Active Psychiatric Symptoms Research Articles

Childhood Trauma And Emotion Regulation In Psoriazis Patients

Aim: The aim of the present study was to determine if there is any relationship between childhood traumas, emotion regulation, depression, and anxiety with psoriasis severity; it also attempted to find out whether these factors affect the development of psoriasis. Materials and Methods: This study enrolled 100 patients with psoriasis aged 18-65 years and 100 healthy volunteers who were free of any form of psychiatric treatment, active psychiatric symptoms, and dermatological diseases. Sociodemographic Data Form, Childhood Traumas Scale (CTS), Difficulties in Emotion Regulation Scale (DERS), Hamilton Anxiety Scale (HAM-A), and Hamilton Depression Scale (HAM-D) were filled by the study subjects. Results: The patients and controls were compared with respect to HAM-D, HAM-A, CTS, and DERS scales. The patients had higher HAM-D, HAM-A, CTS Physical abuse, CTS Physical neglect CTS Emotional neglect, CTS Sexual abuse, CTS Total, DERS Clarity, DERS Impulse scores than the controls (Table 2) (p<0.001, p:0.011, p:0.021, p:0.005, p<0.001, p:0.045, p<0.001, p<0.001, respectively). Conclusions: Psoriasis should be treated in collaboration of dermatology, psychiatry, immunology, rheumatology, and even medical pharmacology departments.

Symposium Title: Viscera-Brain Axis and Mental Health

Cobalamin deficiency is a common disorder associated with numerous neuropsychiatric presentations. Prior literature addresses the neurocognitive and affective symptoms, which include psychotic presentations. We present the first reported case of an individual with isolated auditory and visual hallucinations in the absence of other neurocognitive, mood, or psychotic symptoms.Mr. C, a 74-year-old male with a psychiatric history of PTSD (in remission), presented to the emergency department with one month of gait instability, frequent urinary incontinence while sleeping, and near-daily auditory and visual hallucinations. Given hallucinations, psychiatry was consulted. Mr. C had no other active psychiatric symptoms at time of interview and demonstrated a high degree of insight about his hallucinations. There were no cognitive deficits, delusions, or confusion discernible on exam. Medical work-up was remarkable for vitamin B12 of 148 pg/mL (normal 200-900 pg/mL) and increased red cell distribution width of 17% (normal 11.5-14.5%) with normal folate. Cobalamin was replenished with a 1000 mcg injection of cyanocobalamin and daily oral supplementation (100 mcg). He experienced complete resolution of hallucinations over five days.Our case demonstrates that hallucinations can be a presenting symptom of cobalamin deficiency without other neurocognitive, psychotic, or mood symptoms. We will review the literature on psychosis and cobalamin deficiency, discuss the neurobiological explanations for neuropsychiatric effects of cobalamin deficiency, and provide diagnostic and treatment recommendations.Consultation-liaison psychiatrists should be aware of isolated auditory and visual hallucinations as a presentation of cobalamin deficiency since prompt treatment can lead to rapid resolution of symptoms.

A Research on the Mechanism of Excellent Social Belief of Learning Records, Affection, Driving out Laziness and Maintaining

Cobalamin deficiency is a common disorder associated with numerous neuropsychiatric presentations. Prior literature addresses the neurocognitive and affective symptoms, which include psychotic presentations. We present the first reported case of an individual with isolated auditory and visual hallucinations in the absence of other neurocognitive, mood, or psychotic symptoms.Mr. C, a 74-year-old male with a psychiatric history of PTSD (in remission), presented to the emergency department with one month of gait instability, frequent urinary incontinence while sleeping, and near-daily auditory and visual hallucinations. Given hallucinations, psychiatry was consulted. Mr. C had no other active psychiatric symptoms at time of interview and demonstrated a high degree of insight about his hallucinations. There were no cognitive deficits, delusions, or confusion discernible on exam. Medical work-up was remarkable for vitamin B12 of 148 pg/mL (normal 200-900 pg/mL) and increased red cell distribution width of 17% (normal 11.5-14.5%) with normal folate. Cobalamin was replenished with a 1000 mcg injection of cyanocobalamin and daily oral supplementation (100 mcg). He experienced complete resolution of hallucinations over five days.Our case demonstrates that hallucinations can be a presenting symptom of cobalamin deficiency without other neurocognitive, psychotic, or mood symptoms. We will review the literature on psychosis and cobalamin deficiency, discuss the neurobiological explanations for neuropsychiatric effects of cobalamin deficiency, and provide diagnostic and treatment recommendations.Consultation-liaison psychiatrists should be aware of isolated auditory and visual hallucinations as a presentation of cobalamin deficiency since prompt treatment can lead to rapid resolution of symptoms.

