Dependency and eating disorders in female psychiatric inpatients

Research indicates that oral dependent and eating-disordered individuals have similar personality traits, attitudes, and behaviors, suggesting that dependency may be a factor in the dynamics of anorexia and bulimia. To investigate this issue, we compared the proportions of dependent and food-related percepts in the Rorschach protocols of matched samples of eating-disordered (N = 16), obese (N = 18), and non-eating-disordered, normal-weight female psychiatric inpatients (N = 17). Eating-disordered patients reported significantly more dependent Rorschach imagery than did obese or normal-weight control patients, but no difference in the proportion of food-related imagery was found among the three groups. These results support the hypothesis that unresolved dependency issues underlie anorexia and bulimia.     

Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders

The current study the relationship between eating disorders (EDs) and suicidal ideation and suicide attempt in adult inpatients. In particular, the present study investigated one potential mechanism, body dissatisfaction (BD), which may contribute to increased risk for suicide in adult ED patients. A sample of 432 psychiatric inpatients ranging from 18 to 65 years of age participated in the current study. Findings indicated that patients who have higher levels of BD also had higher levels of passive and active suicidal ideation and previous suicide attempts. Higher levels of BD were also related to increased suicidal ideation after controlling for depression and emotion dysregulation. Although additional risk factors for suicide should be investigated in adults with EDs, this study provides evidence regarding the relationship between BD and risk for suicide ideation and attempt.     

Diagnosing personality disorders in psychiatric inpatients

This study investigated assumptions made by DSM-III and DSM-III-R regarding Axis I-Axis II associations and sex differences for the 11 personality disorders (PD). A total of 112 patients formed 4 Axis I diagnostic groups: recent-onset schizophrenia (n = 35); recent-onset mania (n = 26); unipolar affective disorder (n = 30); and a mixed diagnostic group (n = 21). The prevalence of PD was determined using the Structured Interview for DSM-III Personality Disorders (SIDP). Schizophrenia was associated with antisocial PD and schizotypal PD; manic disorder was associated with histrionic PD; and unipolar affective disorder was associated with borderline, dependent and avoidant PD. Some of these results were consistent with DSM-III/DSM-III-R postulates. However, there was little support for the DSM-III/DSM-III-R statements on sex differences in the prevalence of PD, except for antisocial PD. The implications of the results for DSM-III/DSM-III-R assumptions are discussed.     

Dissociative disorders in Dutch psychiatric inpatients

OBJECTIVE: The goal of this study was to determine the frequency of dissociative disorders in Dutch psychiatric inpatients. METHOD: During a period of 12 months, 122 consecutively admitted adult psychiatric patients were screened with the Dissociative Experiences Scale. Patients scoring 25 and higher and a random selection of patients scoring lower than 25 were blindly interviewed with the Structured Clinical Interview for DSM-IV Dissociative Disorders, Revised. Interviews were scored independently by a blind rater. RESULTS: Ten (8%) of the 122 patients were diagnosed as having a dissociative disorder; two (2%) were diagnosed as having a dissociative identity disorder. Two patients (2%) had factitious dissociative identity disorder. CONCLUSIONS: The rate of dissociative disorders in this group of Dutch patients is comparable to the rates reported in other European studies but lower than rates reported in North American studies.     

Impulse control disorders in psychiatric inpatients

The aim of this study was to examine the prevalence of impulse control disorders (ICDs) in a European psychiatric inpatient sample. Two hundred thirty four consecutive psychiatric inpatients (62% female) were examined using a module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) that has been developed for ICDs (SCID-ICD). In addition to intermittent explosive disorder, pyromania, kleptomania, pathological gambling, and trichotillomania, the proposed ICDs not otherwise specified were assessed, including compulsive buying, nonparaphilic compulsive sexual behavior, pathological internet use, and pathological skin picking. Based on the SCID-ICD, a lifetime ICD rate of 23.5% and a current ICD rate of 18.8% were found. The most frequent ICDs were pathological skin picking (lifetime 7.3%, current 6.8%), compulsive buying (lifetime 6.8%, current 6.0%), and intermittent explosive disorder (lifetime 5.6%, current 3.4%). In contrast, referring to admission diagnoses taken from patients' charts only 3.8% of the inpatients were diagnosed with any current ICD. Individuals with comorbid ICD were significantly younger and had more admission diagnoses other than ICD. The results suggest high rates of ICDs among psychiatric inpatients that remain to be under-diagnosed in clinical routine.     

Impulse control disorders in adult psychiatric inpatients

OBJECTIVE: The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. METHOD: They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. RESULTS: Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. CONCLUSIONS: Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.     

