Injury risk in young people with intellectual disability

Epidemiological studies have established injury as a major public health problem for young people in the general population, but minimal population‐based injury information exists on those with intellectual disability (ID). The present study investigated risk factors for injury to subjects in the Australian Child and Adolescent Development (ACAD) programme, which is examining emotional and behavioural problems in young people with ID. Extensive biopsychosocial data for the ACAD programme were collected at two time intervals (i.e. 1990–1991 and 1995–1996). Carer report of medically attended injury over one year was collected for the first time period (1995–1996) on a sample of 465 ACAD subjects (aged 5–29 years) representative of young people with ID (IQ < 70) to determine risk factors for injury using the ACAD biopsychosocial data. Psychopathology [odds ratio (OR) = 3.4] epilepsy (OR = 2.4) and an overly sociable temperament (OR = 2.2) are associated with injury in young people with ID. Social and family factors had minimal influence on injury risk in this population. Those who are highly disruptive, self‐absorbed, anxious, have problems relating socially, have communication disturbance or have attention deficit hyperactivity symptoms are particularly at increased risk for injury. The present study demonstrates a largely under‐recognized public health problem of a high unintentional injury risk for young people with ID, and identifies substantial and important risk factors for injury. Injury prevention programmes, with a particular focus on those with highly disturbed behaviours or epilepsy, are warranted in this population.     

Treatment compliance among psychiatric outpatients in Kenya

One hundred psychiatric outpatients discharged from mental hospital in Kenya were studied to estimate the treatment compliance after 3 months. The relatives and patients were interviewed separately to assess treatment adherence; 55 percent of them had defaulted in their treatment. Various factors were responsible for failure of compliance which included amongst many: unavailability of drugs which appears to be a common factor in Third World countries. Suggestions for better compliance included easily available injectable depot preparations or simple generic psychotropic drugs.     

Post-influenzal psychiatric disorder in adolescents

The association between influenza and psychiatric disorder in adolescents was studied at a time when both were highly prevalent concurrently. First 505 secondary school pupils aged 15-18 completed questionnaires, including a symptom inventory derived from the SCL-90-R. Subsequently, 113 blood samples were examined for influenza antibody titers of five virus strains. Statistical analysis showed that adolescents who had been ill with influenza in the previous six months had significantly more psychiatric disorder than those who had not been ill with influenza in that period.     

Lack of associations between modifiable risk factors and dementia in the very old: findings from the Cambridge City over-75s cohort study

ABSTRACT

Objectives: To investigate the association between modifiable risk and protective factors and severe cognitive impairment and dementia in the very old. Additionally, the present study tests the predictive validity of the ‘LIfestyle for BRAin health’ (LIBRA) score, an index developed to assess an individual's dementia prevention potential.

Method: Two hundred seventy-eight individuals aged 85 years or older from the Cambridge City over-75s cohort study were followed-up until death. Included risk and protective factors were: diabetes, heart disease, hypertension, depression, smoking, low-to-moderate alcohol use, high cognitive activity, and physical inactivity. Incident severe cognitive impairment was based on the Mini-Mental State Examination (score: 0-17) and incident dementia was based on either post-mortem consensus clinical diagnostic assessments or death certificate data. Logistic regressions were used to test whether individual risk and protective factors and the LIBRA score were associated with severe cognitive impairment or dementia after 18 years follow-up.

Results: None of the risk and protective factors or the LIBRA score was significantly associated with increased risk of severe cognitive impairment or dementia. Sensitivity analyses using a larger sample, longer follow-up period, and stricter cut-offs for prevalent cognitive impairment showed similar results.

Conclusion: Associations between well-known midlife risk and protective factors and risk for severe cognitive impairment or dementia might not persist into very old age, in line with suggestions that targeting these factors through lifestyle interventions should start earlier in life.     

抑郁症患者首次至精神科首次就诊的特征

目的:调查精神科首诊抑郁症患者特征.方法:调查196例初次就诊精神科的抑郁症患者,对病程、就诊主动性、非精神科求治史等特征及其他相关因素进行分析. 结果:患者至精神科门诊初诊时平均病程(6.4±4.4)个月,仅37.6％患者主动来诊,46.7％曾求治过非精神科.逐步回归分析显示,影响初诊时病程的因素为性别、文化程度及发...     

Treatment of psychiatric morbidity in the mentally retarded adult

302 mentally retarded (MR) adults, representative of the total Danish MR population were surveyed for present psychiatric treatment and care. The care was generally satisfactory with the majority living under good conditions and provided with a fairly sufficient level of training and occupational therapy. The psychopharmacological treatment was balanced and performed after modern principles. However, more elaborate psychiatric treatment approaches, such as psychotherapy and behavioural therapy, were only used in very few cases, despite the obvious need. A brief review is given and a guide to the literature on psychiatric treatment in the field of mental retardation.     