Factors affecting the grieving process after perinatal loss

BackgroundFactors associated with the grief process in response to perinatal loss have been investigated. However, few studies focused on the intrapersonal factors, such as developmental and personality traits. Hence, this study aimed to investigate medical and psychosocial risk factors, including inter- and intrapersonal factors for the development of complicated grief following perinatal loss, while considering emotional support.MethodsA total of 50 patients who were treated for grief due to perinatal loss at the National Center for Child Health and Development were divided into two groups according to the treatment period (< 6 months: n = 28; ≥ 6 months: n = 22). We compared medical and psychosocial variables between the two groups using the χ2 test and t test. All data were further analyzed using a logistic regression model to adjust for confounding effects.ResultsPatients who had traits of developmental/personality disorders (adjusted odds ratio [OR]: 7.21, 95% confidence interval (CI): 1.21–42.9, P = .030), and those treated with psychoactive drugs (adjusted OR: 5.77, 95% CI 1.09–30.5, P = .039) required a longer treatment period (≥ 6 months).ConclusionsPatients with personality/developmental traits and those with active psychiatric symptoms required a more extended treatment period in response to loss, suggesting the accumulation of negative factors in these patients; thus, more intensive and specialized care is necessary for these patients. Precise analysis of the coping style, attachment style, communication skills, and life history including relationship with the original family of the patients may have implications on the approach toward patients with complicated grief after perinatal loss. Studies with larger sample size are required to increase the reliability of the present findings, and future research should address the effects of the differential attachment and coping styles of patients with developmental/personality traits on the grief process.

A171 FACTORS OF SOCIAL PARTICIPATION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) imposes a significant burden on health-related quality of life, particularly in social domains. We sought to investigate the factors that limit social participation in patients with IBD. Aims Our first aim was to identify if active IBD symptoms had an effect on an objective measure of social participation. Our secondary aim was to determine if psychiatric comorbidity and/or active psychiatric symptoms in IBD patients had an influence on social participation. Methods We assessed a cohort of 239 Manitobans with IBD. We collected sociodemographic information, medical comorbidities, disease phenotype, symptom activity and psychiatric comorbidity (using the Structured Clinical Interview for DSM-IV). Participants completed the 8-item Ability to Participate in Social Roles and Activities questionnaire, which assesses participation restriction, including problems experienced in social interaction, employment, transportation, community, social, and civic life. Results Poorer social participation score were associated with earning less than average income (p&amp;lt;0.001), being unemployed (p&amp;lt;0.001), actively smoking (p=0.006), higher symptom scores, and having an increasing number of chronic medical conditions (R= -0.296). History of depression (p&amp;lt;0.001) and anxiety (p=0.001) and having active depression (p&amp;lt;0.001) and anxiety (p=0.001) all predicted poor social participation scores. Patient’s with UC on 5-ASA (PO/PR) seem to have higher social participation than other therapies. Phenotype was not predictive. Based on multivariate linear regression analysis, 38.8% of variability in social participation was explained by medical comorbidity, psychiatric comorbidity, psychiatric symptoms, and IBD related symptoms. Conclusions The factors that predict social participation by IBD patients include income, employment, smoking, medical comorbidities, IBD symptom burden, and psychiatric comorbidities. Multivariate linear regression suggests that the most relevant factors are medical comorbidity, psychiatric comorbidity, psychiatric symptoms, and IBD symptoms. Funding Agencies CIHRCrohn’s and Colitis Canada

Psychiatric Illness and Medical Decision-Making Capacity: A Retrospective Study in Medical Settings

