Caffeine and psychiatric symptoms: a review

Caffeine is a widely used psychoactive substance that has the potential to contribute to many psychiatric symptoms. This review article aims to address the specific research studies and case reports that relate caffeine to psychiatric symptoms. Caffeine can cause anxiety symptoms in normal individuals, especially in vulnerable patients, like those with pre-existing anxiety disorders. Caffeine use is also associated with symptoms of depression due to either a self-medication theory, or a theory that caffeine itself causes changes in mood. Psychosis can be induced in normal individuals ingesting caffeine at toxic doses, and psychotic symptoms can also be worsened in schizophrenic patients using caffeine. Sleep and symptoms of ADHD may be altered by caffeine as well. Prevention of caffeine-induced psychiatric symptoms is possible by recognizing, educating, and treating patients using a tapering approach.     

Premenstrual mood changes in affective disorders.

Mood changes during the premenstrual phase have been the focus of considerable research in recent years. Although there has been significant progress in the diagnosis and etiology of major affective disorders, the relation between these disorders and menstrual changes remains controversial. There have been contradictory reports and speculations on women's susceptibility to psychiatric disorders during the premenstrual phase. We describe three patients with a history of mood swings associated with menstruation in whom major affective disorders developed, necessitating intensive psychiatric treatment or admission to hospital. Among women who manifest menstrual mood changes, manic-depressive illness may develop only in a subgroup with genetic predisposition. In such cases the possibility of postpartum mania or depression should be kept in mind in follow-up.     

Psychopathology in adolescent children of physicians

The clinical records of 27 adolescent children of physicians who were treated in a psychiatric unit for adolescents were studied. Most of the children had been referred by their physician fathers for evaluation of conduct or mood disorders. These referrals were often the focus of family distress. There appeared to be no typical syndrome presented by physicians' children. Those treating such patients should be especially sensitive to the possibility that parental denial will increase the patient's resistance to therapy. Family therapy, an effective treatment for psychologic problems in adolescents, is often avoided by physicians.     

浙江省精神病专科医院住院患者疾病谱调查

目的调查2010年浙江省精神病专科医院住院患者的疾病构成情况,为我省精神病防治提供理论依据。方法从我省42家精神专科医院采用两阶段分层随机抽样方法,抽出14家精神病院．再从14家医院中抽出3个月（3、7、11月）的出院患者进行调查。编制《住院患者住院情况调查表》收集患者住院诊断、性别、年龄、合并症及医院感染情况。结果调查住院患者共7684例,男3102例（4037％）,女4582（59．63％）例;年龄10～92（43．4±16．8）岁;住院患者疾病构成前5位的分别为精神分裂症和其他精神病性障碍（40．6％）,心境障碍（34．6％）,癔症、应激相关障碍、神经症（14．1％）,器质性精神病（5．6％）和精神活性物质或非成瘾物质所致精神障碍（1．98％）。次要诊断主要有高血压、白细胞减少症和糖尿病。医院感染主要有上呼吸道感染（26．1％）,胃肠道感染（24．4％）,肺部感染（22．4％）等。结论我省精神病防治仍应以精神病性障碍、心境障碍和神经症及器质性精神障碍的防治为主。躯体疾病在精神科临床工作中值得重视,精神疾病单病种管理需要考虑躯体疾病的影响。     

Psychiatric problems in the elderly.

Psychosocial changes and physical disabilities that occur in the elderly contribute to an increase in the prevalence of psychiatric disorders in the elderly. A comprehensive approach to diagnosis is required. Depression, dementia, delirium and paranoid disorders are common psychiatric disorders seen in the elderly. Underlying treatable causes must be excluded. Treatment requires special considerations such as adverse drug reactions, drug interactions, side effects and concomitant physical illnesses. Management of the elderly should involve the family as well as the patient.     

共患病对注意缺陷多动障碍执行功能的影响

注意缺陷多动障碍(attention deficit hyperactivity disorde,ADHD)最早被认为是发生于儿童期、以"多动"为主要表现的疾病[1].随着对该疾病认识的深入,研究者发现"注意缺陷"也是核心症状之一[1],于是研究者开始关注ADHD是否存在与注意缺陷相关的认知功能损害.     

