Scurvy and Psychiatric Symptoms

Scurvy is not just a disease of the past, but of the present as well. Yet, the possibility of scurvy is often overlooked in assessing a client's mental health status. Prompt recognition and treatment of scurvy can prevent unnecessary diagnostic testing, as well as a delay in treatment. The author presents a case history of a 55-year-old man with scurvy, delusions, and depression. The client's history, course of illness, treatment, and plan of care are discussed.     

Cocaine and Psychiatric Symptoms

BACKGROUND: Cocaine is an addictive drug that produces numerous psychiatric symptoms, syndromes, and disorders. The symptoms include agitation, paranoia, hallucinations, delusions, violence, as well as suicidal and homicidal thinking. They can be primary to the drug's effect or secondary to exacerbation of comorbid psychiatric disorders. DATA SOURCES: A computerized literature search was conducted using MEDLINE to identify reports of psychiatric symptoms secondary to cocaine use. Additional reports were found via bibliographies of various published reports. DATA SYNTHESIS: The use of cocaine in the "crack" form is often associated with more frequent and intense symptoms. Paranoia occurs in 68% to 84% of patients using cocaine. Cocaine-related violent behaviors occur in as many as 55% of patients with cocaine-induced psychiatric symptoms. Homicide has also been associated with cocaine use in as many as 31% of homicide victims. In suicide, cocaine has been found to be present in as high as 18% to 22% of cases. Many patients with cocaine dependence have also been found to have a comorbid psychiatric disorder. CONCLUSION: Cocaine can produce a spectrum of psychiatric symptoms with which primary care practitioners need to be familiar. Comorbid psychiatric disorders are frequent in patients with cocaine use disorders and can worsen with cocaine use. Nonaddictive medication may be necessary to treat comorbid conditions such as anxiety and depressive disorders. Primary care practitioners need to be familiar with the treatment programs for patients with cocaine use disorders so appropriate referral can easily take place and follow-up care can be understood and maintained.     

Psychiatric Hospitalization Characteristics Associated with Insurance Type

This study examines the relationship among types of insurance and characteristics of inpatient psychiatric treatment. Data include 46,998 adult psychiatric or substance abuse cases from all 1991–1992 Washington State discharges from short-stay general hospitals. Large and significant differences among payers exist in treatment characteristics, controlling for diagnosis and patient age. For example, length of stay is longest among commercial and Medicare payers. Emergency admissions are more common among public payers, and elective admissions are more common among private payers, including HMOs. Results are discussed in light of policy and administration issues that will arise as financing for mental health services comes under greater capitation.     

On Psychiatric Symptoms of Neuro-Behcet's Syndrome

Studies were made on the groups of psychiatric symptoms of Neuro-Behçet's syndrome in six cases considered to be brain stem encephalitis, including one case of autopsy. Psychiatric symptoms appeared from one to eight years after neurological symptoms first occurred. This group of psychiatric symptoms can be divided roughly into the early-stage, middle-stage, terminal-stage and episodic groups. The initial-stage symptom group concerns mainly a change in, and regression of, personality, consisting of being childish, shallow, indifferent, careless, rude, slow in action, euphoric, or depressive. The middle-stage symptom group is made up of indifference, forced smiling, forced crying, amnesia, recent memory impairment, and disorder of sleep rhythm. The terminal-stage symptom group comprises the “locked-in” syndrome, which if advanced, will become Apallisches Syndrome. The episodic symptom group is made up of pathologically abnormal experiences such as hallucinations and delusions and symptoms due to a decline in the level of consciousness such as confusion, delirium and twilight state. Dementia hitherto mentioned in Neuro-Beh¸et's syndrome should be classified as subcortical dementia.     

Symptoms of Psychiatric Disturbance in Epilepsy

To assess the severity and nature of symptoms of psychiatric distress among tertiary center epilepsy patients, we administered the Brief Symptom Inventory (BSI) and Center for Epidemiologic Studies-Depression Scale (CES-D) to adult patients evaluated at our tertiary center who were diagnosed with Epilepsy (EPI; n = 37), or Chronic Lyme Disease (CLD, n = 38). We compared results in these groups to published studies in normal healthy adults (NHA) and psychiatric outpatients (Psych). Mean global BSI and CES-D scores were both markedly elevated in the EPI and CLD groups compared to NHA but less than Psych. Subscores of the BSI varied among the EPI and CLD groups with higher obsessive compulsive symptoms among CLD patients (p = .014), higher paranoid symptoms in the EPI group (p = .021), and a trend toward higher somatization subscores in the CLD group (p = .054). Symptoms of psychiatric distress including depression are common among tertiary epilepsy center patients as well as patients with CLD.     

Psychiatric Symptoms Due to Brain Metastases

Brain metastases account for nearly 170,000 new cases annually in the United States. Although the majority of patients present with neurological symptoms, a minority will develop psychiatric symptoms. Misdiagnosis and delayed treatment are common, with potentially serious consequences. Appropriate intervention may improve the patient’s prognosis and quality of life; thus, early and accurate diagnosis is crucial. This article provides an overview of the diagnosis and management of patients with psychiatric symptoms due to brain metastases.     