Urban–rural disparities in mild cognitive impairment and its functional subtypes among community-dwelling older residents in central China

BackgroundSubstantial variations in the prevalence of mild cognitive impairment (MCI) and its subtypes have been reported, although mostly in geographically defined developed countries and regions. Less is known about MCI and its subtypes in rural areas of less developed central China.AimsThe study aimed to compare the prevalence of MCI and its subtypes in residents aged 65 years or older in urban and rural areas of Hubei Province, China.MethodsParticipants aged 65 years or older were recruited between 2018 and 2019. Inperson structured interviews and clinical and neuropsychological assessments were performed at city health community centres and township hospitals.ResultsAmong 2644 participants without dementia, 735 had MCI, resulting in a prevalence of 27.8% for total MCI, 20.9% for amnestic MCI (aMCI) and 6.9% for non-amnestic MCI (naMCI). The prevalence of MCI in urban and rural areas was 20.2% and 44.1%, respectively. After adjusting for demographic factors, the prevalence of total MCI, aMCI and naMCI differed significantly between rural and urban areas (adjusted odds ratio (OR) 2.10, 1.44 and 3.76, respectively). Subgroup analysis revealed an association between rural socioeconomic and lifestyle disadvantage and MCI and its subtypes.ConclusionsOur findings suggest that the prevalence of MCI among urban residents in central China is consistent with that in other metropolis areas, such as Shanghai, but the prevalence in rural areas is twice that in urban areas. Prospective studies and dementia prevention in China should focus on rural areas.     

Recreational physical activity and risk of Parkinson's disease

The purpose of this study was to investigate associations between recreational physical activity and Parkinson's disease (PD) risk. We prospectively followed 143,325 participants in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2001 (mean age at baseline = 63). Recreational physical activity was estimated at baseline from the reported number of hours per week on average spent performing light intensity activities (walking, dancing) and moderate to vigorous intensity activities (jogging/running, lap swimming, tennis/racquetball, bicycling/stationary bike, aerobics/calisthenics). Incident cases of PD (n = 413) were confirmed by treating physicians and medical record review. Relative risks (RR) were estimated using proportional hazards models, adjusting for age, gender, smoking, and other risk factors. Risk of PD declined in the highest categories of baseline recreational activity. The RR comparing the highest category of total recreational activity (men ≥ 23 metabolic equivalent task‐hours/week [MET‐h/wk], women ≥ 18.5 MET‐h/wk) to no activity was 0.8 (95% CI: 0.6, 1.2; P trend = 0.07). When light activity and moderate to vigorous activity were examined separately, only the latter was found to be associated with PD risk. The RR comparing the highest category of moderate to vigorous activity (men ≥ 16 MET‐h/wk, women ≥ 11.5 MET‐h/wk) to the lowest (0 MET‐h/wk) was 0.6 (95% CI: 0.4, 1.0; P trend = 0.02). These results did not differ significantly by gender. The results were similar when we excluded cases with symptom onset in the first 4 years of follow‐up. Our results may be explained either by a reduction in PD risk through moderate to vigorous activity, or by decreased baseline recreational activity due to preclinical PD. © 2007 Movement Disorder Society     

The school behaviors of children in three psychiatric treatment settings: An outpatient clinic,a day hospital,and an inpatient hospital

Compares teachers' ratings of the school behaviors of children entering an outpatient clinic, a day psychiatric program, and an inpatient psychiatric hospital. Many of the ratings did not discriminate among the three groups. Children starting outpatient versus day treatment were rated as higher in aggression, anxiety, and hostile withdrawal, and children beginning outpatient and day treatment versus inpatient treatment, were reported as more skilled socially.     

Psychiatric disorders in Danish children aged 5–7 years: A general population study of prevalence and risk factors from the Copenhagen Child Cohort (CCC 2000)

