个公因子,累积解释变异量为70.2%.结论 CNPI的同质性信度和重测信度较高,内容效度和结构效度较好.     

Should doctors wear white coats?

Objective: To compare the views of doctors and patients on whether doctors should wear white coats and to determine what shapes their views. Methods: A questionnaire study of 400 patients and 86 doctors was performed. Results: All 86 of the doctors'' questionnaires were included in the analysis but only 276 of the patients were able to complete a questionnaire. Significantly more patients (56%) compared with their doctors (24%) felt that doctors should wear white coats (p<0.001). Only age (>70 years) (p<0.001) and those patients whose doctors actually wore white coats (p<0.001) were predictive of whether patients favoured white coats. The most common reason given by patients was for easy identification (54%). Less than 1% of patients believed that white coats spread infection. Only 13% of doctors wore white coats as they were felt to be an infection risk (70%) or uncomfortable (60%). There was no significant difference between doctor subgroups when age, sex, grade, and specialty were analysed. Conclusion: In contrast to doctors, who view white coats as an infection risk, most patients, and especially those older than 70 years, feel that doctors should wear them for easy identification. Further studies are needed to assess whether this affects patients'' perceived quality of care and whether patient education will alter this view.     

网络成瘾住院患者冲动、攻击性人格特点及治疗转归

目的 了解网络成瘾住院患者冲动、攻击性人格特点以及经过综合性网瘾戒治后转归情况.方法 采用Barratt冲动性量表(BIS)、Buss行为攻击问卷(BAS)、症状自评量表(SCL-90)分别对58例网络成瘾住院患者在入院1周内和综合性网瘾戒治3月后进行评估,并与54例正常对照比较.结果 ①IAD组治疗前冲动、攻击量表各因子分以及总分均比正常对照组高[BIS评分(99.3±15.1)分,(75.0±15.4)分,t=8.47,P＜0.01;BAS评分(78.3±24.4)分,(54.8±17.7)分,t=5.87,P＜0.01];治疗后冲动、攻击量表除躯体攻击外,其余各因子分以及总分明显降低但仍比正常对照高[BIS评分(86.3±16.6)分,(75.0±15.4)分,t=4.98,P＜0.01;BAS评分(66.2±22.6)分,(54.8±17.7)分,t=3.65,P＜0.01];②IAD组SCL-90总分与BAS量表总分存在显著相关性(r=0.376,P＜0.01),治疗后SCL-90总分降低值与BAS降低值亦存在相关(r=0.508,P＜0.01).结论 网络成瘾组冲动、攻击性比正常对照组高,经治疗后其冲动、攻击性降低,但仍高于对照组.

Abstract：

Objective To explore the impulsivity and aggressivity,and its treatment outcomes of the inpatients with intemet addiction disorder (IAD) by intergration interview. Methods Barratt Impulsiveness Scale ( BIS), Buss Aggressive Scale (BAS) were used to assess the impulsiveness and aggressivity in 58 IAD patients, at the first week and after the point of intergration interview 3 months,54 normal subjects in the control group were conducted by BIS and BAS only when they were recruited. Results ①The intemet addiction group had significantly higher scores on the BIS and BAS total scores than the control group at the first week ( BIS score 99.3 ±15. 1vs 75.0 ± 15.4, t=8.47, P＜0. 01; BAS score 78.3 ±24.4 vs 54.8 ± 17.7, t=5.87 , P＜0. 01 ). IAD group had lower scores on the total scores of BIS-Ⅱ and BAS after intergration interview than before, but the subscales and total scores were higher than those in the control group ( BIS score 86.3 ± 16.6 vs 75.0 ± 15.4, t =4.98, P ＜ 0.01 ;BAS score 66.2 ± 22.6 vs 54.8 ± 17.7, t = 3.65, P ＜ 0. 01 ). ②Total score of SCL-90 in IAD group were significantly correlated with the BAS total score ( r=0. 376, P＜0. 01 ) ,and the decreased SCL-90 total score was also related with the decreased BAS score ( r= 0.508, P＜ 0. 01 ). Conclusion This study suggests that IAD group exhibit more impulsivity and aggressivity than those in the control group. After interview, their impulsivity and aggressivity are significantly decreased, but are still higher than those in the normal control group.     

