Irritable bowel syndrome in a psychiatric patient population

The prevalence of irritable bowel syndrome (IBS) in psychiatric practice was studied in 41 consecutive psychiatric outpatients. Different criteria for IBS were applied to the data set to determine the effects on the rates of IBS obtained. Depending on an option in the Rome criteria, IBS rates varied from 13% using the "and" requirement for combining abdominal pain and altered bowel function symptoms, to 41% using the "and/or" option described in the formal definition statement in 1990. The resultant prevalence rates of IBS varied greatly according to which published criteria were applied, with a maximum of 71%. This wide variation in rates depending on the criteria underscores the critical importance of standardizing diagnostic research criteria for IBS. An exemplary model of empirically based validation has been developed for psychiatric disorder criteria which, like IBS, are symptom-based and lack physiological determinants. Validated diagnostic criteria for IBS await similar study.     

Psychiatric staff perceptions of patient attachments: a pilot study to investigate differences in and predictors of psychiatric staff perceptions of patient attachments

Objectives

We explored the extent to which a group of psychiatric staff differed in their ratings of patients’ attachment styles and whether deviations in mean ratings were related to education, clinical experience, familiarity with patients, or staff attachment styles.

Method

Fifteen mental healthcare workers assessed the attachment styles of nine patients with schizophrenia or schizoaffective disorder using the Psychosis Attachment Measure. Staff also reported on their own attachment styles. Similarity in ratings was investigated using two-way random interclass correlation coefficients (ICCs). An index showing how much each rater’s assessments of attachment style deviated from the mean attachment style rating for each of the patients was used to investigate possible predictors of deviations from mean ratings.

Results

Average staff ICCs for attachment anxiety and avoidance suggested reasonable levels of convergence between staff perceptions. Deviations from mean ratings were unrelated to staff qualifications or years of experience in mental health. However, staff who had known patients for longer periods tended to rate patients more similarly, whereas staff who had higher levels of attachment anxiety and avoidance tended to deviate from colleagues’ ratings.

Conclusions

Attachment styles in psychosis are observable characteristics that can be rated by mental health professionals, although length of time staff have known patients, as well as their own attachment styles are likely to influence perceptions.     

High prevalence of intermittent acute porphyria in a psychiatric patient population

The authors screened 3,867 psychiatric inpatients for intermittent acute porphyria by use of a spot test to detect diminished activity of the erythrocyte enzyme porphobilinogen (PBG) deaminase. Eighteen individuals so identified also had persistently diminished quantitative activity of PBG deaminase. Eight of these appeared to have intermittent acute porphyria by the added criteria of increased urinary delta-aminolevulinic acid or PBG or a family history of intermittent acute porphyria. The overall prevalence of intermittent acute porphyria was 0.21%, a considerably higher rate than that in the general population. Most of the subjects with the disorder had periods of agitated psychosis and apathetic or depressed withdrawal, with signs of neuropsychological impairment. Neurologic abnormalities were not prevalent.     

Learning disability nursing staff: a response to psychiatric teaching

Learning disability nursing staff have an important role in the assessment and management of dual diagnosis patients. The present study assesses the level of psychiatric knowledge and interest of nursing staff in core psychiatric topics. Nursing staff were invited to attend a series of tutorials, and their knowledge of psychiatric topics was tested via a set of multiple‐choice questions before and after the tutorials. The reasons for the low attendance rate (22%) and knowledge (47% mean correct score) are discussed. Ensuring attendance is vital because the tutorials were found to be effective in improving knowledge.     

The changing patient population in general hospital psychiatric services

There has been a profound expansion in the past 25 years in the numbers and categories of psychiatric patients treated in general hospital programs. These changes have been stimulated by new technologies, better integration of health and other human services systems, and changing fiscal concerns. Particularly affected have been inpatient units, emergency services, and the ambulatory care and consultation-liaison sections. Much greater attention and more effective treatments are currently available for involuntary, geriatric, and substance abuse patients, as well as patients with chronic psychiatric illnesses and a few discrete clinical entities. General hospitals need to continue to refine and expand their role as a major clinical component in the comprehensive psychiatric care delivery system.     

Guidelines for a psychiatric hospital intake staff meeting

Guidelines are presented that help to make psychiatric intake conferences more efficient and productive. The emphasis is placed on having designated personnel meet individually with the patient as well as review the patient's chart prior to the formal intake conference. Thus, the personnel is able to spend more time on formulating a diagnosis and treatment plan than on reviewing the past history of the patient. Information presented at such conferences should consist more of unique contributions from the personnel (e.g., observations, impressions, testing, etc.) than of redundant material commonly known by the personnel assigned to the patient.     

Reactions of staff members to the relocation of a psychiatric department to a new building

This study, which was conducted in Israel, examined staff members' reactions to the relocation of three closed psychiatric wards to a new building. Participants' (N=61) levels of uncertainty were significantly higher before the relocation than they were after the relocation. In addition, a significant positive correlation was found between anxiety levels before the relocation and anxiety levels after the relocation. A significant positive correlation was also found between anxiety levels before the relocation and uncertainty levels before and after the relocation. No significant correlation was found between the perceived success of the relocation and the other study variables.     

Detection and management of dyslipidemias in the psychiatric patient population

Coronary heart disease (CHD) accounts annually for half of all deaths in the United States. The morbidity and mortaility of CHD can be reduced with early and aggressive treatment. Mentally illnesses are at special risk because of their associated higher rates of smoking compared with the general population. Risk factor modification is a necessary component of the treatment plan and includes smoking cessation, weight reduction, increased physical activity, or a combination of these. Using guidelines set forth by the National Cholesterol Education Program, psychiatric physicians can screen for patients with elevated cholesterol, provide education or methods to modify risk factors, initiate cholesterol-lowering therapy, and monitor patients to ensure that goal low-density lipoprotein is achieved. The clinical outcome anticipated is reduced risk of cardiovascular-related event and decreased cost to the health care system.     

Difficult patients in extended psychiatric hospitalization: a research perspective on the patient, staff and team

A series of publications has emerged from a comprehensive research project on difficulties in extended psychiatric hospital treatment, each of which describes factors that may influence difficulty: staff perceptions, difficult patient profiles, countertransference, intrapsychic features, organic brain impairment, problematic areas of treatment. This paper is intended to provide an overview and clinical integration of those diverse findings and an application of the findings to clinical conceptualization. The research supplements existing knowledge about treatment difficulty and countertransference in dyads by providing information about how such phenomena are influenced by clinical teams, by professional roles or disciplines, and by the treatment delivery system. Finally, I will describe future issues, questions and research efforts that are generated by these findings.     

Training physicians to treat substance use disorders

The importance of training physicians to effectively assess and manage substance use disorders has become increasingly recognized. Studies highlighting the effort to enhance curricula are described and common practices identified. Preferable curricula incorporate interactive teaching methods along with experiential and didactic components. Addiction specialists serve an important role in training programs designed for medical students and residents (ie, role models) and practicing physicians (ie, clinical support). Further integration of online training into current programs may expand and enhance training opportunities.     

Mortality in a psychiatric population: a Nigerian psychiatric hospital experience

Out of a total of 10,661 patients admitted over a 10-year period in a Nigerian psychiatric hospital, 138 deaths were recorded. A decreasing trend in the mortality figures was demonstrated despite a marked increase in the number of admissions. There were more male deaths (60%) than female deaths (40%). The majority of the patients who died (64%) were under the age of 40 years. Infection was the single most important cause of death. There was one case of suicide and one other death resulted from ECT. Sudden unexplained deaths occurred in 19% of the cases. Possible ways of further reducing the mortality figures are suggested.