Psychiatric morbidity in adults with hypopituitarism.

Forty-one adults with established hypopituitarism and deficiency of growth hormone (GHD) were compared to an age and sex-matched group with another chronic metabolic disorder (diabetes mellitus) using standardized psychiatric rating and diagnostic measures. Nineteen (46%) of the GHD group were identified as definite psychiatric cases compared with 10 (24%) of the diabetics (odds ratio 1:9:1). The most frequent DSM III-R axis I psychiatric diagnoses were major depression (32% GHD patients and 10% of diabetic patients) and dysthymia. The risk of being a psychiatric case showed an association with duration of illness in the diabetic group, but not in the GHD group. Biochemical indices were not related to the risk of being a case in either group. Hypopituitarism is associated with a higher prevalence of psychiatric disturbance than can be attributed solely to the presence of a chronic disorder.     

Psychiatric aspects of alcohol misuse.

Alcohol and psychiatric disorder have a complicated relationship. Certain important psychiatric syndromes arise from the toxic effects of alcohol and thiamine deficiency. Liver disease and hypoglycaemia are also associated with their own psychiatric syndromes. Many psychiatric patients also turn to alcohol as an easily available 'medication'.     

Psychiatric illness does not protect against a somatic disease

In four patients, two women aged 68 and 73 years and two men aged 65 and 57 years, serious diseases were not recognised because of more prominent psychiatric symptoms. Three of the patients had malignancies and one was suffering from dehydration with a urinary tract infection and de novo diabetes mellitus. The patient with a meningioma recovered after surgery, the other three patients died despite treatment. Somatic diseases may not be recognised in patients with psychiatric illness because doctors may be more likely to ascribe the symptoms to a psychiatric cause. Patients may also present their symptoms in an unusual way. It is important not only to diagnose the psychiatric disease but also to check the patient's physical condition. This applies particularly to elderly patients, because they are more likely to have somatic diseases. Good education of psychiatrists in terms of somatic diseases remains important.     

Diagnosis of psychiatric disorder in clinical evaluation of chronic fatigue syndrome

The overlap of symptoms in chronic fatigue syndrome (CFS) and psychiatric disorders such as depression can complicate diagnosis. Patients often complain that they are wrongly given a psychiatric label. We compared psychiatric diagnoses made by general practitioners and hospital doctors with diagnoses established according to research diagnostic criteria. 68 CFS patients referred to a hospital fatigue clinic were assessed, and psychiatric diagnoses were established by use of a standardized interview schedule designed to provide current and lifetime diagnoses. These were compared with psychiatric diagnoses previously given to patients. Of the 31 patients who had previously received a psychiatric diagnosis 21 (68%) had been misdiagnosed: in most cases there was no evidence of any past or current psychiatric disorder. Of the 37 patients who had not previously received a psychiatric diagnosis 13 (35%) had a treatable psychiatric disorder in addition to CFS. These findings highlight the difficulties of routine clinical evaluation of psychiatric disorder in CFS patients. We advise doctors to focus on subtle features that discriminate between disorders and to use a brief screening instrument such as the Hospital Anxiety and Depression Scale.     

Patient satisfaction and the detection of psychiatric morbidity in general practice.

This study explores the relationship between the detection of psychiatric illness during general practice consultations and patient satisfaction. Psychiatric illness was defined as a score of greater than or equal to 3 on the 12-item General Health Questionnaire (GHQ-12). The hypothesis was that patient satisfaction would be higher after consultations during which psychiatric illness was correctly identified by the GP than after those during which it was 'missed'. Two hundred and twenty two patients attending seven doctors at one inner London practice participated. One hundred and ten patients (50%) scored greater than or equal to 3 on the GHQ-12. The GPs classified 76 of these 110 patients as having a psychiatric component to their illness and 34 as having an entirely physical illness. Only one significant difference in satisfaction was found between these two groups--patients in whom psychiatric illness was correctly identified reported more benefit from the consultation than patients in whom psychiatric illness was present but 'missed'. Possible explanations for the largely negative findings are discussed including the difficulties of measuring patient satisfaction and the distinction between detection and management of psychiatric illness in general practice.     

Evaluation of a telepsychiatry pilot project.