Longitudinal study of the course and outcome of first-episode psychosis

BackgroundStudy of first episode psychosis (FEP), an episode of psychotic nature, which manifests for the first time in an individual in the longitudinal continuum of his/her illness, has been a matter of research interest in recent years, as this may give more insight to the overall phenomenology and course of psychotic illnesses.MethodsA study was undertaken to evaluate course and outcome of first episode psychosis. A total of 100 consecutive inpatients were selected for the study. Informed consent was obtained. Structured Proforma was used for recording psychosocial profiles and relevant medical history. Brief Psychiatric Rating Scale (BPRS) was given to assess the severity of psychopathology; Positive and Negative Symptom Scale (PANSS) to assess the severity of psychosis; Becks Suicidal Ideation Scale (BSI) to assess the extent of suicidality and Global Assessment of Functioning (GAF) to assess global functioning of the individual. The assessment was done at baseline, at six months, and at one year.ResultsFirst episode psychosis constituted around a tenth of the caseload. It commonly affected people in the third decade of life. There was an improvement in 92% of the cases over a year of study. Schizophrenia constituted the majority of first episode psychosis. The history of smoking was relatively higher in acute and transient psychotic disorders. Age inversely correlated with the severity of psychopathology. There was no difference in improvement in psychopathology over time in patients of schizophrenia and related disorder vis--vis other psychotic disorders.ConclusionOur study did not find any significantly varied sociodemographic factors in the course and outcome of the illness. It also refuted the schism between various types of psychosis based on the current classificatory system. It draws our attention toward the unitary concept of psychosis and is a call to re-think our strategies in the management of psychosis.     

冠状动脉粥样硬化性心脏病患者及其家属在手术前后心理状态的对比研究

目的 本研究旨在调查住院冠状动脉粥样硬化性心脏病（以下简称冠心病）患者及其家属在经皮冠状动脉支架置入（percutaneous coronary intervention,PCI）术前、后的焦虑和/或抑郁状态的发生情况及变化特点。方法 选取拟行PCI术的住院冠心病患者和与陪同就诊的家属共50对。在术前1 d、出院当天及术后1个月分别进行抑郁自评量表（Self-rating Depression Scale,SDS）和焦虑自评量表（Self-rating Anxiety Scale,SAS）评估。并增设开放性问题补充了解患者及其家属的关注点。结果 在术前、出院当天及术后1月共3个时间点,有、无心理困扰的家庭,患者及家属的SDS和SAS评分呈现出4种不同的变化特点,无心理困扰的家庭比例逐渐升高,分别占42%、52%及54%;存在心理困扰的家庭比例在出院当天略降低（占8%）,术前（占12%）和术后（占14%）相似;存在心理困扰的家属比例逐渐降低,分别占30%、26%及18%;存在心理困扰的患者比例未见明显变化,分别占16%、14%及14%,但上述变化的差异无统计学意义（P值为0.437~0.948）。随着时间的变化,家属SDS和SAS平均值逐渐减低,而患者SDS和SAS平均值在术前和出院1个月时均较高,但患者和家属上述变化的差异均无统计学意义（P值为0.113~0.610）。存在心理困扰的研究对象共同的主要症状为睡眠障碍。术前患者及其家属最关系的焦点均是手术相关问题;在术后1个月时,患者最为担心的方面涉及病情、药物及工作和/或生活,家属最关心患者的手术效果。结论 术前存在焦虑或抑郁状态的冠心病患者和家庭,其心理状态在PCI术后未见明显改善趋势。     

Stigma of mental illness: A study in the Indian Armed Forces

Background

Stigma against mental illness exists across all countries. Stigma devalues the ill person and their relatives and denies them from attaining their rightful place in society. Stigma also prevents the ill person from seeking help. Stigma in the Armed Forces of UK and USA has been identified as a barrier to help seeking and a cause for concern as it could affect operational efficiency. However, studies conducted in the services of this country are lacking. Hence we decided to measure stigma perceived by patients and caregivers of the mentally ill and to assess stigma regarding the mentally ill patients and their caregivers, in the general population.

Methods

A cross sectional survey of patients (302), their caregivers (98), and members of the general population (102) who had no relatives suffering from mental illness was done. The patients were given the Stigma Scale developed by King et al. The caregivers (98) were given the devaluation of consumers scale and devaluation of consumer families scale developed by Struening et al.

Results

90% of patients admitted to experiencing stigma. 86% of patients had experienced discrimination. Females experienced more discrimination than males. Stigma perceived was irrespective to age, mental status, rank and education of the patient. Caregivers perceived stigma and felt blamed by the community. Members of the general population gave similar responses.

Conclusions

Study has brought out the high levels of stigma faced by the patients and their caregivers. High levels of stigma observed are a barrier to care.     

Stigma of mental illness: A study in the Indian Armed Forces

Background

Stigma against mental illness exists across all countries. Stigma devalues the ill person and their relatives and denies them from attaining their rightful place in society. Stigma also prevents the ill person from seeking help. Stigma in the Armed Forces of UK and USA has been identified as a barrier to help seeking and a cause for concern as it could affect operational efficiency. However, studies conducted in the services of this country are lacking. Hence we decided to measure stigma perceived by patients and caregivers of the mentally ill and to assess stigma regarding the mentally ill patients and their caregivers, in the general population.

