Implementation of a rational pharmacotherapy intervention for inpatients at a psychiatric department

The objective of the study was to develop, implement and evaluate two treatment algorithms for schizophrenia and depression at a psychiatric hospital department. The treatment algorithms were based on available literature and developed in collaboration between psychiatrists, clinical pharmacologists and a clinical pharmacist. The treatment algorithms were introduced at a meeting for all psychiatrists, reinforced by the project psychiatrists in the daily routine and used for educational purposes of young doctors and medical students. A quantitative pre-post evaluation was conducted using data from medical charts, and qualitative information was collected by interviews. In general, no significant differences were found when comparing outcomes from 104 charts from the baseline period with 96 charts from the post-intervention period. Most of the patients (65% in the post-intervention period) admitted during the data collection periods did not receive any medication changes. Of the patients undergoing medication changes in the post-intervention period, 56% followed the algorithms, and 70% of the patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms. All of the 10 interviewed doctors found the algorithms useful. The treatment algorithms were successfully implemented with a high degree of satisfaction among the interviewed doctors. The majority of patients admitted to the psychiatric hospital department for the first time had their medications changed according to the algorithms.     

医院内职业康复对精神症状的影响

目的：评估医院内职业康复对慢性精神分裂症患者精神症状的影响。方法：83例慢性精神病住院患者随机分为康复组和对照组,对康复组病例施行医院内职业康复,在治疗前、后以简明精神病评定量表（BPRS）、阳性症状评定量表（SAPS）、阴性症状评定量表（SANS）、住院病人护士观察量表（NOSIE－30）评估。疗程6个月。结果：康复组BRPS总分及缺乏活力和思维障碍两个因子的减分值显著大于对照组;SAPS总分减分值两组间差异无显著性;康复组SANS总分及其各因子分的减分值均显著大于对照组;康复组NOSIE－30总分及社会兴趣因子的减分值显著大于对照组。结论：医院内职业康复对于慢性精神分裂症患者的精神症状有一定的影响,尤其有助于改善阴性症状。     

基于决策树方法分析住院精神分裂症患者骨密度异常的影响因素

目的 探索影响住院精神分裂症患者骨密度异常的相关因素,为预防骨质疏松和骨折提供参考.方法 选取天津市精神卫生中心2015年1~7月住院的精神分裂症患者,采用自制问卷进行调查,收集被试的社会经济状况、既往病史、治疗史、骨密度、催乳素(PRL)等生化指标及住院期间的饮食、运动情况;按照骨密度是否异常进行分组,采用决策树方法探讨影响骨密度异常的因素.结果 444例住院精神分裂症患者中,存在骨密度异常的有300例(67.57%),其中骨质疏松者156例(35.14%)."有无骨折史"是住院精神分裂症患者骨密度异常的首要影响因素(χ2=46.347,P<0.01),"饮用咖啡浓茶"(χ2=55.424,P<0.01)和"每天室内运动"(χ2=31.191,P<0.01)是二阶节点,三阶节点为"吃豆制品"(χ2=35.801,P<0.01)和"血钙水平"(χ2=25.281,P<0.01).结论 住院精神分裂症患者中,骨密度异常状况严重;既往骨折史对于住院患者预防骨质疏松意义重大,对于有骨折史的患者,适当增加室内运动可以减少骨质疏松的发生;对于无骨折史的患者,除了定期监测其骨钙值以外,还应加强对其膳食习惯的干预.     

精神障碍患者出院处方中抗抑郁药的分析

目的分析我院抗抑郁药的临床使用和合理用药情况。方法随机抽查我院2007年10～12月出院带药处方,采用限定日剂量(DDD)和药物利用指数(DUI)对抗抑郁药物的使用进行了回顾性分析。结果SSRIs类抗抑郁剂使用频率较高。在联合用药方面,抗抑郁药主要是和抗精神病药物、镇静催眠药、心境稳定剂并用。在使用的13种抗抑郁药中除氟西汀和曲唑酮外,其余药物的DUI均≤1.0。结论我院抗抑郁药物的使用基本合理,且新型抗抑郁药的应用越来越多。     

Prevalence,correlates and recognition of depression in Chinese inpatients with cancer

Objective

To determine the prevalence, correlates and recognition rates of depressive disorders (DDs) in Chinese inpatients with cancer.

