Clinical symptomatology and drug compliance in schizophrenic patients

The differences in the psychopathologic status of 26 complaint and 32 noncomplaint schizophrenic patients were evaluated on the basis of rating scales used at discharge. Noncomplaint patients had significantly higher scores for grandiosity, lack of feeling of illness and insight into it. Their score for global psychopathological state and disturbance in social adjustment was also significantly higher. The compliant patients had significantly higher score for self-rated depression.     

Individualized measures of outcome versus standardized rating scales in evaluation of in-hospital psychiatric treatment. A methodological study

The differentiating power of two individually related measures of outcome, target complaints and psychiatrists' evaluation of individually defined treatment objectives, were studied in two models of treatment planning, one with and one without active patient participation. Target complaints were measured at admission, after 5 days and at discharge. Treatment objectives were initially defined in written treatment contracts and evaluated at discharge. These measures were compared with patients' self-reported symptoms as well as with independently rated clinical symptoms at admission and discharge. Both target complaints and psychiatrists' evaluations measured improvement during treatment. The differentiating power between the two experimental conditions was, however, much weaker than that of the symptom rating scales. The psychiatrists' evaluations were strongly influenced by state at discharge and only to a minor extent by changes during treatment. It is concluded that symptom rating scales are superior to individualized measures of outcome in studies on a general psychiatric ward, possibly because the patients are fairly homogenous concerning anxiety.     

Development of a novel EEG rating scale for head injury using dichotomous variables.

We developed a new EEG rating scale for electrographic assessment of head injured patients. Phenomena present in posttraumatic EEG were scored as dichotomous variables (present or absent). These phenomena included background activity (alpha, beta, theta, delta), sleep spindles, focal abnormalities, reactivity and variability, epileptiform activity, and specific comatose patterns. Each variable was weighted according to its perceived prognostic value: i.e., normal alpha 10, flat EEG -10, spindles 4, etc. Combinations of possible scores ranged from +23 to -10. Fifty-seven EEGs from different head injured patients were independently and retrospectively analyzed by two investigators. There was a high correlation for intra- (r = 0.95) and inter- (r = 0.85) observer rating using the dichotomous test. When patients with scores over 15 (i.e., with reactive alpha) and patients with scores of -10 (i.e., ECI records) were excluded, the intra-rater and inter-rater correlations were still high (0.81 and 0.76, respectively). There was a high correlation between Glasgow outcome score at discharge and the dichotomous EEG score. This EEG scale scores most major categories of EEG activity, utilizes a multipoint scale for correlation purposes, and allows data to be analyzed in sub-categories (i.e., spindles in coma). The separate weighting score allows for refinement of the scale after data collection (i.e., to fit prospective outcome). We feel that this scale is reproducible and valid, and may be applicable to other patient groups with severely altered EEGs.     

Application of automated medial temporal lobe atrophy scale to Alzheimer disease

OBJECTIVE: To compare an automated intensity-based measure of medial temporal atrophy in Alzheimer disease (AD) with existing volumetric and visually based methods. DESIGN: Longitudinal study comparing a medial temporal atrophy measure with 2 criterion standards: (1) total hippocampal (HC) volume adjusted for total intracranial volume and (2) standard visual rating scale of medial temporal atrophy. SETTING: Cognitive disorders specialist clinic. PARTICIPANTS: Forty-seven patients with AD and 26 age- and sex-matched controls. INTERVENTION: Subjects were scanned using volumetric T1-weighted magnetic resonance imaging at baseline and 1 year later. MAIN OUTCOME MEASURE: Automated Medial Temporal Lobe Atrophy Scale (ATLAS) score, derived from dividing mean intensity of a standardized perihippocampal volume by that of a standardized pontine volume. RESULTS: Patients with AD had significantly reduced ATLAS scores and HC volumes and increased visual rating scores at baseline and repeat scanning. Rates of HC atrophy and decline in the ATLAS score were significantly higher in patients with AD compared with controls. The ATLAS scores were significantly correlated with HC volumes and visual rating scores. With specificity set at 85%, the sensitivities of HC volume and visual rating scale score were similar (84% and 86%, respectively), whereas ATLAS score had a lower sensitivity (73%). At repeat scanning, all 3 measures had similar sensitivities (86%-87%). Rate of decline in the ATLAS score required a similar sample size to HC atrophy rate to provide statistical power to clinical trials, but being automated, it is less labor intensive. CONCLUSIONS: Like the visual rating scale, ATLAS is a simple medial temporal atrophy measure, which has the additional advantage of being able to track AD progression on serial imaging.     

