Is the prevalence of psychiatric disorders associated with urbanization?

Objectives In many countries, the total rate of psychiatric disorders tends to be higher in urban areas than in rural areas. The relevance of this phenomenon is that it may help in identifying environmental factors that are important in the pathogenesis of mental disorders. Moreover, urban preponderance suggests that the allocation of funds and services should take urbanization levels into account. Method The Netherlands Mental Health Survey and Incidence Study (NEMESIS) used the Composite International Diagnostic Interview (CIDI) to determine the prevalence of DSM-III-R disorders in a sample of 7,076 people aged 18–64. The sample was representative of the population as a whole. The study population was assigned to five urbanization categories defined at the level of municipalities. The association between urbanization and 12-month prevalence rates of psychiatric disorders was studied using logistic regression taking several confounders into account. Results The prevalence of psychiatric disorders gradually increased over five levels of urbanization. This pattern remained after adjustment for a range of confounders. Comorbidity rates also increased with level of urbanization. Conclusion This study confirms that psychiatric disorders are more common and more complex in more urbanized areas. This should be reflected in service allocation and may help in identifying environmental factors of importance for the aetiology of mental disorders.     

Is insomnia a marker for psychiatric disorders in general hospitals?

BACKGROUND AND PURPOSE: The aim was to evaluate the relationship between insomnia and psychiatric disorders in general hospital inpatients. PATIENTS AND METHODS: Information about insomnia was collected using a structured and codified questionnaire adapted from a previously validated one in Brazil. For Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) psychiatric diagnosis, the Portuguese version of the International Neuropsychiatric Interview (MINI) was used. RESULTS: Out of the 200 patients interviewed, 56.5% complained of insomnia, and 50.0% suffered from at least one psychiatric disorder. Major depressive episode (MDE) (P<0.001), generalized anxiety disorder (P=0.025) and suicide risk (P=0.034) were associated with insomnia (univariate analysis). The results of the multivariate analysis showed that only MDE had a statistically significant association with insomnia (OR=3.6; 95% CI=1.9-6.9). CONCLUSIONS: This study found a high prevalence of psychiatric disorders and insomnia in a general hospital population and found that insomnia can be a marker for MDE.     

Procedural learning difficulties: reuniting the developmental disorders?

During the past 30 years, research into developmental disorders has fragmented, emphasizing differences rather than commonalities. We propose that reunification might be achieved by using a "neural-systems" approach. Deficits in dyslexia are attributed to an intact declarative learning system combined with an impaired procedural learning system--a network that includes prefrontal language systems and basal ganglia, parietal and cerebellar structures. A typology is provided for other prevalent learning disabilities; this framework focuses on different learning skills in the understanding of learning disabilities and emphasizes the diagnostic significance of "secondary" symptoms. This approach highlights the need for development of "neurocognitive" tests to probe the function of components of each neural system and improve strategies for explanation, diagnosis and support of developmental disorders.     

Deficits in social cognition: a marker for psychiatric disorders?

Research on social cognition focuses on several human abilities with a huge diversity in the approaches to tap the different functions. Empathy, for instance, is a rather elaborated human ability, and several recent studies point to significant impairments in patients suffering from psychiatric disorders, such as schizophrenia or autism. Neuroimaging data from these patients commonly indicate neural dysfunctions accompanying the behavioral deficits. Studying the neural correlates of social cognition is of particular importance, because deficits in these domains may explain the major dysfunctions in psychiatric disorders that prevent effective (re) integration into work and social life. It has also become clearer that social cognition deficits, similar to emotion dysfunctions, may represent trait markers and endophenotypes of the diseases. However, there are several challenges for future studies on social cognitive dysfunctions: on the one hand, the complexity of the constructs and thus the variety of definitions which make it hard to develop adequate tasks. On the other hand, results are needed that particularly address the disorder specificity of these impairments, as well as their potential as endophenotypes via analyzing people at high-risk and their relatives.     

Is the volume-outcome relationship sustained in psychiatric care?

Background Although much prior research has found a consistently positive volume-outcome relationship, there is scanty documentation on this issue in mental healthcare. This study examines the association between a hospitals’ psychiatric inpatient volume and 30-day readmission rates. Methods Using administrative data from Taiwan’s National Health Insurance Research Database for 2003, the likelihood of 30-day readmission is examined relative to the hospital’s volume of voluntary psychiatric admissions and total bed-days. Results As hospital volume increases, so too does the 30-day readmission rates for patients with schizophrenia, bipolar disorder and major depressive disorders. Conclusions The positive volume-outcome relationship in patients suffering from psychiatric disorders suggests a different scenario from the ‘practice makes perfect’ phenomenon that may underlie the inverse volume-outcome relationship found among most physical disorders, both surgical and medical.     

Is Basaglia responsible for a better psychiatry? On the biography of the Italian psychiatric reform

Ohne Zusammenfassung     

Is there a personalized medicine for mood disorders?

