Preexisting psychiatric illness worsens acute care outcomes after orthopaedic trauma in obese patients

PurposePre-existing psychiatric illness, illicit drug use, and alcohol abuse adversely impact patients with orthopaedic trauma injuries. Obesity is an independent factor associated with poorer clinical outcomes and discharge disposition, and higher hospital resource use. It is not known whether interactions exist between pre-existing illness, illicit drug use and obesity on acute trauma care outcomes.Patients and methodsThis cohort study is from orthopaedic trauma patients prospectively measured over 10 years (N = 6353). Psychiatric illness, illicit drug use and alcohol were classified by presence or absence. Body mass index (BMI) was analyzed as both a continuous and categorical measure (<30 kg/m² [non-obese], 30–39.9 kg/m² [obese] and ≥40 kg/m² [morbidly obese]). Main outcomes were the number of acute care services provided, length of stay (LOS), discharge home, hospital readmissions, and mortality in the hospital.ResultsStatistically significant BMI by pre-existing condition (psychiatric illness, illicit drug use) interactions existed for LOS and number of acute care services provided (β values 0.012–0.098; all p < 0.05). The interaction between BMI and psychiatric illness was statistically significant for discharge to locations other than home (β = 0.023; p = 0.001).DiscussionObese patients with orthopaedic trauma, particularly with preexisting mental health conditions, will require more hospital resources and longer care than patients without psychiatric illness. Early identification of these patients through screening for psychiatric illness and history of illicit drug use at admission is imperative to mobilize the resources and provide psychosocial support to facilitate the recovery trajectory of affected obese patients.     

Patients with psychogenic non-epileptic seizures referred to a tertiary epilepsy centre: patient characteristics in relation to diagnostic delay

Objective

This clinical study examines patient and seizure characteristics of patients with psychogenic non-epileptic seizures (PNES) in a tertiary epilepsy centre. The main focus was whether a new subgroup of PNES patients emerged with a relatively short referral time and possible specific characteristics.

Methods

All PNES patients referred to a specialist program in our centre between mid 2007 and mid 2009 were consecutively included. This yielded a study cohort of 90 patients.

Results

The majority of the patients have a patient history with many medical symptoms and they were or had been in treatment by a medical specialist. Furthermore diffuse psychological/psychiatric symptoms and subsequent treatments are also remarkably common, in general without a clear psychological diagnosis. The average time between seizure onset and referral to an epilepsy centre is remarkably low (4.29 years). About 50% of the patients were referred within 2 years of seizure onset. This ‘active high speed referral group’ had significantly more previous psychological complaints, significantly more previous psychological/psychiatric treatments and a trend towards more previous medical investigations.

Conclusion

There seems to be a new subgroup of PNES patients with a short referral time, characterized by a more active attitude towards examination of the symptoms in combination with an active attitude to apply for treatment. However, the PNES cohort as a whole is characterized by having somatoform symptoms based on a process of somatization.     

精神科护士的职业压力调查

目的调查精神科护士在工作中面临的职业压力。方法采用问卷调查法,对贵州省贵阳市两所医院精神科61名护士与贵州省贵阳市多所医院173名护士的职业压力进行调查分析。结果精神科护士职业压力处于较高水平,其他科护士压力处于中等水平。结论建议从管理角度减轻精神科护士工作压力,并对精神科护士进行减轻工作压力的训练。     

Psychiatric symptoms in boys with fragile X syndrome: A comparison with nonsyndromic autism spectrum disorder

In the present study, we examined the profile of psychiatric symptoms in boys with fragile X syndrome (FXS) using a parent report instrument. In addition, by comparing boys with FXS to boys with nonsyndromic autism spectrum disorder (ASD) utilizing multiple matching strategies, we examined between-group differences in the types of psychiatric symptoms observed and in the strength of their concurrent associations. Across all matching strategies, symptoms of manic/hyperactive behaviors and general anxiety were more frequently reported for boys with FXS than for boys with nonsyndromic ASD. Results also indicated a positive association between social avoidance and general anxiety in FXS that was stronger than that observed in nonsyndromic ASD across all matching strategies. Theoretical and treatment implications are discussed.     

A retrospective and explorative study of hypokalemia in psychiatric disorders: a beta2-receptor related phenomenon

Summary Since the serum potassium level is under beta₂-adrenergic influence, we studied serum potassium values on admission in psychiatric patients. Data are reported on 683 patients from nine major diagnostic groups. Among these nine groups significant differences were found concerning the mean serum potassium level and incidence of hypokalemia. Significant differences existed between the alcohol withdrawal and attempted suicide groups compared to the dysthymic, bipolar manic, schizophrenic and nonschizophrenic psychosis groups. Like alcohol withdrawal, attempted suicide is assumed to be a hyper-adrenergic state. Although the relative contribution of factors like nutritional state, aldosterone, insulin, and beta₂-receptor density or sensitivity is unclear, the catecholamine-potassium relationship deserves further study.An abstract of this study will be published as a letter to the editor in the J Clin Psychiatr     

2006年天津市精神科住院服务现状分析

目的了解天津市精神科住院服务现况。方法现况调查。使用天津市医疗机构精神卫生服务状况调查问卷调查天津市18个区县365家医疗机构2006年精神科床位的分布情况以及精神科住院服务的利用情况。结果 2006年天津市有21家医疗机构提供精神科住院服务,共拥有精神科医生497人,精神科护士876人,精神科床位4281张,按人口密度计算分别为4.76人/10万人、8.4人/10万人、4.11张/万人。全年总住院人次10449人次。精神卫生资源主要分布在中心城区、精神专科医院、三级医院,住院服务的利用主要在中心城区和精神专科医院。结论天津市精神科住院服务资源水平相对较高,但是精神科床位在全市的分布不均衡。     

Axis I and Axis II diagnoses in patients with chronic idiopathic urticaria

OBJECTIVE: This study presents the current prevalence of Axis I and Axis II psychiatric diagnoses and factors associated with the existence of Axis I psychiatric disorders in patients with chronic idiopathic urticaria (CIU). METHOD: The study sample was composed of 89 patients with CIU and 64 control subjects. Axis I and Axis II psychiatric disorders were ascertained by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, respectively. RESULTS: Of patients with CIU, 44 (49.4%) had at least one Axis I diagnosis, and 40 (44.9%) had at least one personality disorder. The most common Axis I disorder was obsessive-compulsive disorder (25.8%), and the most common Axis II disorder was obsessive-compulsive (30.3%) personality disorder in patients with CIU. Obsessive-compulsive disorder, major depression, obsessive-compulsive and avoidant personality disorders were more prevalent in patient group compared to control group. Obsessive-compulsive and avoidant personality disorders were related to the existence of Axis I disorders in patients with CIU. CONCLUSION: Psychiatric morbidity seems to be a frequent healthy problem in patients with CIU.     

Metabolic syndrome and associated factors among psychiatric patients in Jimma University Specialized Hospital,South West Ethiopia

Background

Metabolic syndrome is a multisystem disorder which coined to describe the recognized clustering of metabolic and cardiovascular abnormalities including obesity, hypertension, dyslipidemia, and abnormalities of glucose homeostasis.