We assessed a telepsychiatry pilot project in which a psychiatric hospital was linked with mental health clinics in five general hospitals. Information was collected through questionnaires administered to patients, service providers and psychiatric consultants, and by interviews. The technology was considered easy to use by participating health-care professionals and patients, and the quality of the sound and picture was adequate. Survey data suggested acceptance and satisfaction on the part of patients, service providers and psychiatric consultants. An economic analysis indicated that at 396 consultations per year the service cost the same as providing a travelling psychiatrist (C$610 per consultation); with more consultations, telepsychiatry was cheaper. Information gathered during the evaluation suggested that the use of videoconferencing for psychiatric consultations was a viable option for an integrated, community-based mental health service.     

Borna disease virus infection in animals and humans.

The geographic distribution and host range of Borna disease (BD), a fatal neurologic disease of horses and sheep, are larger than previously thought. The etiologic agent, Borna disease virus (BDV), has been identified as an enveloped nonsegmented negative-strand RNA virus with unique properties of replication. Data indicate a high degree of genetic stability of BDV in its natural host, the horse. Studies in the Lewis rat have shown that BDV replication does not directly influence vital functions; rather, the disease is caused by a virus-induced T-cell mediated immune reaction. Because antibodies reactive with BDV have been found in the sera of patients with neuropsychiatric disorders, this review examines the possible link between BDV and such disorders. Seroepidemiologic and cerebrospinal fluid investigations of psychiatric patients suggest a causal role of BDV infection in human psychiatric disorders. In diagnostically unselected psychiatric patients, the distribution of psychiatric disorders was found to be similar in BDV seropositive and seronegative patients. In addition, BDV-seropositive neurologic patients became ill with lymphocytic meningoencephalitis. In contrast to others, we found no evidence is reported for BDV RNA, BDV antigens, or infectious B DV in peripheral blood cells of psychiatric patients.     

Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown

The present study aimed at identifying psychological and psychosocial variables that might predict weight gain during the COVID-19 lockdown in patients affected by overweight/obesity with and without a psychiatric diagnosis. An online survey was administered between 25 April and 10 May 2020, to investigate participants’ changes in dietary habits during the lockdown period. 110 participants were recruited and allocated to two groups, 63 patients had no psychiatric diagnosis; there were 47 patients with psychiatric diagnosis. ANOVA analyses compared the groups with respect to psychological distress levels, risk perception, social support, emotion regulation, and eating behaviors. For each group, a binary logistic regression analysis was conducted, including the factors that were found to significantly differ between groups. Weight gain during lockdown was reported by 31 of the participants affected by overweight/obesity without a psychiatric diagnosis and by 31 patients with a psychiatric diagnosis. Weight gain predictors were stress and low depression for patients without a psychiatric diagnosis and binge eating behaviors for patients with a psychiatric diagnosis. Of patients without a psychiatric diagnosis, 60% reported much more frequent night eating episodes. The risk of night eating syndrome in persons affected by overweight/obesity with no psychiatric diagnosis should be further investigated to inform the development of tailored medical, psychological, and psychosocial interventions.     

Psychiatric nurse reports on the quality of psychiatric care in general hospitals

Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, compared with a larger sample of 11,071 registered nurses who work permanently on medical, surgical, or medical-surgical units. Compared with nonpsychiatric nurses, psychiatric nurse characteristics reveal an older, more experienced workforce, with a higher proportion of male nurses. Nurses rated quality of patient care lower in the psychiatric specialty than in the medical-surgical specialty. Furthermore, psychiatric nurses reported significant concern about the readiness of patients for discharge and higher incidence of adverse events. They also experienced more verbal abuse, physical injuries, and complaints from patients and families. Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively.     

Recognition of alcoholism among patients with psychiatric problems in a family practice clinic

The prevalence of psychiatric disorders associated with alcoholism is reported to be as high as 65 percent. A retrospective chart study was performed to determine whether physicians in a primary care center were adequately evaluating for alcoholism their patients with psychiatric problems. Thirty-five percent of the patients with psychiatric problems seen over a six-month period were not questioned about alcohol use. Younger patients and those with a nonspecific psychiatric diagnosis were questioned even less frequently. In a review of the charts for signs of alcohol abuse, 23 percent of the psychiatric patients had signs of possible alcoholism, and 6 percent were definite alcoholics. Since the presence of alcoholism may significantly alter the approach to therapy, primary care physicians should fully evaluate all patients for this problem, especially if they present with a psychiatric disorder.     