1998年--2007年住院精神疾病病种构成情况分析

目的分析该院10年病种分布,为精神卫生事业提供参考资料。方法回顾性研究1998年～2007年出院病例资料。结果精神疾病病种构成比较20世纪80年代前发生了明显变化,精神分裂症构成比下降,心境障碍、神经症等构成比上升,但近10年间病种构成比则相对稳定。结论精神卫生专科医院应针对性加强对心境障碍、轻型精神障碍的诊治工作。     

Making a diagnosis of adult attention deficit hyperactivity disorder

This paper describes the diagnosis of adult attention deficit hyperactivity disorder (ADHD) in a 26-year-old female. Adult ADHD is being increasingly acknowledged as a cause of psychiatric morbidity particularly since the diagnosis is frequently missed in childhood. Greater recognition of this disorder is important because it can be a cause of low productivity and employment disruption as well as a risk factor for other psychiatric problems such as substance abuse and mood disorders.     

已婚男性性病患者心理障碍与调适初步探讨

性病是一组特殊的疾病，其发病与道德、伦理、法律有着密切的关系，易使患者产生不同程度的心理障碍，严重时可产生恐惧或抑郁情绪。这些心理障碍影响着性病的康复。作者通过自制调查表随机对性病门诊就诊者心理状态进行问卷调查，发现性病患者可出现焦虑情绪、负罪感、恐惧感、悲观绝望心理、疑病心理、享乐心理及被社会遗弃感等心理障碍，通过心理调适可降低心理障碍的出现。本项研究结果提示注重性病的病原体治疗的同时还应重视性病患者心理障碍的调适。     

Psychiatric illness in inpatients with neurological disorders: patients' views on discussion of emotional problems with neurologists

The prevalence of psychiatric morbidity in inpatients with neurological disorders and the extent to which it is detected by neurologists were measured by using a two stage model of psychiatric assessment and from information recorded in the patients' medical notes. The prevalence of psychiatric morbidity was estimated as 39%, of which 72% was unrecognised by the neurologists. Only a minority of patients with an uncertain physical diagnosis had a psychiatric illness, showing the error in assuming that a patient's physical symptoms arise from a psychological disturbance if an organic aetiology cannot be determined. When the patients were interviewed on their discharge from hospital they were divided on whether they had wished to discuss their mood with neurologists while they were in hospital. The reasons that they gave suggested that interactions between patients and doctors and the lack of ward facilities for private consultations with doctors are important determinants of hidden psychiatric morbidity in medical inpatients.     

Impaired driving from medical conditions: a 70-year-old man trying to decide if he should continue driving

Some medical disorders can impair performance, increasing the risk of driving safety errors that can lead to vehicle crashes. The causal pathway often involves a concatenation of factors or events, some of which can be prevented or controlled. Effective interventions can operate before, during, or after a crash occurs at the levels of driver capacity, vehicle and road design, and public policy. A variety of systemic, neurological, psychiatric, and developmental disorders put drivers at potential increased risk of a car crash in the short or long term. Medical diagnosis and age alone are usually insufficient criteria for determining fitness to drive. Strategies are needed for determining what types and levels of reduced function provide a threshold for disqualification in drivers with medical disorders. Evidence of decreased mileage, self-restriction to driving in certain situations, collisions, moving violations, aggressive driving, sleepiness, alcohol abuse, metabolic disorders, and multiple medications may trigger considerations of driver safety. A general framework for evaluating driver fitness relies on a functional evaluation of multiple domains (cognitive, motor, perceptual, and psychiatric) that are important for safe driving and can be applied across many disorders, including conditions that have rarely been studied with respect to driving, and in patients with multiple conditions and medications. Neurocognitive tests, driving simulation, and road tests provide complementary sources of evidence to evaluate driver safety. No single test is sufficient to determine who should drive and who should not.     

Cerebrotendinous xanthomatosis with psychiatric disorders: report of three siblings and literature review

Cerebrotendinous xanthomatosis (CTX), a rare familial lipid metabolic disease inherited via an autosomal recessive trait, is caused by mutations of the sterol 27-hydroxylase gene. Psychiatric disorders may occur in patients with CTX. In Taiwan, Chang et al presented patients with CTX. However, there has not been a case presented about CTX with psychiatric disorders in Taiwan. We present three siblings in one family with CTX combined with moderate mental retardation. One of the siblings had long-term depressed mood, irritability, poor appetite, insomnia, fatigability, and pessimistic thinking and was diagnosed as dysthymic disorder. After 2.5 years of antidepressant treatment at our outpatient clinic, the depressive symptoms of the dysthymic sibling improved greatly. However, the results of the IQ tests of the three siblings did not change after effective treatments for physical manifestations of CTX. In addition, the authors reviewed the literature of CTX combined with psychiatric disorders.     

