Psychiatric comorbidity among hepatitis C-positive patients.

This study assessed the prevalence of psychiatric disorders among hepatitis C patients at a Veterans Affairs Medical Center. Medical records of 306 randomly selected hepatitis C-positive patients were reviewed for past and present DSM-IV-based psychiatric disorders. Each psychiatric diagnosis was independently confirmed with DSM-IV criteria using symptoms recorded in the chart. Only independently confirmed diagnoses were included for analysis. Mood disorders were present in 38% of patients; personality disorders in 30%; PTSD in 19%; other anxiety disorders in 9%; and psychotic disorders in 17%. Although alcohol use disorders were found in 86% of this patient population, intravenous drug use disorders were present in only 28%. Our data indicate that prevalence rates of a variety of psychiatric disorders are higher in veterans with hepatitis C than in the general population. Mood, anxiety, personality, and psychotic disorders were all relatively common in these patients. Psychiatric disorders may influence the course and treatment of hepatitis C infection, and psychiatrists as well as internists should be aware of the substantial psychiatric comorbidity in patients with this infection.     

中国五地区饮酒情况及相关问题调查Ⅲ.普通人群的饮酒相关问题

目的：了解我国社区普通人群饮酒相关问题的患病率和主要社会损害。方法：应用半定式健康状况调查表和酒依赖及相关问题筛查问卷，调查24992例受试饮酒相关的心理社会和躯体疾病，应用DSM-Ⅲ-R诊断标准，对1874例问题饮酒者进行酒精所致精神疾病的诊断。结果：酒精所致精神障碍的男性、女性和总体时点患病率分别为9．0％、0．2％和5．1％；酒依赖时点患病率分别为6．625％、0．200％和3．797％；三月急性醉酒率分别是14．237％、0．745％和8．299％，均是男性高于女性。酒依赖者的社会损害严重于问题饮酒者。躯体损害以胃炎或胃溃疡和腰背痛的发生率最高。结论：饮酒相关问题已严重影响着我国人民的身心健康，需要得到政府、社会团体和医务工作者的极大关注，以采取相应措施进行有效防治。     

Psychiatric co-morbidity and hospital utilization in the general medical sector

BACKGROUND: This article provides evidence about the relationship between psychiatric disorders, physical disorders and hospital use in the general medical sector using a broadly based survey of the US population. METHODS: The data are from the 1989 National Health Interview Survey. This survey contains medical and mental health evaluations for the entire sample. In a multivariate framework, the author estimates the effect of mental illness on the probability of being admitted to a general hospital, the number of admissions and the length of stay. RESULTS: Hospital use in the general medical sector is significantly higher for persons with coexisting physical and psychiatric conditions than for those with no psychiatric disorders. For a wide range of medical conditions, the predicted number of hospital admissions and the length of a hospital stay increase substantially when the physical illness is accompanied by a psychiatric condition. CONCLUSIONS: One implication of this finding is that economic evaluations of alternative psychiatric treatments should consider any differences in hospital costs related to the treatment of coexisting medical conditions. Another implication pertains to health care systems where insurers have some discretion over which individuals to insure. In the absence of adequate adjustments in insurance payments for high-risk potential enrollees, psychiatrically disabled persons may have more limited access to health insurance.     

酒精所致精神障碍患者的脑电图观察

目的:观察酒精所致精神障碍患者的脑电图(EEG)变化及其与临床的关系。方法:对72例酒精所致精神障碍患者分别进行EEG检查,并对检查结果进行分析。结果:EEG正常17例,边缘状态31例,异常24例;24例异常EEG均表现为广泛性异常,有8例显示局部明显,多见于额、颞顶部导联。结论:酒精所致精神障碍患者EEG异常率较正常人高,且多为广泛性异常,有时呈现局部明显,EEG的异常程度多与临床神经及精神症状的严重程度有关,EEG的表现与大脑功能的损伤具有一定的相关性,能客观反映患者的脑功能状况,对患者大脑功能损伤的诊断、治疗及判断预后有一定的临床价值。     

Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study

BACKGROUND: South Africa's history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools. METHOD: The South African Stress and Health Study was a nationally representative in-person psychiatric epidemiological survey of 4351 adults (aged 18 years) that was conducted as part of the WHO World Mental Health (WMH) Survey Initiative between January 2002 and June 2004. Twelve-month prevalence and severity of DSM-IV disorders, treatment, and sociodemographic correlates were assessed with Version 3.0 of the WHO Composite International Diagnostic Interview (CIDI 3.0). RESULTS: The 12-month prevalence of any DSM-IV/CIDI disorder was 16.5%, with 26.2% of respondents with disorder classified as severe cases and an additional 31.1% as moderately severe cases. The most common disorders were agoraphobia (4.8%), major depressive disorder (4.9%) and alcohol abuse or dependence (4.5%). Twenty-eight percent of adults with a severe or moderately severe disorder received treatment compared to 24.4% of mild cases. Some 13.8% of persons with no disorder received treatment. Treatment was mostly provided by the general medical sector with few people receiving treatment from mental health providers. CONCLUSIONS: Psychiatric disorders are much higher in South Africa than in Nigeria and there is a high level of unmet need among persons with severe and moderately severe disorders.     

Predicting rapid relapse following treatment for chemical dependence: a matched-subjects design

Explored the prognostic significance of treatment and posttreatment variables on rapid relapse following residential treatment for chemical dependence. 54 persons were identified as 3-month treatment failures by the criteria of 1-3 months of alcohol/drug use in combination with alcohol/drug-related consequences and poor life adjustment. To limit heterogeneity, these persons were matched on MMPI scores with persons who were 3-month outcome successes. Additionally, these MMPI patterns were classified as near normal or indicative of psychiatric symptoms. Multivariate statistics revealed a high level of outcome predictability; continued emotional turmoil (depression, anxiety, and sleep problems) posttreatment was strongly related to failure among the psychiatric MMPI group. Failure to engage in a continuing posttreatment aftercare plan was associated with failure among persons in the near-normal MMPI group. Research approaches that attempt to limit heterogeneity among alcoholics appear to have promise in uncovering powerful prognostic indicators.     

Screening psychiatric patients for illicit drug use disorders and problems

BACKGROUND: Illicit drug use is prevalent but under-detected among psychiatric patients. This paper reviews the need for a valid, practical screening instrument for detecting drug problems and disorders among psychiatric patients, and describes the appropriateness of existing screening instruments for this purpose. METHODS: Research literature on illicit drug screening instruments is reviewed. RESULTS: All existing instruments lack one or more of the following characteristics that would enable them to be used routinely in psychiatric settings: brief and easy to administer, demonstrated validity for male and female psychiatric patients, measuring illicit drug use problems without confounding with alcohol use problems, and assessing drug problems over an optimal timeframe for screening (e.g., past 12 months). CONCLUSION: Current instruments are not appropriate for routine drug screening of psychiatric patients. A brief, easy to use drug screen should be developed and validated on male and female psychiatric patients for routine screening of drug disorders and problems.     

What psychiatric screening and monitoring might be needed with the new generation of hepatitis C treatments?

Psychiatric difficulties, including depression and alcohol use disorders, pose a challenge to treatment decision-making for chronic hepatitis C. This is especially made worse because interferon-alpha, as part of the standard of care, may exacerbate depressive symptoms and cause suicidal symptoms to appear. This requires a treatment setting that has the capacity to carry out psychiatric assessment and monitoring, and the capability to deliver patient education regarding these aspects of care. Psychiatric comorbidities create a challenging decision-making situation, especially since success rates for the most common hepatitis C genotype, genotype 1, hover around 40%. In recent years, new treatments have emerged. These significantly boost the likelihood of sustained viral response, including for genotype 1, and do not seem to have the side effects of interferon-alpha or ribavirin. Relevant data are reviewed to assess the degree that these new treatments might reduce the portion not eligible for treatment due to psychiatric comorbidities, and might reduce the emergence of psychiatric symptoms during treatment. Several organizations have recently released evidence-based treatment recommendation guidelines. It is apparent that interferon-alpha continues to be a standard of care, with the new drugs added to this recognized regimen in order to shorten treatment and to boost efficacy. Clinical settings must continue to assess appropriateness for treatment, including current or recent psychiatric comorbidities, and must continue to closely monitor patients for the emergence of psychiatric side effects. The newly developed hepatitis C treatments may affect the metabolism of several categories of psychiatric drugs, and so drug-drug interactions must also be considered and monitored. With many promising drugs under development, an all-pill regimen, with no interferon-alpha and no ribavirin, may emerge in the near future. This will greatly change the challenge of treatment decision-making, and should expand the portion of patients able to successfully complete a treatment regimen.     