Increasing effectiveness by sectorization of psychiatric care--an epidemiologic study

Results of social-psychiatric analyses explained the lacks of the traditional psychiatric homes. This perception led to development of new systems of care in an international scope, which are based on the principle of sectorial psychiatric care. Based on epidemiological data (distribution of diagnoses, space of origin, duration of stay, number of patients treated, first and repeated admission), the alteration of the spectrum of performances of the Psychiatric Clinic of the KMU Leipzig is analysed. To sectorial principle this Clinic attends to all psychiatric patients of the district Leipzig South requiring stationary treatment since 1976. The increase of performances of the clinic and the improved care about psychiatric patients by sectors as well became obviously.     

Bipolar illness in primary care: an overview

Primary care providers are in the front line of detecting and diagnosing psychiatric illness. Managed care barriers to direct psychiatric treatment have made it necessary for primary care providers to increase their sophistication in the recognition of psychiatric disorders. Primary care providers often formulate provisional diagnoses and initiate treatment or specialty referral in spite of the time constraints of the primary care setting. The patient presenting in primary care with an affective disturbance must be evaluated for a major mood disorder, which includes unipolar and bipolar illness. Research has shown that more patients than previously estimated have milder forms of bipolar illness disorder, such as bipolar type II and cyclothymia. Patients with these milder forms of bipolar are less likely to present for treatment in a psychiatric setting and more likely to share symptoms of the illness in a primary care setting. This article provides an overview for the primary care provider in the detection, assessment, and treatment of bipolar patients with an emphasis on the differentiation of unipolar and bipolar depression.     

Medizinische Versorgung und therapeutische Optionen unter gesundheitsökonomischen Aspekten bei psychiatrischen Patienten in Deutschland am Beispiel schizophrener und depressiver Störungen

Optimal and effective medical care of patients suffering from psychiatric disorders and their integration into society leads undoubtedly not only to a higher quality of life of the person affected, but also to a reduction of direct and indirect disease-related costs such as loss of earnings and disability pension. Both schizophrenia and depressive disorder display an early age of onset and inclination to a chronic course under inadequate medical care and thus are interesting examples for diseases with enormous direct and indirect disease-related health costs. We want to illustrate with these diseases the necessity for further effort, more extensive financial support, and the will for change to maintain the standard of medical care for psychiatric patients which has been achieved during the last 20 years in Germany. To achieve this goal, all sectors of the healthcare system have to recognize the health economic effects of inadequate medical care of psychiatric patients either as a result of understaffing, insufficient application of therapeutic options, inadequate exploitation of the care system, or as an effect of inaccurate legislation and to draw the right conclusions together. Furthermore, more research on the care system of psychiatric patients dealing with economic aspects is required.     

Patient participation in fundamental psychiatric genomics research: a Dutch case study

Objective To analyse the results of an action research process, the aim of which is to involve patients in fundamental psychiatric genomics research, against theoretical backgrounds that formulate a Dialogue Model for patient involvement. Background Mixed views continue to exist about the value, appropriateness and potential of involving consumers and patients in basic medical research. There is a need to learn from practical examples. Design An action research process was set up to facilitate and stimulate the involvement of a Dutch patient organization and a family organization in a psychiatric research consortium. Findings The premises and procedures of the Dialogue Model constitute good guidelines for involvement in fundamental research. However, the normative core features for patient involvement underlying the model prove problematic due to: (i) properties of complex psychiatric genomics research; (ii) the entanglement of subjectivity and basic psychiatric science; (iii) universal notions of citizenship and difficulties of delineating the patient in psychiatric genomics research. Conclusion Interaction and dialogue among scientists, patients and family members are possible in fundamental genomics research. The best approach for involvement would seem to be based on the creation of common ground and an evolving dialogue, which the guidelines of the Dialogue Model can provide. The challenge here will be to create also a dialogue on the normative anchor points of the dialogue process and to identify and monitor power relations inherent in these (tangible) dialogues.     

A comprehensive payment model for short- and long-stay psychiatric patients

In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.     