医院就诊肠易激综合征患者精神障碍共病的临床观察

目的 通过人格及精神障碍评估问卷了解医院就诊肠易激综合征(IBS)患者精神障碍的共病状况.方法 顺序纳入2008年11月至2010年3月北京大学第三医院消化科门诊就诊、符合罗马Ⅲ标准的IBS患者83例,由经过培训的人员通过人格诊断问卷4(PDQ-4)、复合型国际诊断交谈(CIDI)表进行人格障碍、躯体形式障碍及其他精神障碍诊断.结果 83例IBS患者中男43例,女40例,年龄(38±14)岁.其中便秘型20例(24.1%)、腹泻型31例(37.3%)、混合型15例(18.1%)、未分型17例(20.5%).(1)62例(74.7%)患者被检出1型或多型人格障碍,性别差异无统计学意义,其中以强迫和回避为特征的焦虑-抑制类(C组)人格障碍最多(58例,69.9%).存在人格障碍者躯体形式障碍检出率为46.8%(29/62),高于无人格障碍者[19.0%(4/21),P=0.025].(2)IBS患者的CIDI-3.0精神障碍终生患病率44.6%(37例),显著高于对照组,性别差异无统计学意义.焦虑与心境障碍是最多见的精神障碍共病类型,分别为21例(25.3%)和19例(22.9%).物质滥用和依赖、间歇性暴发障碍分别检出9例(10.8%)和7例(8.4%).腹泻型IBS患者精神障碍共病率最高(58.1%,18/31),但不同IBS亚组之间精神障碍检出率差异无统计学意义.(3)IBS患者中33例(39.8%)存在躯体形式障碍,性别差异无统计学意义.各亚组间躯体形式障碍检出率差异无统计学意义.焦虑障碍同时合并躯体形式障碍者为61.9%(13/21),显著高于无焦虑障碍者[32.3%(20/62),P=0.016].结论 综合医院消化科就诊的IBS患者精神障碍共病较为常见,尤其是焦虑障碍和心境障碍.存在人格偏离及焦虑障碍的IBS患者更容易出现躯体形式障碍,消化专业医师应对此有充分认识并予以恰当治疗建议.

Abstract：

Objective To assess the prevalence of psychiatric comorbidities in patients referred for irritable bowel syndrome(IBS)with questionnaires for mental disorders.Methods A total of 83 IBS patients at our hospital were enrolled and assessed with the Personality Diagnostic Questionnaire for DSM-IV,version 4(PDQ-4)and Composite International Diagnostic Interview,version 3.0 and 2.1(CIDI-3.0 & CIDI-2.1)by trained interviewers.Such items as personality dysfunction,mental disorder and somatization disorder were examined.Results The male-female ratio was 1.08/1.Their mean age was(38±14)years old.Among them,20 patients(24.1%)were constipation-predominant,31(37.3%)diarrheapredominant,15(18.1%)mixed and 17(20.5%)unclassified type.(1)Sixty-two(74.7%)patients scored positive for any personality dysfunction.There was no significant gender difference.The cluster C (anxious-fearful)personality disorder was most commonly found in IBS patients(n=58,69.9%).The prevalence of somatoform disorders plus personality dysfuntion was 46.8%(29/62).It was significantly higher than those without personality dysfunction[19.0%(4/21),P=0.025].(2)Thirty-seven patients (44.6%)had a lifetime CIDI-3.0 diagnosis.It was significantly higher than that in the general population.There was no gender difference.Anxiety and mood disorders were the most common types of psychiatric comorbidities[n=21(25.3%)and n=19(22.9%)respectively].The lifetime prevalence of alcohol or nicotine abuse and(or)dependence and intennittent explosive disorder were 10.8%(n=9)and 8.4%(n=7).Psychiatric comorbidities were most commonly found in diarrhea-predominant patients(58.1%).But there was no significant difference among the subgroups.(3)Thirty-three patients(39.8%)had somatoform disorders.Neither gender nor subgroup differencc wag observed.The IBS patients with anxiety disorders presented significantly more somatoform disorders than the remainders[61.9%(13/21)vs 32.3%(20/62),P=0.016 1.Conclusion Such psychiatric comorbidities as anxiety disorders and mood disorders are common in patients referred for IBS.The patients with personality dysfunction and(or)anxiety were more likely to suffer somatoform disorders.A gastroenterologist should grasp a thorough knowledge and make appropriate therapeutic recommendations for those patients.     