Determination of medical decision-making capacity (DMC) is one of the common encounters in Consultation-Liaison Psychiatry (CLP) services. It is a common misbelief that patients with “psych history” lack capacity more often than patients without mental illness. The study aims to examine the relationship between mental illness and DMC in patients presented to acute medical settings. The study is a retrospective chart review, where data were collected from the patients admitted to the medical units and assessed for capacity by a psychiatrist. Clinical and demographic characteristics were compared between two groups (patients having capacity and lacking capacity) using t-tests or chi-square tests, as appropriate. The commonest reason for DMC evaluation requests was for the patients who wanted to leave the hospital against medical advice. Overall, 53% (52/98) of the patients evaluated for DMC were found to lack capacity. Group of patients lacking DMC had a significantly higher percentage of males (58% vs. 35%) but were significantly less employed (8% vs. 10%). No significant difference was observed in other demographic characteristics and primary psychiatric diagnoses (past and current) among the two groups. However, patients lacking capacity were found to have a significantly more occurrence of current (48% vs. 11%) and past (23% vs. 4%) history of neurocognitive disorder, and larger trend significance (31% vs. 15%) of active psychiatric symptoms. We conclude that patients with neurocognitive disorders and active psychiatric symptoms might have poor DMC but not all patients who have psychiatric diagnoses lack medical DMC. Larger studies especially in outpatient psychiatric settings are suggested to derive more conclusive results.

A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders.

Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.

Efficient Prediction of Vitamin B Deficiencies via Machine-Learning Using Routine Blood Test Results in Patients With Intense Psychiatric Episode.

BackgroundVitamin B deficiency is common worldwide and may lead to psychiatric symptoms; however, vitamin B deficiency epidemiology in patients with intense psychiatric episode has rarely been examined. Moreover, vitamin deficiency testing is costly and time-consuming, which has hampered effectively ruling out vitamin deficiency-induced intense psychiatric symptoms. In this study, we aimed to clarify the epidemiology of these deficiencies and efficiently predict them using machine-learning models from patient characteristics and routine blood test results that can be obtained within one hour.MethodsWe reviewed 497 consecutive patients, who are deemed to be at imminent risk of seriously harming themselves or others, over a period of 2 years in a single psychiatric tertiary-care center. Machine-learning models (k-nearest neighbors, logistic regression, support vector machine, and random forest) were trained to predict each deficiency from age, sex, and 29 routine blood test results gathered in the period from September 2015 to December 2016. The models were validated using a dataset collected from January 2017 through August 2017.ResultsWe found that 112 (22.5%), 80 (16.1%), and 72 (14.5%) patients had vitamin B1, vitamin B12, and folate (vitamin B9) deficiency, respectively. Further, the machine-learning models were well generalized to predict deficiency in the future unseen data, especially using random forest; areas under the receiver operating characteristic curves for the validation dataset (i.e., the dataset not used for training the models) were 0.716, 0.599, and 0.796, respectively. The Gini importance of these vitamins provided further evidence of a relationship between these vitamins and the complete blood count, while also indicating a hitherto rarely considered, potential association between these vitamins and alkaline phosphatase (ALP) or thyroid stimulating hormone (TSH).DiscussionThis study demonstrates that machine-learning can efficiently predict some vitamin deficiencies in patients with active psychiatric symptoms, based on the largest cohort to date with intense psychiatric episode. The prediction method may expedite risk stratification and clinical decision-making regarding whether replacement therapy should be prescribed. Further research includes validating its external generalizability in other clinical situations and clarify whether interventions based on this method could improve patient care and cost-effectiveness.

Depression during Pregnancy

A proportion of women enter pregnancy with active psychiatric symptoms or disorders, with or without concomitant psychotropic medication. Studies report that exposure to untreated depression and stress during pregnancy may have negative consequences for birth outcome and child development. Studies also report that antenatal exposure to antidepressant medications may have adverse consequences for birth outcome and child development. Antidepressant medication use during pregnancy leads to a small increased risk of miscarriage, a possible small increased risk of congenital cardiac malformations, a small increased risk of preterm birth, a small increased risk of persistent pulmonary hypertension of the newborn (PPHN), and transient neonatal symptoms in up to one-third of neonates. In addition, there is a possible increased risk of delayed motor development in children. Several recent systematic reviews and meta-analyses of the existent literature emphasize that there are minimal definitive conclusions to guide treatment recommendations. This review describes best practices for the management of depression in pregnancy, and it provides suggestions for future research.

Predictors for readmissions after video-EEG monitoring.