Brief detection and co-occurrence of violence,depression and alcohol risk in prenatal care settings

Summary The purpose of the study was to examine the rates and inter-relationships among violence receipt, alcohol use problems, and depression in women seeking prenatal care. While waiting for their prenatal care appointment, women (n = 1054) completed measures of past year partner and non-partner violence receipt, alcohol misuse (TWEAK and quantity and frequency of alcohol use in past year), and depression (Center for Epidemiological Studies Depression Scale – CESD and prior history of depression). Over 30% of women reported either violence receipt, alcohol use problems or depression risk. Significant inter-relationships among all measured risk variables were found. Although violence receipt was significantly related to alcohol misuse, cigarette use, less education, and scoring above the cutoff on the CESD (≥ 16) was most strongly associated with violence. Practitioners should be well-equipped to provide assessment, interventions, or referrals as needed to the high numbers of women encountered in prenatal care settings experiencing psychosocial and behavioral problems that may affect their pregnancy.     

Relapse to alcohol and drug use among individuals diagnosed with co-occurring mental health and substance use disorders: a review

This paper reviews the literature investigating relapse to alcohol and drug use among individuals dually diagnosed with a substance use and a co-occurring mood, anxiety, schizophrenia-spectrum, or personality disorder. Prevalence rates for each co-occurring set of disorders are discussed, followed by research studies that examine predictors of relapse to substance use within these groups. Relevant conceptual models well-suited to incorporating relapse as an outcome variable, and psychiatric factors both as predictor and outcome variables, are presented. Suggestions for future studies are provided. A priority area is developing and using consistent and well-articulated definitions of relapse across studies. Several diagnostic issues surfaced such as using structured clinical interviews to determine diagnosis (preferably following detoxification from alcohol and/or drugs), separating individuals with only alcohol use disorders from those with alcohol and drug use disorders in analyses, reporting the rates and types of overlap in mental health diagnoses, and conducting analyses that include and exclude multiply disordered individuals. Finally, future studies that focus on isolating predictors of relapse and abstinence could make substantive contributions to improving treatment for individuals with co-occurring substance use and mental health disorders.     

New diagnostic criteria for alcohol use disorders and novel treatment approaches – 2014 update

The study is aimed at presenting new diagnostic and therapeutic proposals for patients with alcohol use disorders. The revised ICD-11 which is currently being updated is coming closer to American standards in disease classification. The latest update of the American DSM-5 has been a notable step forward as it integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder. Recent developments in research into diagnostic tools have brought changes in the approach to therapy. According to most international guidelines, the form of treatment should be customised to the individual patient, with consideration given to his/her mental and physical condition, personality and natural setting. A significant change is the recommendation of a harm reduction strategy as a useful alternative to total abstinence in alcohol dependence treatment for some patients.     

Psychiatric behavioral aspects of comanagement of hepatitis C virus and HIV

Coinfection with HIV hastens the progression of liver disease in persons with hepatitis C virus (HCV) infection. As mortality directly due to HIV continues to decrease among persons who are HIV-positive, coinfection with HCV has emerged as a leading cause of death. There is increasing attention to the need to actively treat HCV infection in HIV/HCV coinfected patients. Current HCV treatment with pegylated interferon and ribavirin achieves sustained viral response in up to 40% of coinfected patients but has numerous neuropsychiatric side effects. Providers are hesitant to begin HCV treatment in the coinfected population given the high prevalence of existing psychiatric illness, cognitive impairment, and substance use disorders. There is an urgent need for research into the psychiatric and behavioral predictors of HCV treatment adherence and virologic outcome, as well as into the optimal psychiatric management of the neuropsychiatric sequelae of HCV therapy.     

Psychometric assessment of psychiatric disorders in people with learning difficulties (mental handicap): a review of measures

Instruments designed to assess psychiatric disorders in people with learning difficulties (mental handicap) were critically reviewed from a psychometric perspective. Major trends were found in the assessment of psychopathology related to DSM-III and depressive disorders although research in other areas was patchy. Although some psychometrically sophisticated measures were identified the area was characterized by an absence of important psychometric data for many measures. Future research should attend to developing assessments of schizophrenia, psycho-sexual disorders, adjustment disorders and the validation of screening procedures and instrument formats. Future studies should include more people with severe and profound learning difficulties.     