Methods

Four hundred and sixty cancer inpatients were recruited from the oncology ward of a university hospital in Beijing, China. Patients were interviewed with a Chinese version of the Mini International Neuropsychiatric Interview 5.0 by eight trained psychiatrists. Case records of inpatients with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) DDs were reviewed to determine whether treating oncologists made a diagnosis of depression, prescribed antidepressant medications and/or recommended psychiatric consultation/referral.

Results

The 1-month prevalence rates (95% confidence intervals) of DDs and major depressive disorder (MDD) were 25.9% (21.9%–29.9%) and 12.6% (9.6%–15.6%), respectively. In our multiple logistic regression analysis, being unmarried [odds ratio (OR)=1.41], cancer stage of metastasis (OR=2.35), time since cancer diagnosis ≤ 20 months (OR=2.05), frequent pain (OR=1.99~6.83) and being scored between two and four on the Eastern Cooperative Oncology Group Scale (OR=2.25~4.97) were independently associated with depression. Only 6.9% of patients with MDD were recognized by treating oncologists.

Conclusions

DDs are very common among Chinese inpatients with cancer. The high prevalence rate and low recognition rate of depression in cancer patients indicate a pressing need for routine screening, evaluation and treatment of depression in this patient population.     

Parent and teacher reports of problem behaviors in child psychiatric inpatients: Cross-informant correlations on admission and at 5-month follow-up

The present study compared parent and teacher evaluations of behavioral problems in a sample of school-age child psychiatric inpatients on admission and at 5-month follow-up. Both parents and teachers viewed changes in children's emotional/behavioral problems over the course of the follow-up period rather similarly. In general, parents and teachers viewed children's behavior as significantly improved relative to pretreatment.     

Prospects for a rational pharmacotherapy of alcoholism

There is little evidence from current practice that pharmacotherapy has a place, as an adjunctive or primary modality, in the rehabilitation of alcoholic patients. Pharmacologic approaches in the treatment of other substance dependence disorders, as well as recent research on the neuropharmacology of acute and chronic ethanol administration, suggest the feasibility of a potential pharmacotherapy of alcoholism. This review describes the prospects for a rational pharmacotherapy in the rehabilitation of alcohol-dependent patients. In the main, the review is speculative and serves to highlight some areas of research progress related to alcoholism and other addictive disorders, some specific areas of research need, and some implications for clinical practice.     

A snapshot of cognitive functioning: Deriving a tool for the efficient assessment of cognition in schizophrenia and other chronic psychiatric disorders in a real-world inpatient setting

Previous research has led to the development of short batteries of tests that efficiently measure the cognitive functioning of individuals with schizophrenia. To attempt to replicate previous findings, we applied an empirical test selection strategy to archival cognitive test data of two non-overlapping inpatient samples of individuals with schizophrenia or schizoaffective disorder (total N=110). We then extended previous findings by applying the empirical test selection strategy to the archival data of two non-overlapping inpatient samples of individuals with various psychiatric disorders (total N=149). For each sample, tests were selected by examining the relationships between individual test scores and averaged test scores representing global cognitive functioning while taking into account test administration times. Across patient samples, digit symbol coding tasks, verbal fluency tasks, and tests with a processing speed component (Trail Making Test Part A and Stroop) emerged as efficient and effective indicators of overall cognitive functioning. A brief cognitive assessment tool incorporating coding, fluency, and processing speed tasks would provide a valid and clinically useful snapshot of a patient's level of cognitive functioning if more comprehensive testing cannot be completed.     