基于PEO模式的家庭作业治疗对卒中偏瘫患者功能预后的影响

目的 研究基于人-环境-作业（person-environment-occupation,PEO）模式的家庭作业治疗对卒中偏瘫患者上肢功能、日常生活活动能力及生活质量的影响。方法 前瞻性、连续纳入2020年1月—2020年12月南京市浦口人民医院（原南京市浦口区中心医院）康复医学科出院的卒中偏瘫患者,随机分为试验组和对照组,并分别建立微信群聊,对照组定期更新康复小视频,有任何问题随时咨询。试验组基于PEO模式,个性化更新每位患者的小视频,两组分别于出院时、出院3个月、6个月和12个月分别进行Fugl-Meyer运动功能量表上肢部分（Fugl-Meyer assessment upper extremity scale,FMA-UE）、日常生活活动能力Barthel指数（Barthel index,BI）及卒中专用生活质量量表（stroke-specific quality of life scale,SS-QOL）的评定。结果 最终纳入卒中偏瘫患者60例,平均年龄（63.10±6.83）岁,其中男性30例。将入组患者随机分为对照组和试验组各30例。组内比较显示,试验组出院3个月BI评分...     

Impact of Shorter Lengths of Stay on Status at Discharge in Bipolar Mania

This study assesses the impact of shortening the inpatient length of stay on status at discharge in patients with mania. Methods: The authors performed a chart review on 131 patients with discharge diagnoses of bipolar disorder, current episode manic type, admitted to the private attending service at Colorado Psychiatric Hospital between 1985 and 1995. In 1990, a new program (the alternatives program) that provides a continuum of acute care services and shorter inpatient lengths of stay was instituted. Retrospectively assessed GAF, CGI, treatment outcome rating scores, and length of stay (LOS) were compared for the prealternatives (1985–1989), early alternatives (1990–1992), and recent alternatives (1993–1995) program treatment eras. A progressive decrease in inpatient LOS, duration of the acute care episodes, and total service utilization was seen across eras. Despite the more recent shortening in LOS, no significant differences were seen in GAF and treatment outcome rating scores at discharge. GAF and treatment outcome rating scores on hospital days 3 and 7, however, suggested that patients were improving more rapidly in the more recent eras. Inpatient LOS and duration of the acute care episodes have significantly decreased over the last 10 years, but patients appear no more ill at discharge. The authors postulate that changes in psycho-pharmacologic practice and the inpatient treatment model may have facilitated the more rapid clinical improvement seen in the more recent eras. The authors caution that we need prospective studies that include postdischarge follow-up to assess further the impact of shorter inpatient stays on the posthospital course of manic patients.     

Functional outcome following rehabilitation in chronic severe traumatic brain injury patients: A prospective study

Objective:

The objective was to assess functional outcome of rehabilitation in chronic severe traumatic brain injury (TBI) in-patients.

Setting:

The study was performed at university tertiary research hospital.

Study Design:

A prospective cross-sectional study

Materials and Methods:

Forty patients (34 men) with mean age of 30.1 years (range 6--60, SD 10.8), severe TBI (Glasgow coma scale 3--8, duration of coma > 6 hours, post-traumatic amnesia> 1 day postinjury) were admitted in rehabilitation unit minimum 3 months (mean 7.7±4.6 months, range 3--22 months) following injury falling in Glasgow outcome scale (GOS) of 3. Functional recovery was assessed using the Barthel Index (BI) score and disability rating scores (DRS).

Data Analysis:

Paired Student''s t-test was used for the assessment of functional recovery using mean BI scores at admission and discharge. The Wilcoxon nonparametric test was used for the assessment of functional recovery by comparing admission and discharge DRS scores.

Results:

Mean duration of stay was 30.8 days (range 18--91, SD15.6). Significant functional recovery observed in patients comparing BI and DRS scores at admission and discharge (mean BI admission 50.5±25.4, range 0--85 vs. mean discharge BI score 61.1±25.3, range 0--95, P<0.001, mean DRS admission score 7.57±4.1, range 2.5--21.0 vs. mean discharge DRS score 6.36±4.3, range 1.0-21.0, P<0.001).

Conclusion:

Patients with severe TBI continue to show functional recovery even in chronic phase with rehabilitation. They are left with significant residual physical and cognitive deficits and would require long-term care and assistance from care givers for the daily activities, as suggested by the mean DRS score at discharge.     

