Brief Psychiatric Rating Scale Research Articles

Application of Facial Expression Analysis Technology in Violence Risk Assessment of Individuals with Mental Disorders in Supervised Settings.

To explore the association between violent behaviors and emotions in individuals with mental disorders, to evaluate the application value of facial expression analysis technology in violence risk assessment of individuals with mental disorders in supervised settings, and to provide a reference for violence risk assessment. Thirty-nine male individuals with mental disorders in supervised settings were selected, the participant risk of violence, cognitive function, psychiatric symptoms and severity were assessed using the Modified Overt Aggression Scale (MOAS), the Historical, Clinical, Risk Management-Chinese version(HCR-CV), the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). An emotional arousal was performed on the participants and the intensity of their emotions and facial expression action units was recorded before, during and after the arousal. One-way analysis of variance (ANOVA) was used to compare the differences in the intensity of emotions and facial expression action units before, during and after the arousal. Pearson correlation analysis was used to calculate the correlations between the intensity of the seven basic emotional facial expressions and the scores of the assessment scales. The intensity difference of sadness, surprise and fear in different time periods was statistically significant (P<0.05). The intensity of the left medial eyebrow lift action unit was found significantly different before and after the emotional arousal (P<0.05). The intensity of anger was positively correlated with the Modified Overt Aggression Scale score throughout the experiment (P<0.05). Eye action units such as eyebrow lifting, eyelid tightening and upper eyelid lifting can be used as effective action units to identify sadness, anger and other negative emotions associated with violent behaviors. Facial expression analysis technology can be used as an auxiliary tool to assess the potential risk of violence in individuals with mental disorders in supervised settings.

Evaluation of the pharmacodynamic interaction effect of augmentation agents with clozapine in patients with treatment-resistant schizophrenia: A simulation study of clinical data

IntroductionThe aim of the study was to evaluate interaction effect of various augmentation strategies with clozapine in patients with Treatment-resistant schizophrenia. MethodsData was extracted for change in positive and negative syndrome scale (PANSS) or brief psychiatric rating scale (BPRS) scores for monotherapy with various antipsychotic agents alone and their combination with clozapine. Individual patient data was generated using simulation of data (factorial trial framework) from published clinical trials for sample sizes from eight to 400 to evaluate interaction effect through linear modeling. Dose equivalents were calculated, and best fit models were determined for simulated data. ResultsThe polynomial model was found to be the best fit for the simulated data to determine interaction effect of combination. The clozapine augmentation with risperidone and ziprasidone was found to be antagonistic, whereas it was additive for haloperidol, aripiprazole, and quetiapine. A synergistic effect was observed for ECT combined with clozapine (Interaction effect: -7.62; p <0.001). A sample size of 250-300 may be sufficient to demonstrate a clinically significant interaction in future trials. ConclusionClozapine may be augmented with electroconvulsive therapy, leading to the enhancement of antipsychotic effect. Though some antipsychotics like aripiprazole demonstrate additive effects, they may also add to the adverse effects.

The associations of psychopathology and metabolic parameters with serum bilirubin levels in patients with acute-episode and drug-free schizophrenia: a 5-year retrospective study using an electronic medical record system

BackgroundThe oxidative system plays an important role in the pathogenesis of schizophrenia. Inconsistent associations were found between hyperbilirubinemia and psychopathology as well as glycolipid metabolism in patients with schizophrenia at different episodes. This current study aimed to examine these associations in patients with acute-episode and drug-free (AEDF) schizophrenia.MethodsThis is a retrospective study using 5 years of data from May 2017 to May 2022 extracted from the electronic medical record system of Chaohu Hospital of Anhui Medical University. Healthy controls (HCs) from the local medical screening center during the same period were also included. Participants’ data of the bilirubin levels [total bilirubin (TB), conjugated bilirubin (CB), unconjugated bilirubin (UCB)], glycolipid metabolic parameters and the score of the Brief Psychiatric Rating Scale (BPRS) were collected.ResultsA total of 1468 case records were identified through the initial search. After screening, 89 AEDF patients and 100 HCs were included. Compared with HCs, patients had a higher CB level, and lower levels of glycolipid metabolic parameters excluding high density lipoprotein-cholesterol (HDL-C) (all P < 0.001). Binary logistic regression analyses revealed that high bilirubin levels in the patients were independently associated with higher total and resistance subscale scores of BPRS, a higher HDL-C level, and lower total cholesterol and triglyceride levels (all P < 0.05).ConclusionBilirubin levels are elevated in patients with AEDF schizophrenia. Patients with high bilirubin levels have more severe psychopathology and relatively optimized glycolipid metabolism. In clinical practice, regular monitoring of bilirubin levels in this patient population should be carried out.