Triple diagnosis: dual diagnosis and HIV disease,Part 1

Substance use disorders and psychiatric illness commonly co-occur in what is known as dual diagnosis. With the spread of HIV infection in persons with dual diagnoses, the triple diagnosis has emerged as a clinically challenging condition for primary care physicians, addiction medicine specialists, and psychiatrists. Existing data support the high prevalence of triple-diagnosis patients in psychiatric, substance abuse, and HIV treatment settings. This review highlights the features of substance abuse-psychiatric illness and its association with changes in antiretroviral therapy use, adherence, and HIV treatment outcomes. An integrated and interdisciplinary approach addressing substance abuse and mental health issues should be a primary element of comprehensive HIV care. Evaluating the safety and efficacy of psychopharmacologic and psychotherapeutic interventions and understanding the complex interactions among the components of the triple diagnosis are areas for future research. Service delivery and intervention models based on "1-stop shopping" should be developed and put into practice in order to optimize clinical outcomes.     

Pretransplant psychiatric and medical comorbidity of alcoholic liver disease patients who received liver transplant

The authors examined the pretransplant prevalence of comorbid physical and psychological disorders in 112 alcoholic liver disease patients who received liver transplant. Fifty-six percent of the patients had comorbid hepatitis C or hepatitis B virus, 40% had used other substances in addition to alcohol, 25% met the criteria for a lifetime DSM-IV nonalcohol substance use disorder, 36% for a lifetime depressive disorder, and 12% for a lifetime anxiety disorder. The findings suggest the need for pretransplant psychiatric evaluation of alcoholic liver disease patients to identify nonalcohol substance use disorders and other psychiatric disorders that may require treatment.     

The prevalence of psychiatric morbidity and its associated factors in general health care in Taiwan

BACKGROUND: This paper reports the prevalence, disability, sociodemographic and clinical association of psychiatric morbidity among attenders in general health care in Taiwan where, as in the rest of non-Western countries, few studies have been carried out. METHODS: A cross-sectional survey with a two-phase design was carried out at out-patient clinics of three health stations and a general hospital. RESULTS: A total of 990 patients completed the brief screen in the first phase, 486 of whom completed the independent assessment in the second phase. The proportion of screening positives was 46.0% and the weighted prevalence of definite psychiatric disorder was 38.2%. Common mental disorders were associated with female gender and unemployment. Housewives, students and patients with higher educational attainment were at lower risk of having alcohol use disorders. Patients with common mental disorders were more likely to present with psychological complaints, to attribute their illness to psychosocial causes and to perceive their mental and physical health as poor. Psychiatric morbidity was associated with excess life events. Common mental disorders, particularly depressive disorders, were significantly associated with self-reported disability. CONCLUSIONS: Psychiatric morbidity is a major health problem in general health care in Taiwan. Physicians should be aware of these health problems.     

Construction and evaluation of an alcohol vapor chamber system

An increasing number of studies demonstrated that alcohol vapor chamber is an effective way to model physical signs of alcohol use disorders. Although researchers are developing different vapor chambers to study chronic alcohol exposure model worldwide, few studies build and modify their own vapor chambers in China. Here, we designed and established an alcohol vapor chamber system for small animals. We described a paradigm showing how to control and monitor alcohol concentration in whole system. The vapor chamber system with several advantages including accommodating up to ten standard mouse cages. Furthermore, the system was tested by evaluating the blood alcohol concentration and neuron injury in mice. Importantly, the alcohol withdrawal after vapor exposure caused motor coordination impairment, anxiolytic- and depression-like behavior. Finally, the N-methyl-D-aspartate receptor (NMDAR)-mediated glutamatergic transmissions in the medial prefrontal cortex was changed after alcohol vapor exposure-induced behaviors. The frequency and amplitude of spontaneous excitatory postsynaptic currents between control and alcohol groups were not different, suggesting that alcohol exposure-induced behaviors are associated with the change in NMDAR response. Taken together, the new alcohol vapor chamber system was constructed, which would help to research the relationship between the stable alcohol exposure and withdrawal behaviors and to study chronic alcohol exposure-induced disorders in China.     

137例酒精所致精神障碍的临床分析

目的探讨酒精斯致精神障碍的临床特点。方法对近2年．137例我院诊断酒精所致精神障碍的患者人口学资料，饮酒史，躯体情况，精神症状，实验室检查，治疗方法及疗效进行回顾性调查和统计分析。结果共收集137例符合条件的对象，皆为男性，平均年龄46岁，患者文化程度较低，体力劳动者最多。酒龄3～32岁，饮酒量白酒300～1500g，精神症状分布较少，以幻觉妄想状态，意识障碍为多见。近期疗效痊愈和好转，未发现患者文化程度对疗效的影响。结论酒精所致精神障碍多与饮酒时间及饮酒量有关。对患者心疽，生理和社会功能有不同程度的损害。应大力宣传长期饮酒的危害，早期干预。