Increased proapoptotic serum activity in patients with chronic mood disorders

BACKGROUND: Growing evidence suggests that endothelial dysfunction may be present in patients with chronic mood disorders. We hypothesized that circulating factors in the sera of patients with chronic mood disorders could induce vascular endothelial damage that in turn may be responsible for increased vascular risk. In this study, we sought to determine whether serum of patients with chronic mood disorders could directly induce apoptosis in human endothelial cells. METHODS: We examined the proapoptotic activity by an ex vivo proapoptotic activity assay in the serum of 100 individuals: 25 patients with major depressive disorder (MDD) and no lifetime diagnosis of anxiety disorder, 25 patients with bipolar disorder (BPD) with a current comorbid anxiety disorder, 25 patients with BPD and no anxiety, and 25 age- and gender-matched healthy controls. RESULTS: The proapoptotic serum activity of all mood disorder patients was significantly higher than that of the control group (all p values<0.01). This association was found to be independent from potential confounders including age, gender, smoking status, body mass index, blood pressure parameters, family history of cardiovascular disease, serum creatinine, plasma glucose, total cholesterol, triglycerides, NT-proBNP, and C-reactive protein (beta=0.44, t=2.93, p=0.012). CONCLUSIONS: Together our findings indicate that chronic mood disorders are associated with higher proapoptotic serum capacity. Although subject to future confirmation, it is possible that the increased systemic proapoptotic activity of the serum in these patients could exert deleterious vascular effects resulting in endothelial dysfunction.     

Heart and mind: (1) relationship between cardiovascular and psychiatric conditions

The relationship of our emotions and psyche to heart disease is intriguing. In this article we have reviewed the evidence linking cardiovascular and neuropsychiatric disorders and the possible mechanisms and pathophysiology of this association. This review is derived from Medline searches (1966-2002) using the relevant search terms (psychiatric disease, cardiovascular disease, depression, anxiety, and pathophysiology). Finally, the possible role of using mood enhancing therapies (mainly antidepressants) and their safety in patients with cardiovascular disorders is briefly discussed. In a companion paper, the therapeutic aspects of these two conditions is highlighted.     

Premenstrual syndrome: current knowledge and management.

Premenstrual syndrome (PMS) has become a popular self-diagnosis. Faulty research has led to confusion about the diagnosis, epidemiologic features, causes and treatment of this disorder. There is no proof that the premenstrual period is a time of increased violence. An association between menstrually related mood disorders and other psychiatric illness is also unproven. Despite many theories no definitive cause of PMS has been established, and controlled studies of various treatments have failed to find a universally effective approach. Conservative measures involving support, diet and exercise seem to help in most cases. The use of alprazolam and mefenamic acid may help some women. Rectal or vaginal progesterone therapy has been proven ineffective and should not be used.     

两种自评问卷筛查综合医院诊断抑郁障碍患者的既往躁狂症状

目的 探索两种躁狂症状问卷在综合医院门诊ICD-10诊断的抑郁障碍是否筛查出既往有躁狂症状,及两个问卷识别躁狂症状的差异及其与临床特征的关系.方法 连续评估同济大学附属同济医院精神科门诊符合ICD-10诊断的抑郁障碍102例,调查工具包括自编问卷、中文版心境障碍调查问卷(Chinese version mood disorder questionnaire,CV-MDQ)、中文版32项轻躁狂症状清单(Chinese version 32 items hypomania check list,CV-HCL-32),CV-MDQ≥7分为既往躁狂症状阳性,CV-HCL-32≥14分为既往轻躁狂症状阳性.结果 1.内部一致性检验显示,CV.MDQ的Cronbach's α值为0.808,P<0.01,CV-HCL32的Cronbach's α值为0.916,P<0.01.2.11例患者(10.8%)在CV-MDQ报告躁狂症状阳性,14例(13.7%)在CV-HCL-32报告躁狂症状阳性,两问卷判别躁狂或轻躁狂的一致性有显著差异(Kappa=0.227,P<0.05).3.CV-HCL-32阳性组的首发年龄、总病程、本次病程、复发次数的中位数(35.0岁,60.0月,12.0月,2.5次)与阴性组(50.5岁,22.0月,6.0月,1.0次)差异具有显著性(Z=-2.065,-2.102,-2.180,-2.168,均P<0.05),年龄、性别、文化程度差异无显著性(P>0.05);CV-MDQ阳性组与阴性组间差异无显著性(P>0.05).结论 CV-MDQ和CV-HCL-32可在综合医院门诊ICD诊断为抑郁障碍患者中检出一定比例既往有躁狂或轻躁狂症状,但CV-HCL-32是否较CV-MDQ更适用于筛查双相Ⅱ型障碍值得探索.