Methods

A cross sectional survey of patients (302), their caregivers (98), and members of the general population (102) who had no relatives suffering from mental illness was done. The patients were given the Stigma Scale developed by King et al. The caregivers (98) were given the devaluation of consumers scale and devaluation of consumer families scale developed by Struening et al.

Results

90% of patients admitted to experiencing stigma. 86% of patients had experienced discrimination. Females experienced more discrimination than males. Stigma perceived was irrespective to age, mental status, rank and education of the patient. Caregivers perceived stigma and felt blamed by the community. Members of the general population gave similar responses.

Conclusions

Study has brought out the high levels of stigma faced by the patients and their caregivers. High levels of stigma observed are a barrier to care.     

Four gland parathyroidectomy without reimplantation in patients with chronic renal failure

Background: The optimal surgical management of patients in end stage chronic renal failure with secondary hyperparathyroidism is controversial. One approach advocated is four gland parathyroidectomy without reimplantation. The aim of this study was to review the medium term results of this procedure. Methods: Fifty four consecutive patients with end stage chronic renal failure and secondary hyperparathyroidism who had a four gland parathyroidectomy without reimplantation were studied. The procedure was performed by a single surgeon with a median (range) follow up of 29 (0–70) months. Results: Most patients (76%) developed postoperative hypocalcaemia but this was easily treated and doses of long term drugs necessary to prevent this were low. Pre-operative bone symptoms, hypercalcaemia, hyperphosphataemia, and an increased alkaline phosphatase were improved or resolved in most patients. Thirteen (24%) patients had an undetectable postoperative parathyroid hormone (PTH), (6 of 12 (50%) with a functioning renal transplant and 7 of 42 (17%) who required dialysis, p = 0.02). Median (range) postoperative PTH values in these groups were 0.1 (0.1–31) compared with 1.0 (0.1–24) pmol/l (p = 0.085) respectively. The remaining 41 of 54 (76%) patients had residual PTH secretion and postoperative hyperparathyroidism was identified in eight (15%) patients with only two requiring neck re-exploration. Conclusion: Four gland parathyroidectomy without reimplantation produced good medium term biochemical and clinical results. Most patients had minor residual PTH secretion that may contribute to this and mitigate concerns regarding adynamic bone disease. Endogenous PTH secretion is only completely lost in a few patients but occurs more often in those with a functioning renal transplant. Bone densitometry is required to investigate the long term impact of this procedure.     

Complications of ileal conduit diversion in adults with cancer followed up for at least five years

A total of 111 adults with malignant disease of the bladder were studied to determine the long term complications of ileal conduit diversion. Each patient had survived at least five years (mean 10 years) after cystectomy. At final follow up the radiological appearance of one or both kidneys had deteriorated in 50 (47%) of 107 patients: deterioration worsened significantly (p less than 0.01) with increasing duration of follow up. Eighteen patients (16%) developed biochemical evidence of impaired renal function, of whom four died of complications of renal failure. Bilateral upper tract dilatation was noted in 30 patients (28%), and in 21 its cause was obscure. Ten patients formed renal stones, and an additional 12 required further operations on the conduit or stoma. Despite the age of patients with bladder cancer and the poor prognosis of those with invasive tumours clinically important side effects were observed in a significant proportion of the long term survivors. Further efforts to determine the aetiology of upper tract dilatation in patients with an ileal conduit diversion are justified.     

Granulomas of the liver

The authors personally studied 138 patients with liver granulomas: seventy-five (54%) had sarcoidosis, twenty-six (19%) had primary biliary cirrhosis, twenty-three (17%) had miscellaneous recognizable disorders and fourteen (10%) were undiagnosed. The modes of presentation, the clinical, biochemical and radiological features are compared, and the course of each disease is followed. The undiagnosed group were frequently middle-aged men presenting with abdominal pain, fever and hepato-splenomegaly. The unsatisfactory term granulomatous hepatitis, if used, should be reserved for this undiagnosed residue until follow-up reveals a more definite aetiology.     

Anxiety,depression, and stress in caregivers of children and adolescents with mental disorders in Ghana and implications for medication adherence