兰州市重性精神疾病社区管治效果观察

目的了解兰州市七里河区重症精神疾病患者的既往病史、发病和治疗等情况,为建立健全社区精神疾病防治管理系统和提高精神卫生服务水平提供科学依据。方法将七里河区精神疾病管理系统收录的患者资料录入Epi Data 3.0数据库,应用Excel 2003和SPSS 16.0进行统计分析。结果精神疾病患者起病以亚急性为主,有1 223例,占61.52%,连续病程超过1年的有1 416例(71.23%),接受治疗的患者连续服药者有1 457例,占74.57%;经过治疗有737例(37.72%)痊愈,不同病情状态的患者治疗结果差异显著。结论精神疾病患者的防治康复管理已取得一定的效果,应继续加强对精神疾病患者的防治和管理。     

Psychiatric hospitalizations in a cohort of Danish polio patients

Although previous polio infection remains a considerable cause of long-term morbidity worldwide, few studies have examined the psychiatric consequences of poliomyelitis. The authors followed 4,660 polio patients hospitalized at the primary infectious disease hospital in Copenhagen, Denmark, between 1922 and 1954 as well as 19,017 age- and gender-matched Danes for psychiatric hospitalizations from January 1, 1977, to December 31, 1993. Incidence rates of all psychiatric disorders combined and of separate diagnostic groups of psychiatric diseases in the two cohorts were compared, yielding the incidence rate ratio, a measure of relative risk. Overall, polio patients had a 40% increased risk of being hospitalized for a psychiatric disorder (incidence rate ratio = 1.43, 95% confidence interval: 1.23, 1.66). Apparently, the overall increased risk of psychiatric hospitalizations could not be confined to specific groups of psychiatric disorders but seemed to be explained by slightly increased risks of several different disorders, especially milder psychiatric disorders. Finally, psychiatric morbidity did not differ between paralytic and nonparalytic polio patients. History of hospitalization for polio might be associated with subsequent risk of hospitalization for psychiatric disorders. The underlying mechanism for this association remains uncertain.     

Rethinking nurses' observations: psychiatric nursing skills and invisibility in an acute inpatient setting

In sociological, managerial and clinical investigations of psychiatric nursing, the skills of observing patients are compared unfavourably with nurses' ability to listen, to interview and to engage with patients. This paper examines how nurses in an acute psychiatry unit used observation as a significant part of their everyday assessments of patients, through a working shift. We argue that the knowledge generated in observations is essential to the nurses' gaze in this setting. Based on an ethnographic study of the assessment practices of 11 psychiatric nurses and the first author in an Australian hospital setting, we found that nurses' observations of patients were rich in situated assessment detail and a powerful strategy for producing civil conduct among patients. In particular, we noted how nurses deliberately obscured their practice of observation, in order not to provoke patients. While such discreet practice is productive for everyday clinical work, the invisibility of nursing observations undermines the status of acute inpatient psychiatric nurses. Devaluing of tacit practice may encourage experienced nurses to leave inpatient units, at a time when hospitals struggle to address nursing shortages worldwide. We recommend instead that the productive value of diverse and situated practices be investigated and articulated.     

Psychiatric problems of AIDS inpatients at the New York Hospital: preliminary report

A retrospective review of the charts of 52 patients with acquired immune deficiency syndrome (AIDS) in the New York Hospital was conducted to determine the prevalence of recorded psychiatric complications and the use of psychiatric consultation. Neuropsychiatric complications were found to be pervasive clinical features in AIDS patients hospitalized during acute illness. Mood disturbance was identified in an overwhelming majority of the patients (82.7 percent), and signs of organic mental syndrome (DSM III) were noted in 65.4 percent; references to neuropsychiatric complications appeared in every patient's chart. Neurological complications were seldom explicitly diagnosed or treated. Psychiatric consultation was requested for 10 patients (19.2 percent) because of management problems, for diagnostic assessment, or by self-referral. Only one patient was given a psychiatric diagnosis at discharge. The results suggest that the neuropsychiatric complications of AIDS are underdiagnosed during acute medical illness and that psychiatric consultation is underutilized. AIDS patients have a heightened risk of psychological problems. Contributing factors may include the threat to life, severe physical debilitation, central nervous system involvement, fear of contagion, disclosure of homosexuality or drug abuse, and guilt associated with sexual transmission.