Identification of variables prognosticating 30-day readmission among adult patients admitted for video-EEG (VEEG) monitoring at a major epilepsy center. A retrospective cohort study was conducted, examining 865 consecutive admissions to the epilepsy monitoring unit (EMU) from January 2010 to June 2013. Data extracted from chart review included demographics, length of stay (LOS), seizure type(s), number of 30-day readmissions or emergency department (ED) visits and reasons for these, and patient and system/provider factors potentially contributing to the readmission. Of 865 elective admissions for VEEG monitoring, 49 patients accounted for 33 readmissions and 40 ED visits within 30 days of discharge for an overall 30-day encounter rate of 7.0% after excluding those lost to follow-up; 9 patients had more than one ED visit or readmission. Statistically significant risk factors for urgent 30-day encounters included a history of nonepileptic seizures (NES) (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.4), a dual diagnosis of both epilepsy and NES (OR 5.9, 95% CI 3.0-11.8), an urgent index admission to the EMU (OR 2.5, 95%CI 1.4-4.8), and a shorter LOS of index hospitalization (median 4.0 days vs 5.0 days, p < 0.01). The most common contributing patient factors included active psychiatric symptoms, medically refractory epilepsy, and living alone; the most common hospitalization-related factors included antiepileptic drug (AED) treatment adverse events or AED adjustment. In addition to the presence of intractable epilepsy and shorter LOS, mental health comorbidities and the presence of NES were important risk factors for 30-day readmissions and ED visits in the epilepsy population. Therefore, proactively addressing mental health comorbidities may decrease urgent health care utilization after VEEG monitoring.

Consequences of Receipt of a Psychiatric Diagnosis for Completion of College

Consequences of Receipt of a Psychiatric Diagnosis for Completion of College

Psychotic Denial of Pregnancy

Denial is a defense that can help reduce anxiety when coping with a stressful event, but can be detrimental to an individual if it prevents adaptation. Three types of denial of pregnancy have been described: affective, pervasive and psychotic denial. The pregnancies of women with schizophrenia can be complicated by psychotic denial of pregnancy. Misinterpretations of the symptoms of pregnancy, grief from prior loss of custody of a child, and active psychiatric symptoms may increase the risk for denial of pregnancy. The consequences of failing to accept a pregnancy can be severe, including lack of prenatal care, limited time to prepare for parenting (with subsequent risk of custody loss), and neonaticide. These risks can be alleviated by early identification of women with psychotic denial of pregnancy and implementation of medication, psychotherapy and social support. At the individual level, education about family planning may be helpful in preventing further episodes. At the public policy level, Safe Haven laws may prove to be beneficial in preventing neonaticide. Keywords: Psychotic, denial, pregnancy, schizophrenia, complications, interventions

Association of Preoperative Symptom Profile With Psychiatric Symptoms Following Subthalamic Nucleus Stimulation in Patients With Parkinson's Disease

Association of Preoperative Symptom Profile With Psychiatric Symptoms Following Subthalamic Nucleus Stimulation in Patients With Parkinson's Disease

Thalamic deep brain stimulation for writer's cramp

Writer's cramp is a type of idiopathic focal hand dystonia characterized by muscle cramps that accompany execution of the writing task specifically. In this report, the authors describe the clinical outcome after thalamic deep brain stimulation (DBS) therapy in patients with writer's cramp and present an illustrative case with which they compare the effects of pallidal and thalamic stimulation. In addition to these results for the clinical effectiveness, they also examine the best point and pattern for therapeutic stimulation of the motor thalamus, including the nucleus ventrooralis (VO) and the ventralis intermedius nucleus (VIM), for writer's cramp. The authors applied thalamic DBS in five patients with writer's cramp. The inclusion criteria for the DBS trial in this disorder were a diagnosis of idiopathic writer's cramp and the absence of a positive response to medication. The exclusion criteria included significant cognitive dysfunction, active psychiatric symptoms, and evidence of other central nervous system diseases or other medical disorders. In one of the cases, DBS leads were implanted into both the globus pallidus internus and the VO/VIM, and test stimulation was performed for 1 week. The authors thus had an opportunity to compare the effects of pallidal and thalamic stimulation in this patient. Immediately after the initiation of thalamic stimulation, the neurological deficits associated with writer's cramp were improved in all five cases. Postoperatively all preoperative scale scores indicating the seriousness of the writer's cramp were significantly lower (p < 0.001). In the patient in whom two DBS leads were implanted, the clinical effect of thalamic stimulation was better than that of pallidal stimulation. During the thalamic stimulation, the maximum effect was obtained when stimulation was applied to both the VO and the VIM widely, compared with being applied only within the VO. The authors successfully treated patients with writer's cramp by thalamic DBS. Insofar as they are aware, this is the first series in which writer's cramp has been treated with DBS. Thalamic stimulation appears to be a safe and valuable therapeutic option for writer's cramp.