Predictors of stroke outcome using objective measurement scales

We set out to determine if rehabilitation variables predicted the motor and functional outcomes of stroke patients. Using the Modified Motor Assessment Scale (motor status) and the Barthel Index (functional status), we tested 50 stroke patients less than or equal to 3 days, 1 week, and 1 month after their stroke and at discharge from the hospital. Both measures are reliable and valid. We used the Spearman correlation coefficient (r) and stepwise regression analysis to analyze the data. Balanced sitting and bladder control scores at 1 week correlated significantly with motor score at discharge (r = 0.83), Barthel Index score at discharge (r = 0.82), and walking score at discharge (r = 0.80). The combined arm score at 1 month correlated significantly with the combined arm score at discharge (r = 0.94). Regression equations using the scores at 1 month produced the highest r2 values (range 0.76-0.95) in predicting the Barthel Index, motor, walking, and arm recovery scores at discharge. The correlation coefficients and the regression equations have uses in both research and clinical settings. We suggest that these objective predictors of recovery be used as adjuncts in prioritizing and directing the rehabilitation management of patients with stroke.     

Dystonia-predominant adult-onset Huntington disease: association between motor phenotype and age of onset in adults

BACKGROUND: In juvenile Huntington disease (HD), dystonia as well as parkinsonism and eye movement abnormalities may be the predominant motor signs rather than chorea. Several patients have come to our attention with adult-onset HD in whom there is prominent dystonia and minimal chorea (ie, an adult-onset form of HD that resembles juvenile HD). OBJECTIVES: To estimate the prevalence of these cases of dystonia-predominant HD in a clinic and to study the relationship between the motor phenotype and age of onset in HD. METHODS: The Unified Huntington's Disease Rating Scale (UHDRS) was administered to 127 subjects during their initial visit to the Huntington's Disease Center at the New York State Psychiatric Institute, where dystonia, chorea, bradykinesia, rigidity, and eye movements were rated. The dystonia score was the mean UHDRS rating of dystonia in 5 body regions; the chorea score, the mean rating of chorea in 7 regions; the bradykinesia score, the mean rating of axial and limb bradykinesia; the rigidity score, the mean rating of rigidity in both arms; and the eye movement score, the mean rating of ocular pursuit, saccade initiation, and velocity. Dystonia-predominant HD was defined by the severity of dystonia relative to the severity of chorea. RESULTS: Fifteen (11.8%) of 127 subjects had dystonia-predominant HD. Age of onset correlated negatively (r= -0. 22, P=.02) with the dystonia score divided by the chorea score and negatively (r= -0.28, P=.002) with the severity of dystonia, bradykinesia, and eye movement abnormalities relative to chorea (ie, [(dystonia score + bradykinesia score + eye movement score)/3] - chorea score), suggesting that subjects with younger ages of onset had more severe dystonia, bradykinesia, and eye movement abnormalities relative to chorea. CONCLUSIONS: Cases of adult-onset HD with prominent dystonia and a paucity of chorea may represent 1 in 8 cases in specialty clinics. Age of onset was clearly associated with the motor phenotype. A younger age of onset was associated with more severe dystonia, bradykinesia, and eye movement abnormalities relative to chorea, supporting the notion that in adult-onset HD, the motor phenotype forms a continuum with respect to age of onset.     

Rating scales for cervical dystonia: a critical evaluation of tools for outcome assessment of botulinum toxin therapy

Botulinum neurotoxin is the therapy of choice for all forms of cervical dystonia (CD), but treatment regimens still vary considerably. The interpretation of treatment outcome is mainly based on the clinical experience and on the scientific value of the rating scales applied. The aim of this review is to describe the historical development of rating scales for the assessment of CD and to provide an appraisal of their advantages and drawbacks. The Tsui score and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) have been widely employed in numerous clinical studies as specific instruments for CD. The obvious advantage of the Tsui score is its simplicity so that it can be easily implemented in clinical routine. The TWSTRS allows a more sophisticated assessment of functional features of CD, but only the Tsui score includes a rating for tremor. Other benefits of the TWSTRS are the disability and pain subscales, but despite its value in clinical trials, it might be too complex for routine clinical practice. None of the rating scales used at present has been rigorously tested for responsiveness to detect significant changes in clinical status after therapeutic interventions. Moreover, clinical data support a new classification of CD leading to a differentiation between head and neck subtypes. As the current rating scales are not able to cover all these aspects of the disorder, further research is needed to develop a valid and reliable instrument which considers the most current classification of CD.     