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。     

Personality disorders and unmet needs among psychiatric inpatients

OBJECTIVE: This study sought to examine the association between unmet need and personality disorders in a sample of psychiatric inpatients. The authors tested the hypothesis that the presence of a personality disorder would be independently associated with a significantly greater number of unmet needs. METHODS: A total of 153 psychiatric inpatients from four acute hospital wards serving an inner-city borough in London, United Kingdom, received standardized assessments of need and personality disorder by use of the Camberwell Assessment of Need Short Assessment Schedule and Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: Fifty-four percent of the sample had a personality disorder. The presence of a personality disorder was associated with greater unmet need. In multiple regression analyses, after adjustment was made for the effects of all covariates, severity of personality disorder was significantly associated with unmet need. Personality disorder was significantly associated with greater need in eight of 22 domains of need: self-care, psychotic symptoms, psychological distress, risk to self, risk to others, alcohol use, sexual expression, and budgeting. CONCLUSIONS: Personality disorder was found to be independently associated with a greater level of unmet need among psychiatric inpatients. The study highlights for the first time the importance of a comprehensive assessment of need for patients with personality disorders.     

Personality heterogeneity in female adolescent inpatients with features of eating disorders

Objective

This study examined evidence for personality variability in adolescents with eating disorder features in light of previous evidence that personality variability in adult women with eating disorder symptoms carries important clinical implications.

Method

Millon Adolescent Clinical Inventory personality data from adolescent girls with disturbed eating who were psychiatrically hospitalized were cluster analyzed, and resulting groups were compared in eating and comorbid psychopathology.

Results

Three subgroups were identified among the 153 patients with eating disorder features: high functioning, internalizing, and externalizing. The internalizing group was marked by eating-related and mood dysfunction; the externalizing group by elevated eating and mood psychopathology as well as impulsivity, aggression, and substance use; and the high-functioning group by lower levels of psychopathology and relatively high self-esteem.

Conclusions

These findings converge with previous research using different personality models in adult samples and highlight the clinical use of considering personality heterogeneity among adolescent and adult women with disturbed eating.     

Diagnosis and treatment of psychiatric disorders in medically ill inpatients

Medical and surgical inpatients with coexisting psychiatric disorders pose several challenges to the consulting mental health professional in the general hospital. A major challenge is determining whether presenting signs and symptoms have a medical or psychiatric basis. Making such a determination requires a careful history, a mental status examination, and the utilization of bedside screening and diagnostic instruments. Recommended treatments include psychotherapy, psycho-education, and pharmacotherapy. However, psychotropic drugs must be used with caution because of potential interactions with drugs prescribed for medical conditions. Studies indicate that timely psychosocial interventions can improve the medical patient's mental health and have the potential to reduce length of hospital stay and utilization of health services.     

104例进食障碍患者临床特征分析

目的:了解住院进食障碍患者的临床特征. 方法:将符合国际疾病分类第10版(ICD-10)神经性厌食症(AN)和神经性贪食症(BN)诊断标准的104例住院进食障碍患者按不同临床类型分组,对两组患者心理、生理、社会三方面的临床特征进行回顾性比较. 结果:AN和BN患者的怕胖心理、闭经、误工误学时间及减少食物对身体影响的方式等临床特点差异无显著性(P>0.05).但是AN患者较BN患者发病年龄早,体象障碍比较多见(P均<0.01,或P均<0.05).BN患者比AN患者有更多抑郁症状,病程较长,就诊年龄晚(P<0.01). 结论:进食障碍两大综合征可能是一个疾病进程中的两个不同阶段,而贪食症的危害更应引起重视.     

A method of screening for communication disorders in child psychiatric inpatients

Research indicates that children with speech and language disorders probably are at greater risk for developing emotional and behavior problems. A retrospective review of referral patterns on a child psychiatric inpatient service suggested that some children with speech and language disorders were either being missed or referred late in their hospital stay. A four-part procedure was developed to screen children for speech or language problems at admission to a child psychiatric inpatient service. A pilot study of the new method showed promise as a screening procedure (estimated sensitivity = 81%; estimated specificity = 90%). The four-part screening method, referral guidelines and clinical implications are presented.     

Cocaine/"crack" dependence among psychiatric inpatients

The authors studied 40 cocaine-dependent subjects admitted to psychiatric inpatient wards of a metropolitan hospital because of general psychiatric symptoms. The results indicate that the predominant form of cocaine administration (88%) was freebasing "crack." DSM-III-R cluster B personality disorders (N = 17) and schizophrenia (N = 13) constituted the diagnoses for 75% of the sample. Compared to the schizophrenic patients in this cohort, the patients with cluster B personality disorders used cocaine in greater quantities and more frequently and began abuse of the drug at an earlier age. The escalation in urban areas of psychiatric hospitalizations attributed to use of crack may be largely related to psychiatric symptoms in cocaine-dependent patients with personality disorders as well as cocaine-induced psychopathology in schizophrenic patients.     

住院精神病人中的"知情同意"情况

目的为了提高医疗质量,进一步关心、尊重精神病人、调查住院精神病人的“知情同意”情况。方法采用自制问卷对上沆精神卫生中心封闭式病房内住院的病人就入院、服药等方面的看法进行调查,同时相应问题对住院病人亲属进行调查。结果共收到愿意合作病人的有效答卷５０５份,亲属答卷３３４份。７３％以上的病人对住院及治疗持肯定态度,但对封闭式住院不满意者占６５％。病人是否承认有病及需要住院治疗与婚姻状况有关。结论病人有知