ObjectiveThis study assessed levels of anxiety, depression, and stress among family caregivers of children and adolescents with mental disorders in Ghana and the implication on medication adherence.DesignA cross-sectional study.SettingThe study was conducted at the outpatient departments of the three main public psychiatric hospitals in Ghana.ParticipantsTwo hundred and ten non-paid family caregivers of children and adolescents with mental disorders were recruited for this study.Main Outcome MeasureThe study assessed symptoms of anxiety, depression and stress among the caregivers and estimated caregiver-reported medication adherence.ResultsAbout 56.2%, 66.2% and 78% of the caregivers experienced severe anxiety, severe depression and moderate to severe stress symptoms respectively. From the multiple logistic regression model, while anxiety was significantly affected by religion and education, depression was influenced by sex, age, marital status, proximity to facility, and employment status. Female caregivers had about four times higher odds of being depressed compared to male caregivers (aOR: 3.81, 95% CI: 1.66 – 8.75). The caregiver-reported medication adherence was 11.9%. Anxiety was significantly predictive of medication adherence.ConclusionMost family caregivers of children and adolescents with mental disorders experienced symptoms of anxiety, depression and stress with anxiety having implications for medication adherence. The study findings underscore the need to consider psychological characteristics of caregivers and the provision of mental health support for them, as part of the routine health care for children and adolescents with mental disorders.FundingNone indicated     

乳果糖长短程治疗对亚临床肝性脑病智力测验影响的研究

目的 :对亚临床肝性脑病 (SHE)患者进行乳果糖长短程治疗 ,比较其对智力测验的影响。方法 :随机挑选 6 0名数字连接试验 (NCT)、数字符号试验 (DST)和 /或诱发电位检查异常并配合治疗的SHE患者分配入对照组、乳果糖短程治疗组及长程治疗组中 ,每组各 2 0例。对照组仅给予VitBco治疗 2 4周 ,短程治疗组另再给予口服乳果糖治疗 8周 ,长程治疗组则另再给予口服乳果糖至 2 4周。 3组均在实验开始时、第 8、16、2 4周末随访作NCT、DST、血氨检查。结果 :治疗后三组间比较在NCT、DST、血氨均有显著性差异 (P <0 .0 5 )。其中第 8周 ,长程、短程组NCT、DST均较对照组有明显改善 (P <0 .0 5 ) ,长短程组之间无明显差异 (P >0 .0 5 ) ;第 16周 ,长程组NCT、血氨均较对照组和短程组有明显改善 (P <0 .0 5 ) ,短程组和对照组之间无明显差异 (P >0 .0 5 ) ;第 2 4周 ,长程组NCT、DST、血氨均明显好于对照组和短程组 (P <0 .0 5 ) ,短程组和对照组之间无明显差异 (P >0 .0 5 )。治疗前后自身对比显示对照组血氨无明显变化 ,但NCT、DST第 8、16、2 4周逐渐变差 (均P <0 .0 5 ) ;短程组第 8周血氨、NCT、DST均明显好转 (P <0 .0 5 ) ,第 16周恢复到治疗前水平 (P >0 .0 5 ) ,第 2 4周明显差于治疗前 (P <0 .0 5 ) ;长程     

Psychological reactions and coping strategies of Sri Lankan women carrying fetuses with lethal congenital malformations

INTRODUCTION: Termination of pregnancy is a popular option for pregnancies complicated by lethal congenital malformations (LCMs). In Sri Lanka, where abortion laws are restrictive, this is not available. We studied the psychological responses and coping strategies of women who had to continue their pregnancies knowing the baby had a LCM. SETTING: A teaching hospital in Sri Lanka. STUDY DESIGN: Qualitative inquiry. METHOD: We conducted a semi-structured interview of 10 women whose fetuses were diagnosed to have a LCM. RESULTS: All women showed a grief reaction on hearing the news and were distressed about having to carry a futile pregnancy. Eight women were grateful they knew of the abnormality because it prepared them for the birth better, while the other two wished they had not known. They all found having to share facilities with 'normal' women to be painful. Seven women who received 'routine' antenatal care felt that the doctors were ill-equipped to deal with their situation. All felt that abortion should be legalised for LCMs. All engaged in religious rites believed to have miraculous powers, hoping that these will result in a normal baby. Two required specialised counselling. CONCLUSIONS: The diagnosis of a LCM causes severe distress and psychological reactions, which the staff dealing with these women should be aware of. Ideally, they should be provided care with minimum contact with other women, taking into account the futility of the pregnancy. Engagement in religious rites, even though with unreal expectations, may possibly help them in the long term bereavement process.     

糖尿病患者白内障摘除人工晶体植入的临床观察

目的　探讨糖尿病患者行后房型人工晶体植入术的手术疗效。方法　对 36例 (4 6眼 )糖尿病患者行白内障囊外摘出后房型人工晶体植入术 ,平均随访 2 0个月 ,50例 (54眼 )非糖尿病老年性白内障患者作对照 ,进行 χ2 检验。结果　最终视力两组间经统计学处理无差异 ,P >0 .0 5)。短期并发症糖尿病组明显高于非糖尿病组 (P <0 .0 5)。长期并发症两组差异不明显 (P >0 .0 5)。结论　糖尿病患者植入后房型人工晶体 ,早期并发症的发生率高于非糖尿病患者 ,晚期并发症及最终视力两组无差异。