Hepatitis C Treatment Eligibility and Outcomes in Patients with Psychiatric Illness

Purpose: This report describes the existing status of Hepatitis C Virus (HCV) treatment eligibility, utilization and outcomes in a large sample of patients with HCV and co-morbid psychiatric illness. This would serve as a first step toward the facilitation of HCV treatment in psychiatric populations. Methods: Our sample was derived from the sequential screening of all admissions (N = 3470) to an inpatient psychiatric service at a VA medical center from 1998 to 2002. HCV treatment evaluation and outcomes were tracked in 360 HCV (+) patients. The patient's primary psychiatric admission diagnoses included one of the following: substance use disorders (alcohol, cocaine, marijuana); anxiety disorders; affective disorders (depression, bipolar) or psychotic disorder (schizophrenia). Results: As illustrated in Figure 1, more than 2/3 of patients did not receive HCV treatment due to: non-adherence, active psychiatric symptoms and active substance use. Eleven percent died from HCV complications. Sustained virologic response (SVR) was achieved in 31% of those treated with interferon-α (IFN) and ribavirin (RBV). Patients with psychotic or anxiety disorders were less likely to achieve SVR (p < 0.002) and more likely to have neuropsychiatric adverse effects from IFN treatment (p < 0.004) when compared with patients with affective or substance use disorders. Conclusions: HCV infection in patients with psychiatric illness was associated with significant mortality. IFN-based therapy combined with RBV can be safely administered to patients with HCV and psychiatric illness. However, many patients with HCV and psychiatric illness were found ineligible for HCV treatment due to their psychiatric illness, and non-adherence to the evaluation process leading to HCV treatment was substantial. Our results highlight the need to develop better management and therapeutic approaches to engage, manage and successfully administer HCV treatments to patients with psychiatric illness. [figure 1]Figure

Sleep complaints are not corroborated by objective sleep measures in post-traumatic stress disorder: a 1-year prospective study in survivors of motor vehicle crashes.

Disturbed sleep is a common complaint among patients with post-traumatic stress disorder (PTSD). However, laboratory studies of sleep in PTSD have provided inconsistent evidence of objective sleep disturbances. A major shortcoming of most previous studies is the fact that they were performed retrospectively in patients with chronic PTSD, often complicated by comorbid psychiatric disorders and drug abuse. Thus, little is known about the development of sleep disturbances in recently traumatized subjects. In this study, 102 motor vehicle collision (MVC) survivors were followed from the time of collision throughout 1 year. Nineteen subjects hospitalized for elective surgery served as a comparison group. Subjective quality of sleep was assessed using the mini-Sleep Questionnaire and the Sleep Habit Questionnaire. In addition, a 48-h actigraphic recording was obtained 1 week, 3 and 12 months after the collision. At 12 months, a structured clinical interview (SCID) was administered to reach a formal diagnosis of PTSD. Twenty-six of the MVC survivors, but none of the comparison subjects, met the diagnostic criteria for PTSD. While MVC survivors with PTSD reported markedly poorer sleep as reflected by significantly higher scores on the mini-Sleep Questionnaire, there were no significant differences between the three groups on the actigraphic measures that were largely normal. These results, which were obtained in subjects with no evidence of active psychiatric symptoms at the time of trauma and free of psychotropic or hypnotic medications, further support previous polysomnographic (PSG) studies suggesting that altered sleep perception, rather than sleep disturbance per se, may be the key problem in PTSD.