The Role of Serum Lipids in Predicting Suicidal Ideation in Isotretinoin Therapy for Acne.

Previous studies have demonstrated that lipids could play a role in suicidal ideation and the pathogenesis of psychiatric diseases. The present study aims to investigate the correlation between variations in serum lipid concentration, a side effect of isotretinoin (ITT), psychiatric symptoms, and suicidal ideation in acne vulgaris patients under ITT treatment. Thestudy was completed with 41 acne patients. Patients were analyzed with the sociodemographic and clinical data form, Beck depression inventory (BDI), Beck anxiety inventory (BAI), Beck Suicidal Ideation Scale (BSS), and Brief Psychiatric Rating Scale (BPRS) at the beginning and on the third month of treatment. Lipid levels [serum total cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL)] were measured using the automatic chemistry analyzer (Beckman AU-5800). Serum low-density lipoprotein cholesterol (LDL) values were estimated with the Friedewald formula. A statistically significant correlation was determined between the BSS scores and TC, TG, and LDL parameters at the beginning of treatment and the control date. Thus, it was determined that there was a negative weak correlation between BSS and TC parameters (r = -0.403; P = .009), a moderate negative correlation between BSS and TG (r = -0.526; P < .001), and a weak negative correlation between BSS and LDL (r = -0.421; P = .006). Furthermore, there were statistically significant changes between the BDI and BAI scores at the beginning of treatment and the third month ( P = 0.016 and P = .001, respectively). Although an increase was observed in BSS and BPRS after the treatment compared to pretreatment, the increase was not statistically significant. The present study findings revealed that serum lipid levels could be associated with psychiatric side effects in patients under ITT treatment. But, this must not be the only way to detect the risk when we consider that serum lipid levels that have been associated with suicidal ideation, depression, and several psychiatric diseases have the potential to be an important indicator. In this context, our preliminary results open the doors to a new perspective in this regard, using the concept of blood lipid optimization. These findings need to be considered preliminary and supported by large samples.

Response to electroconvulsive therapy in elderly patients with late-onset bipolar disorder: The impact of cerebral small vessel disease.

Cerebral Small Vessel Disease (CSVD) is a chronic, progressive vascular disorder that confers increased vulnerability to psychiatric syndromes, including late-life mood disorders. In this study, we investigated the impact of CSVD on electroconvulsive therapy (ECT) outcomes in patients with late-onset bipolar disorder (BD). A sample of 54 non-demented elderly patients (≥60years) with late-onset BD and treatment-resistant major depression, mixed state, or catatonia who underwent bilateral ECT were included in this naturalistic observational study. A diagnosis of CSVD was established based on brain neuroimaging performed before ECT. All patients were evaluated before and after ECT using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression scale (CGI). Of the total sample, 19 patients were diagnosed with CSVD (35.2%). No significant differences were observed at baseline between patients with and without CSVD. Overall, a response was obtained in 66%-68.5% of patients, with remission in 56.2%. No significant differences in ECT outcomes were found between those with and without CSVD, and both groups exhibited substantial improvements in symptom severity following ECT. The outcome of ECT in late-onset BD was not influenced by the presence of CSVD. This finding aligns with previous research on unipolar depression. Accordingly, ECT should be considered for elderly patients with late-onset BD, regardless of the presence of CSVD.

Difficult-to-Engage Patients with Severe Mental Illness in Rural Community Settings: Results of the Greek Hybrid Assertive Community Treatment Model of Mental Healthcare.

Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients' hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients' symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients' hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients' functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients' outcomes.

Predicting the Outcome of First Episode Psychosis Subjects by Assessing Dorsolateral Prefrontal Cortex Volume