Background: Knowledge about the presentation of psychopathology in preschool age and associated risk factors is fundamental to preventive intervention before schooling. Aims: To investigate the full spectrum of psychiatric diagnoses in general population children at the period of transition from preschool to school. Methods: A sample of 1585 children from the Copenhagen Child Cohort, CCC2000 aged 5–7 years was assessed using the Development and Well-Being Assessment (DAWBA) with diagnostic classification by experienced clinicians. Perinatal, sociodemographic and socio-economic data was obtained from Danish national registries. Results: The prevalence of any ICD-10 psychiatric disorder was 5.7% (95%CI: 4.4–7.1). Pervasive developmental disorders (PDD) were found in 1.3% (95%CI: 0.8–1.8) and behavioural and hyperkinetic disorders were found in 1.5% (95%CI: 0.9–2.1) and 1.0% (95%CI: 0.4–1.6), respectively. Emotional disorders were found in 2.9% (95%CI: 1.9–40). More boys were diagnosed with PDD, behavioural disorders and tics. No gender differences were found in hyperactivity disorders (HD) and emotional disorders. Co-morbidity was frequent, in particular between HD and PDD, but also between HD and emotional disorder and behavioural disorder. Teenage mothers, single parents and low household income the first two years after the child’s birth were associated with a three-to fourfold increased risk of psychiatric disorder in the child at age 5–7 years. Conclusion: The study results point to two “windows of opportunity” for prevention. In the earliest postnatal years, prevention should target families at socio-economic risk; and in the years before schooling, intervention should focus on children with symptoms of PDD, HD, and behavioural disorders.     

Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial.

BACKGROUND: Enhanced ability to reliably identify risk factors for suicidal behavior permits more focused decisions concerning treatment interventions and support services, with potential reduction in lives lost to suicide. METHODS: This study followed 980 patients at high risk for suicide in a multicenter prospective study for 2 years after randomization to clozapine or olanzapine. A priori predictors related to diagnosis, treatment resistance, and clinical constructs of disease symptoms were evaluated as possible predictors of subsequent suicide-related events. RESULTS: Ten baseline univariate predictors were identified. Historical predictors were diagnosis of schizoaffective disorder, history or current use at baseline of alcohol or substance abuse, cigarette smoking, number of lifetime suicide attempts, and the number of hospitalizations in the previous 36 months to prevent suicide. Predictive clinical features included greater baseline scores on the InterSePT scale for suicidal thinking, the Covi Anxiety Scale, the Calgary Depression Scale (CDS), and severity of Parkinsonism. Subsequent multivariate analysis revealed the number of hospitalizations in the previous 36 months, baseline CDS, severity of Parkinson's, history of substance abuse, and lifetime suicide attempts. Clozapine, in general, was more effective than olanzapine in decreasing the risk of suicidality, regardless of risk factors present. CONCLUSIONS: This is the first prospective analysis of predictors of suicide risk in a large schizophrenic and schizoaffective population judged to be at high risk for suicide. Assessment of these risk factors may aid clinicians in evaluating risk for suicidal behaviors so that appropriate interventions can be made.     

Low risk of vascular events following urgent treatment of transient ischaemic attack: the Aarhus TIA study

Background and purpose: Patients with TIA have a high short‐time risk of stroke and an increased long‐term risk of ischaemic vascular events compared with the general population. Urgent intervention may reduce short‐time stroke risk, but little is known about the effect beyond 3 months. We examined 1‐year outcome and risk factor management in patients with TIA after urgent intervention. Methods: All patients with TIA referred to Aarhus University Hospital 1 March 2007–28 February 2008 were seen by an acute TIA team (ATT), integrating outpatient care and stroke unit facilities. Preventive treatment was initiated immediately, including fast‐track surgery for carotid stenosis. Follow‐up including nurse‐conducted health counseling was carried out after 7, 90, and 365 days. Results: A total of 306 patients were included. Stroke, myocardial infarction, or vascular death occurred in 5.2% during 1 year of follow‐up. The cumulated stroke rate was 1.6%, 2.0%, and 4.4% after 7, 90, and 365 days, respectively, compared to expected 4.5% [relative risk (RR) 0.36, 95% CI 0.13–0.98] and 7.5% (RR 0.26, 95% CI 0.11–0.63) after 7 and 90 days using ABCD² criteria. Recurrent TIA occurred in 10.2% (n = 32). Secondary prevention targets were attained in 47.6% after 1 year. Carotid surgery was performed in 8.1%; median time to operation was 11 days after contact with the ATT. Conclusion: Urgent intervention after TIA by an ATT covering outpatient and stroke unit facilities combined with nurse‐conducted health counseling is associated with a low 1‐year risk of new vascular events and may improve risk factor control.     

Urbanisation as a risk indicator for psychiatric admission

Objective: This study examines the independent effect of urbanisation on the risk for admission irrespective of age, sex and marital status.Method: Logit analysis was performed on a dataset containing all first admissions to Dutch general psychiatric hospitals and psychiatric teaching clinics in 1991.Results: Unmarried people and people living in urbanised municipalities have an increased risk of admission in all diagnostic groups analysed. People over 45 have an increased risk of admission for affective psychosis and organic psychosis. Women have an increased risk of affective psychosis.Conclusion: A high level of urbanisation increases the risk of admission in the diagnosis groups studied. However, being unmarried is a higher risk factor.