Application of ischemic score of Hachinski in differentiation of multi-infarct dementia]

The Beijing Geriatric Mental Health Center has admitted 46 cases of dementia of the aged in recent more than two years. For them many routine examinations as well as rating scale related and CT scanning were carried out. Their final diagnosis at discharge were of 4 categories: (1) Multi-infarct dementia (MID); (2) Alzheimer's disease(AD); (3) MID+AD, mixed type; and (4) dementia of other causes. We applied Ischemic Score of Hachinski for the 14 cases of MID. The score was over 7 points in all the 14 cases. And the CT pictures in 11 cases showed multiple infarctions, only 3 cases gave evidence of cerebral atrophy. Therefore, the Ischemic Score and CT Scanning were very significant in the diagnosis of MID. The role of each item of the total 13 items of the ischemic score in the diagnosis of MID was discussed according to the clinical materials. It is pointed out that the "stepwise deterioration", "fluctuating course", "history of strokes" and "focal neurological signs" were more important in the diagnosis of MID.     

Prediction of homelessness within three months of discharge among inpatients with schizophrenia.

OBJECTIVE: The authors' goal was to identify factors that place inpatients with schizophrenia at risk of becoming homeless after hospital discharge. METHODS: Patients with schizophrenia or schizoaffective disorder (N=263) were assessed at discharge from general hospitals in New York City and reassessed three months later to evaluate whether they had become homeless. Sociodemographic and clinical characteristics associated with homelessness were identified using likelihood ratio chi square analysis and logistic regression. RESULTS: Twenty patients (7.6 percent) reported an episode of homelessness during the follow-up period. Patients who had a drug use disorder at hospital discharge were significantly more likely to report becoming homeless than those without a drug use disorder. Patients with a total score above 40 on the Brief Psychiatric Rating Scale (BPRS) at hospital discharge were more likely to report becoming homeless than patients with lower scores, as were those with Global Assessment Scores less than 43. Twelve of 30 patients with a drug use disorder, a BPRS score above 40, and a GAS score less than 43 at hospital discharge reported becoming homeless. CONCLUSIONS: The combination of a drug use disorder, persistent psychiatric symptoms, and impaired global functioning at the time of hospital discharge poses a substantial short-term risk of homelessness among patients with schizophrenia. Patients who fit this profile may be candidates for community-based programs that are specifically aimed at preventing homelessness among patients with severe mental illness.     

Efficacy and tolerance of alprazolam and bromazepam in flexible doses. Double-blind study in 119 ambulatory anxious patients

Double-blind study comparing efficacy and safety of alprazolam and bromazepam in 119 ambulatory anxious patients receiving flexible dosage. 119 ambulatory anxious patients (global score on the Hamilton anxiety rating scale between 18 and 35) have been included in this double-blind trial (duration 4 weeks) comparing alprazolam and bromazepam given at flexible dosage. The global score on the Hamilton anxiety rating scale improved by 57.8% and 55.3% for alprazolam and bromazepam respectively. The percentage of therapeutic success according to the psychiatrist and the patient were respectively 82.7% and 79.3% for alprazolam compared to 74.1% and 71.9% for bromazepam. Fewer side-effects were recorded in the alprazolam group (97) than in the bromazepam group (120) and global safety of alprazolam seemed superior (p = 0.07). At trial-end, mean dosage reached 1.70 mg/day for alprazolam and 10.35 mg for bromazepam, but no correlation was found between anxiety intensity and optimal daily dosage used; however, a correlation has been found between the improvement of the overall Hamilton rating scale score and the dosage given (p = 0.02). The overall results suggest that the efficacy/safety ratio is better for alprazolam.     

去骨板减压术治疗的重型颅脑损伤出院时预后的影响因素

目的 探讨重型颅脑损伤去骨瓣减压术后出院时预后的影响因素。方法 回顾性分析2014年5月至2019年5月收治的150例重型颅脑损伤的临床资料,均行去骨板减压术治疗。出院时,根据GOS评分评估预后,4~5分为预后良好,1~3分为预后不良。采用多因素logistic回归分析检验预后影响因素。结果 150例中,出院时预后良好39例,预后不良111例。多因素logistic回归分析结果显示,入院时APACHEⅡ评分低、无瞳孔散大及入院时GCS评分较高及气管切开术是预后良好的独立评估指标（P<0.05）。结论 重型颅脑损伤病人预后影响因素很多,对于入院时APACHEⅡ评分较高、瞳孔散大、入院GCS评分较低的病人,应及早采取措施干预,以改善病人预后;另外,重型颅脑损伤建议尽早进行气管切开术     