Aim: Dorsolateral prefrontal cortex (DLPFC), Neurological Soft Signs (NSS) and Cognitive impairment have been described as predictors of outcome of First Episode Psychosis (FEP), therefore we aimed to find the predictors of clinical, social and functional outcome variables in a cohort of first episode non affective psychotic subjects. Subjects and Methods: A prospective follow up study was conducted from August 2018 to August 2020 in a tertiary care hospital of South India. A semi-structured questionnaire was given to all subjects for socio-demographic details. All subjects were assessed with Heidelberg scale, Bender Gestalt Test (BGT) and underwent MRI Brain 3D volumetric scan to examine NSS, cognitive impairment, and DLPFC volume at baseline respectively. Brief Psychiatric Rating Scale (BPRS) and Social and Occupational Functioning Assessment Scale scales (SOFAS) were administered at baseline, 1 month and at three month follow up. At 3 months, clinical and socio-functional outcome was defined by BPRS scores and SOFAS scores. Pearson’s correlation was found between DLPFC volume of all subjects, BPRS, BGT scores at baseline with BPRS and SOFAS at 3 months. To test the statistical significance of the comparison of mean values of all continuous clinical and demographic parameters between two groups of BPRS and SOFAS, Mann Whitney U test was used. Results: Smaller DLPFC volume predicted clinical, socio-functional outcome significantly. A significant moderate correlation was found between NSS and BPRS scores at baseline. Conclusion: Baseline right DLPFC volume can be an important predictor of clinical and socio-functional outcome in FEP.

Economic evaluation of intensive home treatment in comparison to care as usual alongside a randomised controlled trial.

There is a dearth of research on the cost-effectiveness of intensive home treatment (IHT), an alternative to psychiatric hospitalisation for patients experiencing psychiatric crises. We therefore present a health economic evaluation alongside a pre-randomised controlled trial of IHT compared to care as usual (CAU). Patients were pre-randomised to IHT or CAU using a double-consent open-label Zelen design. For the cost-utility analysis, the EuroQol 5-dimensional instrument was used. The cost-effectiveness was assessed using the Brief Psychiatric Rating Scale (BPRS). Data of 198 patients showed that each additional QALY gained from offering IHT instead of CAU was on average associated with an extra cost of €48,003. There is a 38% likelihood that IHT will lead to more QALYs at lower costs compared to CAU. An improvement of one additional point on the BPRS by offering IHT instead of CAU was associated with an extra cost of €19,203. There is a 38% likelihood that IHT will lead to higher BPRS score improvements at lower costs. Based on the NICE willingness-to-pay threshold of £30,000 (€35,000) per QALY, IHT could potentially be considered cost-effective with a likelihood of 55-60% when viewed from a societal perspective, and > 75% from a health care perspective. IHT appears slightly more attractive in terms of cost-utility and cost-effectiveness than CAU, although differences in both costs and effects are small especially when viewed from the societal costs perspective. From the health care sector costs perspective, IHT has a higher probability of being cost-effective compared to CAU. Netherlands Trial Register: NTR6151.

Pretreatment Thyroid Profile and its Relationship with Response to Treatment with Lithium in Bipolar Mood Disorder: A Longitudinal Study from Northeast India

Abstract Background: The thyroid hormone’s significant impact on the treatment of depressive and other mood disorders is well documented. Even minor hypothyroidism can modify the progression and treatment results of major depressive disorder. This research aims to explore the correlation between initial thyroid levels and the treatment outcome in bipolar mood disorder using lithium, a well-established treatment method. Methodology: The study involved 45 bipolar mood disorder patients diagnosed according to the Diagnostic and Statistical Manual 5 criteria and admitted to a tertiary care teaching institute in Northeast India. The patients received lithium treatment, with injectable lorazepam used for immediate agitation control when necessary. On the 1st day, a semi-structured questionnaire and Brief Psychiatric Rating Scale (BPRS) 24-item scale were used to evaluate symptoms, and samples were collected for a thyroid profile, including T3, T4, FT3, FT4, and thyroid-stimulating hormone (TSH). The BPRS scale was used again on the 30th day to assess treatment response. Results: The BPRS subscale showed the highest treatment response for grandiosity and the lowest for depression. Factors such as age, illness duration, substance use, and family history of mood disorder were inversely correlated with the BPRS score’s decrease. Initial thyroid levels were identified as a predictor of treatment response, with baseline T4 levels showing a significant positive correlation with treatment response, while baseline TSH levels showed a negative correlation. Conclusion: Lithium proved to be an effective treatment for bipolar mood disorder, particularly for the manic subtype. Initial T4 and TSH levels were found to significantly predict treatment response, with T4 showing a positive correlation and TSH showing a negative correlation.