Diagnosing mental disorders in offenders: conceptual and methodological issues

Background Studies of mentally disordered offenders have defined and measured mental disorder in very different ways. We evaluated the agreement among six different definitions of mental disorder: narrow versus broad definitions based on measures of psychiatric symptoms (the Brief Psychiatric Rating Scale; Overall and Gorham, 1962), syndromes (the Diagnostic Profile; Hart & Hemphill, 1989), and disorders (lifetime diagnoses on the Diagnostic Interview Schedule, Version III-A; Robins and Helzer, 1985). Methods Participants were 192 adult men remanded in custody before jail. Each was administered the DIS, the BPRS, and the DP. A number of variables related to adjustment problems in the jail, other mental health issues, and any institutional treatment or any pharmacological treatment for mental health problems were also recorded and analysed. Results The agreement between the symptom- and syndrome-based definitions was moderate, especially for the narrow definitions; furthermore, they yielded similar estimates of prevalence and had similar patterns of associations variables related to institutional security and mental health problems. The disorder-based definitions, especially the broad, had low agreement with the other definitions, yielded higher prevalence rates, and were associated only weakly with institutional security and mental health problems. Discussion These findings highlight the need to pay greater attention to definitional issues in research on mental disordered offenders, and support the usefulness of definitions based on active psychiatric symptoms associated with major mental illnesses. Copyright © 2000 Whurr Publishers Ltd.

Daughter of the Queen of Sheba • Sweet Mystery: A Southern Memoir of Family Alcoholism, Mental Illness, and Recovery • My Mother's Keeper: A Daughter's Memoir of Growing Up in the Shadow of Schizophrenia

Daughter of the Queen of Sheba • Sweet Mystery: A Southern Memoir of Family Alcoholism, Mental Illness, and Recovery • My Mother's Keeper: A Daughter's Memoir of Growing Up in the Shadow of Schizophrenia

A Review of Outrage of Modesty Offenders Remanded in a State Mental Hospital

Minor sexual offences have been increasing over the years. These include parasexual offences such as exhibitionism, frotteurism and its variant. In Singapore, a common minor sexual offence which involves touching, grabbing, kissing or fondling is known as outrage of modesty or molestation. To date no known studies have been made on this subtype of sexual offender. This is a five-year retrospective study looking into the profile of 157 outrage of modestry offenders remanded to Woodbridge Hospital, a state mental hospital. Results showed that schizophrenia was the predominant psychiatric diagnosis amongst the offenders (45.3%) followed by mental retardation (21.7%). Only 28.7% of those suffering from a mental illness experienced active psychiatric symptoms at the time of the sexual offence. Touching, stroking or fondling were the most frequently reported type of molestation (60.5%). The majority of the offences took place between 6 am and 6 pm. Only 15.3% had a past history of sexual offences and the majority (94.9%) were of sound mind at the time of the offence. There were no statistically significant differences between first time and repeat offenders with regard to age, ethnic group, educational level, marital status, diagnoses, place of offence, time and type of offence, soundness of mind and fitness to plead.

Antidepressant therapy in 138 patients with irritable bowel syndrome: a five-year clinical experience.

Antidepressant agents may have a therapeutic role in functional gastroenterologic disorders, but controlled investigations in irritable bowel syndrome (IBS) have not provided satisfactory practice recommendations. To help with future study design, we reviewed a five-year clinical experience with antidepressant agents in out-patients with IBS. Presenting features, treatment course, and clinical outcome were determined from a chart review of 138 patients attending a university-based gastroenterology practice. Patients were treated with up to five antidepressants in separate, consecutive trials if a satisfactory end-point had not been reached. Tricyclic antidepressants were utilized 130 times, newer antidepressants 39 times, and anxiolytic-antidepressants 47 times. Improvement and complete remission in bowel symptoms occurred in 89% and 61% of patients, respectively, during antidepressant therapy. Median dosages being prescribed when remission occurred were less than those conventionally used in clinical psychiatry (50 mg/day for several tricyclic antidepressants). Age, gender, symptom duration, and presence of psychological symptoms did not discriminate those who remitted from those who did not, whereas a pain predominant symptom pattern was more commonly associated with symptom remission (P < 0.05 comparing symptom patterns). Symptom remission was more likely during the first antidepressant treatment than with subsequent trials in the group with continued symptoms (P = 0.01), but nearly half of the patients with side effects or no benefit from the first agent who went on to subsequent trials remitted during treatment with an alternative antidepressant. The design of this retrospective review is not capable of determining the efficacy of antidepressants for IBS. Our observations in conjunction with other available data suggest that future trials should employ low daily dosages, carefully assess pain response, include patients with and without active psychiatric symptoms, and utilize a second agent for subjects intolerant or unresponsive to the first.