Benefits of collaborative care for post-CABG depression are not related to adjustments in antidepressant pharmacotherapy

Objective

To determine whether the use and adjustment of antidepressant pharmacotherapy accounted for the beneficial effects of collaborative care treatment on the improvement of mood symptoms and health-related quality of life (HRQoL) after coronary artery bypass graft (CABG) surgery.

Methods

In a post-hoc analysis of data from the Bypassing the Blues (BtB) trial we tested the impact of antidepressant medication on changes in depression and HRQoL from the early postoperative period to 8-month follow-up. Two hundred fifty-nine depressed post-CABG patients scoring ≥ 10 on the Patient Health Questionnaire-9 were classified in four groups according to whether or not they received antidepressants at baseline and 8-months following randomization.

Results

Patients using antidepressant pharmacotherapy at baseline and follow-up tended to be younger and female (p≤0.01), but were similar in various clinical characteristics. Just 24% (63/259) of patients were on an antidepressant at baseline which increased to 36% at follow-up (94/259). Compared to other groups, patients on antidepressants at both baseline and follow-up assessment showed the smallest improvement in mood symptoms and HRQoL. While multivariate analyses confirmed that randomization to collaborative care was associated with greater improvement in mood symptoms (odds ratio [OR] = 3.1; 95%-confidence interval [CI] = 1.8–5.4, p < 0.0001) and mental HRQoL (OR = 3.6, CI = 1.4–9.3, p = 0.01), use of antidepressant medication had no differential impact on either measure (p = 0.06 and p = 0.92, respectively).

Conclusion

The beneficial effects of collaborative care for post-CABG depression were not generated by adjustments in antidepressant medication.Trial Registration: Clinicaltrials.gov Identifier: NCT00091962.(http://clinicaltrials.gov/ct2/show/NCT00091962?term=rollman+cabg&rank=1).     

Changes in the clinical features of child and adolescent psychiatric inpatients: a nationwide time-trend study from Finland

Background: Few studies have focused on the recent trends in clinical features child and adolescent inpatient. Aims: This study focuses on the change in the characteristics of child and adolescent psychiatric inpatients in Finland. Methods: The data collection was carried out on selected study days in 2000 and 2011. Questionnaires were sent to the psychiatrists of all child and adolescent wards in Finland. Results: By comparing the data obtained in 2000 (n = 504) and 2011 (n = 412), several changes were found: the percentage of girls in adolescent wards grew and the diagnoses of depression, anxiety disorders, attention deficit hyperactivity disorder and eating disorders increased. In contrast, the diagnoses of psychosis and conduct or oppositional disorders decreased. General functioning was evaluated with the Childreńs Global Assessment Scale (CGAS). There were no changes in the distribution of CGAS scores among child inpatients, whereas among adolescents the share of inpatients with lowest CGAS scores (1–30) increased significantly. The mean length of stay dropped. Conclusions: The growing percentage of girls in adolescent wards is associated with an increase in diagnoses that are more prevalent among girls than boys, namely depression, anxiety, and eating disorders. The changes in the distribution of diagnoses may be due to changes in diagnostic or referral practices, or reflect true changes in the prevalence of disorders among children and adolescents in need of inpatient treatment. The share of adolescent inpatients with the poorest general functioning has increased. The observed shortening in inpatient treatment time seems to be a result of changes in treatment practices.     

精神分裂症患者家属焦虑抑郁状态的相关因素分析

目的探讨住院精神分裂症患者家属出现焦虑抑郁状态的相关因素，并应用回归分析说明各因素的作用。方法应用自制的一般情况调查表、自评焦虑量表（SAS）、自评抑郁量表（SDS）等调查了100名住院精神分裂症患者的家属，应用SPSS中的Logistic回归进行分析。结果被调查者中有58人同时出现焦虑、抑郁。焦虑抑郁症状的出现与患者家属的年龄、患者的住院次数、患者的家庭收入和患者家属对于精神分裂症的了解相关。结论患者家属的年龄越大、家庭收入越低，以及对疾病的了解越少，家属越容易出现焦虑抑郁症状，三者中以家庭收入的影响最大。     