Unawareness of dyskinesias in Parkinson's and Huntington's diseases

We performed a clinical study to evaluate the unawareness of dyskinesias in patients affected by Parkinson's disease (PD) and Huntington's disease (HD). Thirteen PD patients with levodopa-induced dyskinesias and 9 HD patients were enrolled. Patients were asked to evaluate the presence of dyskinesias while performing specific motor tasks. The Abnormal Involuntary Movement Scale (AIMS) and Goetz dyskinesia rating scale were administered to determine the severity of dyskinesias. The Unified Parkinson's disease rating scale (UPDRS) and Unified Huntington's Disease Rating Scale (UHDRS) were used in PD and HD patients, respectively. In PD we found a significant negative relationship between unawareness score at hand pronation-supination and AIMS score for upper limbs. In HD we found a significant positive relationship between total unawareness score and disease duration. In PD the unawareness seems to be inversely related with severity of dyskinesias, while in HD it is directly related to disease duration and severity.     

Effectiveness of symptom validity measures in identifying cognitive and behavioral symptom exaggeration in adult attention deficit hyperactivity disorder

This study examines the effectiveness of symptom validity measures to detect suspect effort in cognitive testing and invalid completion of ADHD behavior rating scales in 268 adults referred for ADHD assessment. Patients were diagnosed with ADHD based on cognitive testing, behavior rating scales, and clinical interview. Suspect effort was diagnosed by at least two of the following: failure on embedded and free-standing SVT measures, a score > 2 SD below the ADD population average on tests, failure on an ADHD behavior rating scale validity scale, or a major discrepancy between reported and observed ADHD behaviors. A total of 22% of patients engaged in symptom exaggeration. The Word Memory test immediate recall and consistency score (both 64%), TOVA omission errors (63%) and reaction time variability (54%), CAT-A infrequency scale (58%), and b Test (47%) had good sensitivity as well as at least 90% specificity. Clearly, such measures should be used to help avoid making false positive diagnoses of ADHD.      

Changes in depression scores following life-threatening illness

Measuring depression in medically ill patients can be affected by the somatic symptoms occuring due to the underlying illness. This study used the Montgomery and Asberg Depression Rating Scale, over a 21-day period in 211 patients with acute life-threatening illness, to assess the influence of three factors upon the incidence of depression. These were time of measurement, the cut-off point used, and the effect of excluding somatic items. Using the standard rating scale, and a cut-off point for depression of 7,63% of the patients were depressed on admission, 46% at one week and 37% at two weeks. Raising the cut-off point for depression to 14 and 21 led to 39% and 16% being depressed on admission and only 8% and 2% at one week respectively. In those patients scoring up to 14 over 75% of this score was accounted for by somatic symptoms. If the rating scale was modified to exclude somatic items from the score the rating scale performed more consistently, and the influence of somatic items was reduced. This study shows that the time of interview, the cut-off point used, and the influence of somatic items are all important in determining the incidence of psychiatric morbidity detected in this patient population.     

Continuity of care and clinical outcomes in a national health system

OBJECTIVE: Continuity of care is widely viewed as a key quality indicator for outpatient mental health care. However, few studies have been conducted of the relationship between continuity of care and client outcomes. This study examined the relationship between measures of three aspects of continuity of care (regularity of care, continuity of treatment across organizational boundaries, and intensity of treatment) and the Global Assessment of Functioning (GAF), a single-item mental health status measure, in a national health care system. METHODS: Three analytic samples were derived from a nationwide Department of Veterans Affairs administrative data set: patients with at least one inpatient GAF rating and a later outpatient GAF rating (N=8,334) and two groups who had at least two outpatient GAF ratings, one group that was beginning a new episode of treatment (N=49,946) and a second group in ongoing treatment (N=123,371). Hierarchical linear modeling was used to control for potential site-level autocorrelation and to adjust for differences in diagnostic status, sociodemographic characteristics, baseline GAF score, and the length of time between GAF ratings. RESULTS: Several positive and significant relationships were found for discharged inpatients and new outpatients. However, only a few of these relationships could be confidently said to be clinically meaningful. Specifically, among discharged inpatients, for every additional month in which an outpatient visit occurred over a six-month period, there was a .69 increase in the GAF change score for a total increase of 4.1 points. Among new outpatients the equivalent values were smaller, at .3 and 1.8. In contrast with the findings for discharged inpatients and new outpatients, high intensity of care was negatively associated with GAF change scores for continuing outpatients. CONCLUSIONS: In contrast with several earlier studies, this study showed positive and statistically significant associations between several continuity-of-care measures and client outcomes. These relationships were observed only in transitional treatment situations, that is, after hospital discharge and at the beginning an episode of outpatient care, situations in which continuity of care may be especially important. However, although positive and statistically significant, the magnitude of these effects may not have been clinically meaningful.