Factors Associated with the SECLUSION of Psychiatric Patients

Records of adult psychiatric patients in a university hospital revealed 116 patients had been secluded on 263 occasions during one year. Seclusion was more frequent in winter and spring, and during the late night and early morning, but there was no relationship between seclusion and lunar cycle, week day, weather, menstrual cycle, or month of birth. More males than females were secluded, but females had more multiple seclusions. A control group matched for ward, sex, and within ten years of age consisted of 108 patients. The most common diagnoses for both groups were the major affective disorders and schizophrenia.     

Reduced Hippocampal Activation During Recall is Associated with Elevated FMR1 mRNA and Psychiatric Symptoms in Men with the Fragile X Premutation

Recent studies reveal that young carriers of the fragile X premutation are at increased risk for psychiatric conditions, memory problems and executive deficits. Post mortem and structural MRI studies suggest the hippocampus is preferentially affected by the premutation. The current study utilized magnetic resonance imaging (MRI) to explore the relationship between hippocampal structure and function as well as molecular/genetic and psychiatric measures in men with the fragile X premutation. Although the groups did not differ in hippocampal volume, the premutation group showed reduced left hippocampal activation and increased right parietal activation during a recall task relative to controls. These results suggest that brain function underlying memory recall is affected by premutation status. Left hippocampal activation was negatively correlated with both FMR1 mRNA level and psychiatric symptomology in the premutation group. These associations support the theory that increased levels of FMR1 mRNA affect brain function and contribute to psychiatric symptoms.     

A Clinical Case of Klinefelter's Syndrome with Various Psychiatric Symptoms

Abstract: We present here a clinical case of Klinefelter's syndrome with various psychiatric symptoms. A 60-year-old male showed delusions of persecution, poisoning, and reference, auditory, visual and somatic hallucinations, depressive state and memory disturbance. These clinical symptoms except for memory disturbance were the characteristic clinical features of psychiatric symptoms in some cases of Klinefelter's syndrome reported so far. There has been no reported case of Klinefelter's syndrome showing memory disturbance. The memory disturbance of the present case is regarded as an amnestic organic brain syndrome (DSM-III) due to Klinefelter's syndrome.     

Psychiatric Symptoms Endorsed by Somatization Disorder Patients in a Psychiatric Clinic

Patients with somatization disorder (SD) endorse high rates of psychiatric symptoms. However, prior studies have not addressed whether these endorsed symptoms reflect underlying psychiatric illness or whether they represent symptom overendorsement mirroring somatic complaints in patients with SD. Thirty-two female outpatients with SD and 101 with other psychiatric disorders completed a checklist of current and lifetime psychiatric symptoms. These findings were analyzed with respect to the diagnoses given by their treating psychiatrists. Patients with SD displayed significantly more current and lifetime psychiatric symptoms than did patients without either SD or cluster B personality disorder. Patients with SD endorsed a large number of psychotic, manic, depressive, and anxiety symptoms; however, they endorsed few alcohol use disorder symptoms. Psychotic and manic symptoms endorsed by patients with SD did not reflect their clinical diagnoses: only two patients with SD carried an additional clinician diagnosis of either schizophrenia or bipolar disorder, despite high rates of endorsed symptoms by the group. Patients with cluster B personality disorders but without SD showed a symptom profile similar to that of patients with SD. Psychiatric outpatients with SD endorse many more psychiatric symptoms than do other psychiatric patients. Patients with SD in the psychiatric treatment setting may mimic other psychiatric illnesses; therefore, SD should be considered in the differential diagnosis for a wide variety of psychiatric illness, including psychotic and mood disorders     

Psychiatric Symptoms in Temporal Lobe Epilepsy with Left Mesial Hippocampal Sclerosis

A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients.     

Predictors of Psychiatric Symptoms in Children with an Autism Spectrum Disorder

This study examined mental health risk/protective factors for DSM-IV psychiatric symptoms in children with an autism spectrum disorder (ASD) and their contribution to functioning separate from ASD symptom severity. Mothers/teachers completed measures of risk/protection and social, adaptive, and school functioning in 6- to 12-year-olds with a diagnosed ASD (N = 238). Bivariate correlations and simultaneous regression analyses indicated a unique pattern of predictors for attention-deficit/hyperactivity disorder, aggression, anxiety, and depression symptoms. Moreover, psychiatric symptoms differentially predicted social and school performance. Findings indicate that co-occurring psychiatric symptoms and their associated mental health risk/protective factors may have important clinical implications and generally support a biopsychosocial model of psychopathology in children with an ASD that appears to share many similarities with models for nonASD children.     

Psychiatric Symptoms and Psychosocial Difficulties in Young Adults with Autistic Traits

A screening version of the social responsiveness scale (SRS) was administered to 1,847 university students to identify a subgroup reporting significantly greater autism traits relative to their peers (High SRS group). A group reporting minimal autism traits was also identified (Low SRS group) matched for age, gender, and attentional difficulties. We administered the Behavioral Assessment System for Children—2nd edition (BASC-2), a comprehensive questionnaire designed to assess psychiatric symptoms and personality characteristics, to both groups. The high SRS group reported significantly more difficulties across the majority of areas, including depression/anxiety, interpersonal relationships, and personal adjustment. Thus, young adults reporting a greater degree of autistic traits also reported greater psychiatric difficulties across a wide psychosocial range.