Multiple sclerosis and psychiatric disturbances: clinical aspects and a review of the literature

Psychiatric disturbances during the course of multiple sclerosis (MS) may derive from the particular emotional situation induced by a more or less manifest awareness of the disease, or be directly attributable to the pathological process itself. In this latter case, the range of clinical manifestations is somewhat characteristic, as there is often a concomitant impairment of the superior nervous functions, particularly those relating to memory and attention. Interpretation of the role played by affective disorders is particularly controversial, as it is not possible to establish with precision (and the result would in any case be a simplistic interpretation of the problem) a direct relationship between the sites of cerebral lesions and the psychiatric manifestations observed in MS.

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Sommario I disturbi psichici in corso di SM possono originare dalla particolare situazione emotiva indotta dalla più o meno manifesta consapevolezza di malattia o essere ascrivibili direttamente al processo patologico stesso: in quest'ultimo caso lo spettro delle manifestazioni cliniche è piuttosto caratteristico, poiché spesso coesiste una compromissione di funzioni nervose superiori, appartenenti soprattutto alla sferamnestica eattentiva. In particolare l'inquadramento delle turbe dell'affettività risulta controverso, infatti non è possibile stabilire con precisione (e sarebbe d'altro canto una interpretazione semplicistica del problema) un rapporto diretto tra sede di lesioni cerebrali e manifestazioni psichiatriche della SM.

     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t -test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

Characterization of benzodiazepine withdrawal in high- and low-dose dependent psychiatric inpatients

Fourteen patients with high- (n = 7) and low-dose (n = 7) benzodiazepine (BDZ) dependency presented predominantly with anxious and depressive neurotic symptoms which caused long-term BDZ medication. Their BDZ dependency was characterized by giving preference to the abuse of benzodiazepines with long elimination half-life. Significant enlargement of CSF spaces was only found in high-dose dependent patients. Withdrawal after long-term BDZ medication revealed no differences between high- and low-dose BDZ dependency with respect to onset of withdrawal reaction and the correlation between onset of withdrawal and peak fall of BDZ serum level. The peak of withdrawal was reached 3-4 days later in high-dose BDZ dependent patients compared with those with a low-dose dependency. The peak withdrawal in high-dose dependent patients appeared when the serum BDZ metabolite nordiazepam dropped significantly. No such concomitant appearance of peak withdrawal and drop of serum nordiazepam level could be found in low-dose dependent patients. Specificity and intensity of BDZ withdrawal symptoms were the same for those dependent upon high doses of BDZs and those dependent upon low doses, but a protracted withdrawal was only observed in low-dose BDZ-dependent patients. During the withdrawal period psychopathometric measurements consistently revealed parallel changes in the scores for physical withdrawal symptoms, anxiety and depression. It is not clear whether anxiety and depression are "typical" BDZ withdrawal reactions or represent a "reactivated" state of the psychopathological disturbance which lead to the BDZ dependency. Possible implications for the therapeutical management of BDZ-dependent patients are discussed.     

Smoking, quitting, and psychiatric disease: a review

Tobacco smoking among patients with psychiatric disease is more common than in the general population, due to complex neurobiological, psychological, and pharmacotherapeutic mechanisms. Nicotine dependence exposes smokers with co-occurring mental illness to increased risks of smoking-related morbidity, mortality, and to detrimental impacts on their quality of life. The neurobiological and psychosocial links to smoking appear stronger in certain comorbidities, notably depression and schizophrenia. Through its action on the cholinergic system, nicotine may have certain beneficial effects across a range of mental health domains in these patients, including improved concentration and cognition, relief of stress and depressive affect, and feeling pleasurable sensations. Despite the availability of effective smoking cessation pharmacotherapies and psychosocial interventions, as well as increasing evidence that individuals with psychiatric disorders are motivated to quit, nicotine dependence remains an undertreated and under-recognized problem within this patient population. Evidence suggests that provision of flexible and individualized treatment programs may be successful. Furthermore, the complicated relationship observed between nicotine dependence, nicotine withdrawal symptoms, and mental illness necessitates integration of close monitoring in any successful smoking cessation program.     