Abstract：

Objective To explore the prevalence of self reposed mania/hypomania symptoms of depressive disorders and the difference between the two self-rating symptoms questionnaires in setting of psychiatric clinic of a general hospital.Methods 102 outpatients who were diagnosed with depressive disorders by ICD-10 in department of psychiatry of Tongji Hospital of Tongji University were continuously investigated and fulfilled the Chinese Version mood disorder questionnaire(CV-MDQ)and the Chinese Version 32 items hypomania check list(CVHCL-32).The positive mania symptoms were elevated with at least seven positive mania items reported by the CVMDQ.The positive hypomania symptoms were elevated with at least fourteen positive hypomania items reported by the CV-HCL-32.Results The internal consistency(Cronbach alpha)of the CV-MDQ was 0.808(95% CI=0.767～0.845,P<0.01).The internal consistency(Cmnbach alpha) of the CV-HCL-32 was 0.916(95% CI=0.898～0.930,P<0.01).11 patients(10.8%) reported positive mania symptoms by the CV-MDQ.14 patients (13.7%)had been reported positive hypomania symptoms through the CV-HCL-32.The ability of discriminating mania or hypomania between the two scales was significantly different(Kappa=0.227,P<0.05).Compared to the patients who were reported negative hypomania symptoms by the CV-HCL-32.the 11 patients with positive hypomania symptoms by the CV-HCL-32 had much earlier age in first episode(35.0 vs 50.5,z=-2.065,P<0.05),much longer months in total disease course(60.0 vs 22.0,z=-2.102,P<0.05)and present episode (12.0 vs 6.0,z=-2.180,P<0.05),and much higher frequency of relapse(2.5 vs 1.0,z=-2.168,P<0.05),but no significant differences at age,gender and education.No significant differences appeared between CV-MDQ positive and negative group.Conclusion Mania or hypomania symptoms may be screened by CV-MDQ and CV-HCL-32 from the outpatients with depressive disorders who are diagnosed by ICD-10 in general hospital.whether CV-HCL-32 is superior to CV-MDQ when screening bipolar Ⅱ disorder is worthly further study.     

谷氨酸转运蛋白EAAT2参与早产儿脑损伤作用机制研究进展

早产儿每年约占全世界所有新生儿的11%,有较高的伴发神经精神疾病、发育障碍及终身残疾的风险。谷氨酸(glutamic acid,GLU)作为重要的兴奋性神经递质,对中枢神经系统的功能正常起重要作用。兴奋性氨基酸转运蛋白2(EAAT2)是主要的谷氨酸转运蛋白,负责清除高达95%的细胞外谷氨酸,防止神经元兴奋性毒性和过度兴奋。增强EAAT2表达和转运功能作为成人神经系统疾病的潜在治疗方法备受关注,但在预防早产儿脑损伤中的作用仍有待探索。本文就EAAT2在早产儿脑损伤中的相关机制进行综述,为预防早产儿脑损伤的研究提供新方向。     

赣州市复退军人精神病患者残疾状况及相关因素分析

目的 了解赣州市复员退伍军人精神病患者残疾状况并分析相关影响因素.方法 以<中国精神障碍分类与诊断标准>为诊断标准,选用简明精神病量表、阴性症状量表、阳性症状量表、社会功能缺陷筛选量表、日常生活能力量表等为测评工具,采用<军人残疾等级评定标准>为评定标准,进行残疾等级评定.结果 全市共评定196例,致残精神疾病依次为精神分裂症176例、癫痫11例、情感性障碍6例、脑器质性障碍3例;残疾等级分布为:三级2例,四级45例,五级89例,六级60例;残疾程度与疾病本身因素、药物治疗因素和社会支持等诸多因素有关,以ADL评分、总住院时间、病期、病程特点为主要危险因素.结论 复退军人精神病患者残疾状况不容乐观,相关影响因素复杂,减轻精神残疾需采取综合措施.