Major Depressive Disorder (MDD) and antidepressant therapy response are largely based on behavioral criteria, which are known to correlate at best modestly with biological measures. Therefore, it is not surprising that the search for peripheral biological markers (biomarkers) being assessed in distant biological systems such as body fluids has not yet resulted in clinically convincing measures for MDD diagnostics or treatment evaluation. Imaging genetics studies, however, have been successful in the search for intermediate imaging phenotypes of MDD and treatment response that are directly related to the neurobiological underpinnings of MDD, but are not suitable for a broad clinical use today. Hence, we argue that intermediate phenotypes derived from imaging genetics studies should be utilized as substitutes of behaviorally assessed psychiatric diagnoses or therapy response in the search for easily accessible peripheral biomarkers. This article will further cover the current state of peripheral and neural biomarker research.     

Is there a personalized medicine for mood disorders?

Major Depressive Disorder (MDD) and antidepressant therapy response are largely based on behavioral criteria, which are known to correlate at best modestly with biological measures. Therefore, it is not surprising that the search for peripheral biological markers (biomarkers) being assessed in distant biological systems such as body fluids has not yet resulted in clinically convincing measures for MDD diagnostics or treatment evaluation. Imaging genetics studies, however, have been successful in the search for intermediate imaging phenotypes of MDD and treatment response that are directly related to the neurobiological underpinnings of MDD, but are not suitable for a broad clinical use today. Hence, we argue that intermediate phenotypes derived from imaging genetics studies should be utilized as substitutes of behaviorally assessed psychiatric diagnoses or therapy response in the search for easily accessible peripheral biomarkers. This article will further cover the current state of peripheral and neural biomarker research.

     

What distinguishes autism spectrum disorders from other developmental disorders before the age of four years?

Abstract The increasing recognition of the benefits of early intervention for children with autism spectrum disorder (ASD) stresses the importance of early identification of children who might benefit from those programs. However, in the early years of life it may be difficult to distinguish children with ASD from children with other developmental disorders. The aim of the present study was to identify behavioural patterns that could facilitate this differentiation. Prior to diagnostic assessment, 2- and 3-year-old children (n=30), all referred to a clinic for possible autism, were observed in a semi-structured play interaction, and their parents were interviewed about the childrens early development from 0 to 24 months. Following diagnostic assessment, the 17 children fulfilling the ICD-10 criteria for ASD were compared to the 13 children diagnosed with other developmental disorders (outside the autism spectrum). On the basis of parent reports only a few distinguishing signs of ASD were found before 24 months of age. On the basis of professional observations in a semi-structured play interaction several distinguishing signs were found for the 2- and 3-year-olds; smiles in response, responds to name, follows pointing, looks to read faces, initiates requesting verbal and nonverbal behaviours, and functional play.     

Cannabis use and psychiatric and cogitive disorders: the chicken or the egg?

PURPOSE OF REVIEW: Cannabis is the world's most commonly used illicit drug. In this review, we consider the recent literature on the effects of cannabis on mental health and on cognition. RECENT FINDINGS: Cannabis use in adolescence increases the risk of later schizophrenia-like psychoses, especially in genetically vulnerable individuals. Not surprisingly, patients already suffering from psychosis who use cannabis have a worse outcome than those who do not. These effects of cannabis may be consequent on its impact on the dopamine system. There is less evidence of cannabis playing an aetiological role in other mental disorders including depression, but there have been far fewer studies. Heavy cannabis use has also been shown to affect memory and learning performance, both in healthy individuals and in patients suffering from psychosis. Combined cognitive-behavioural therapy and motivational interviewing seems a promising psychological intervention to achieve a cessation of cannabis use in patients suffering from schizophrenia. SUMMARY: Further research is needed to understand the biological mechanisms underlying the effects of cannabis on mental health, but intervention strategies to help patients abstain should currently be implemented in psychiatric services, and public education campaigns should be directed at increasing awareness of the health risks of cannabis.     

Can traumatic brain injury cause psychiatric disorders?

Traumatic brain injury (TBI) may cause psychiatric illness. This article reviews the evidence on the basis of an established set of causation criteria. The evidence is convincing for a strong association between TBI and mood and anxiety disorders. Substance abuse and schizophrenia are not strongly associated with TBI, and there is little research into the rates of personality disorders after TBI. Evidence for a biologic gradient is lacking, but such a gradient may not be relevant to TBI. Evidence for the correct temporal sequence is present. Preliminary evidence suggests a biologic rationale for TBI causing psychiatric illness. Further and methodologically improved research is supported and required.     

Are psychiatric disorders independent risk factors for new-onset epilepsy in older individuals?

This retrospective study examined whether psychiatric conditions are directly related to epilepsy or, rather, are associated with underlying central nervous system (CNS) disorders linked to subsequent epilepsy. We examined data from a sample of older veterans (>65 years) receiving care from the Veterans Health Administration during fiscal year 2000. We compared individuals with new-onset epilepsy and individuals without epilepsy to examine the extent to which psychiatric disorders were associated with new-onset epilepsy; this analysis controlled for demographic and premorbid neurological risk factors previously associated with new-onset epilepsy. Premorbid psychiatric conditions occurred at higher rates in the epilepsy versus nonepilepsy groups, foremost including depression (17% vs 12%), anxiety (12% vs 8%), psychosis (12% vs 5%), and substance abuse (8% vs 4%). However, in the final model, only psychosis (OR = 1.4, CI 1.2–1.6) was significantly associated with epilepsy when controlling for neurological disorders and psychiatric conditions (e.g., stroke, dementia, brain tumor, head injury).