缓解期精神分裂症患者抑郁和自尊状况的调查及心理干预

目的了解缓解期精神分裂症患者抑郁/自尊状况及心理干预对其的影响。方法采用抑郁自评量表(self-ratting depression scale,SDS)及自尊量表(self-esteem scale,SES)对56例缓解期精神分裂症患者进行问卷调查,随机抽取其中20名患者进行深入访谈并进行逐步分析。根据调查分析存在的心理问题,有针对的实施为期6周的心理干预,然后再次测评SDS及SES,并与干预前进行比较。结果进行心理干预前后,缓解期精神分裂症患者SDS评分由(48.96±5.95)下降至(41.76±6.72);SES评分由(26.72±7.84)上升至(34.51±8.63);其差异有统计学意义(P<0.01)。结论缓解期精神分裂症患者存在多种内心体验而表现出抑郁或自卑,心理干预可改善缓解期精神分裂症患者的抑郁和自卑。     

Sleep-dependent memory consolidation of a new task is inhibited in psychiatric patients

Schizophrenic and depressive patients show impeded sleep-dependent procedural memory consolidation. But this has been shown mainly for tasks testing the adaptation of old skills. This study tested the overnight memory consolidation of a new task and the transfer of this new skill to a similar task. Using an adapted version of the sequential finger tapping task, keyboard-naïve Ethiopian depressive (n = 8) and schizophrenic (n = 15) patients and healthy controls (n = 11 and n = 17) were tested twice, 24 h apart. In addition the subjects underwent training in a second sequence after the retest of the first sequence. Both schizophrenic and depressive patients did not show a significant overnight change in performance (1% and 4% improvement respectively) in the task and differed significantly from the healthy control groups who did show significant improvement (16% and 22%). Further in contrast to the healthy controls both patients groups showed no significant transfer of the newly acquired skill to the second sequence. This study shows that depressive and schizophrenic patients are not only deficient in the overnight memory consolidation of a new task, but also fail to show a transfer of this new skill to similar tasks.     

Screening for osteoporosis: a survey of older psychiatric inpatients at a tertiary referral centre

BACKGROUND: Osteoporosis causes much morbidity and mortality among elderly people. Older inpatients with severe mental illness may be at particular risk of osteoporosis because of factors including immobility, vitamin D deficiency and psychotropic medication. METHOD: We screened predominantly older inpatients with severe mental illness for osteoporosis using a peripheral DEXA scanner. Associations were examined between patient variables and osteoporosis as detected by DEXA scan, Z-scores and history of fragility fractures. Patients were followed up to see how many subsequently received drug treatment for osteoporosis. Patient acceptability of the scanning technique was also assessed. RESULTS: It was possible to scan 72/89 (81%) of patients. Mean T-score was -2.79 (SD 1.50) and mean Z-score -0.76 (SD 1.34). Forty-two (58%) patients had osteoporosis and 23 (32%) osteopenia. Twelve (17%) patients with a history of fragility fractures had osteoporosis on DEXA scan. A scan suggestive of osteoporosis and a history of fragility fractures were both associated with age of 75 years and over and thoracic kyphosis. Low Z-scores were associated with longer hospital stay and osteoporosis-predisposing drugs. Patient acceptability of scanning was high. At follow-up, only 7/16 (44%) patients were suitable for central scanning and 9/40 (23%) for bisphosphonates. CONCLUSION: Older institutional patients with severe mental illness are likely to be at high risk of developing osteoporosis. Peripheral DEXA scanning is acceptable to these patients and identifies those at high risk of fractures. Some behaviorally disturbed patients are not suitable for central scans or for some osteoporosis drug treatments.