Awareness and perceptions of managing recovery in psychiatric patients in a rehabilitation center: an observational study

IntroductionIn mental health prevention, person-centered, and rights-based approaches, the role of recovery is highlighted (WHO, 2021). Various evaluation tools are used in rehabilitation objectives and programs, including the Specific Levels of Functioning Scale (SLOF) (Mucci et al. Schizophr Res 2014;159 144-50) and the Recovery Assessment Scale – Domains and Stages (RAS-DS), a self-measure of mental health recovery. It includes 38 items clustered into four recovery domains and meets two functions. In addition to measuring self-reported outcomes, it increases service-user control towards objectives and recovery action plans (Honey et al. BMC Psychiatry 2023;23 500).ObjectivesTo evalue the efficacy of RAD-DS in a psychiatric rehabilitation facility to be used as a routine tool in daily rehabilitation activity.MethodsIn our observational study, we recruited 103 inpatients (total: 103 patients, females: 38 patients, males: 65 patients) in a psychiatric rehabilitation facility. The patient presented with psychiatric disorders that met the diagnostic criteria of DMS-5 (schizophrenia, bipolar disorder, MDD, personality borderline disorder). Epidemiological data are shown in Table 1.All patients were undergoing a psychiatric rehabilitation program and were observed during a one-year evaluation.In all patients, the following rating scales were administered at baseline (T0) and after a year (T1):For the evaluation of social measures, life outcomes, and functioning and recovery:-Recovery Assessment Scale – Domains and Stages RAS-DS-Specific Levels of Functioning Scale (SLOF)-Global Assessment of Functioning (GAF)For psychopathological evaluation:-Brief Psychiatric Rating Scale (BPRS)The data were statistically analyzed with the EZAnalyze 3.0 software for the Excel platform.ResultsThe RAS-DS total score results (Table 2) show a not significant difference between T0 vs. T1 (mean: 101.80 vs. 104.37, p. 0.193). An improvement in the score was observed after one year of rehabilitation treatment in the subgroup “Doing things I value” (T0 vs. T1: mean 16.15 vs. 18.77, p 0.001). Statistically significant differences were observed in the subgroups “Mastering my illness” (T0 vs. T1: mean 18.3 vs. 20.85, p. 0.021). In the other subgroups, the differences were not statistically significant. Interestingly, these results are comparable to those found with SLOF and GAF (respectively, p. 0.972 and p. 0.873).Image:Image 2:ConclusionsThe current trend of research and clinical practice is to give more importance to psychiatric rehabilitation treatment (Franza Psychiatr Danub 2022;34(Suppl 8) 9-13). The results obtained with our observational study indicate the possible usefulness of indicators of patient well-being, as well as the RAS-DS in the management of psychiatric rehabilitation programs. The expectations, indications, and perceptions of psychiatric patients can be decisive in improving recovery.Disclosure of InterestNone Declared

Sexual Dysfunction with Risperidone in Male and Female Patients of Schizophrenia

Background: Sexual side-effects due to use of Antipsychotic drugs have become one of the most important determinants of treatment compliance. Studies regarding sexual side-effects associated with antipsychotics comprise only a handful in the Indian population, especially so in this north-eastern part of the country. Aims and Objectives 1. To assess the sexual dysfunction associated with Risperidone in male and female patients of Schizophrenia. 2. To compare the sexual dysfunction associated with Risperidone between male and female patients of Schizophrenia. Materials and Methods: This was a hospital based comparative study conducted on 50 clinically stable male and female patients of Schizophrenia on Risperidone only. A Sexual Functioning Questionnaire (SFQ) was administered after assessing the clinical stabilities with the Brief Psychiatric Rating Scale (BPRS). Sexual dysfunction was assessed by calculating the mean scores on all the domains of sexual functioning in SFQ which were then compared across the study groups using the Chi square test . The results were analysed using SPSS Version 16.0 setting the significance threshold at p &lt;0.05. Results: From this study, we inferred that with Risperidone, impairment is seen in desire disorders (12%), arousal disorders (14%), orgasmic difficulties (26%) and overall sexual dysfunction (20%) although not statistically significant. It was also found that in females, Risperidone caused more desire disorders, more arousal disorders and a more overall sexual dysfunction; whereas in case of males, Risperidone caused more arousal disorders, more orgasmic difficulties, more sex related pain problems and a more overall sexual dysfunction; Conclusion: Sexual dysfunction is an important side-effect of Antipsychotic drugs. So clinicians should try to address these side-effects to help patients’ attain a better compliance.

Efficacy of probiotic supplements in improving the symptoms of psychosis, anxiety, insomnia, and anorexia due to amphetamine and methamphetamine use: a randomized clinical trial.

Changes in the density and diversity of gut microbiota in chronic use of methamphetamine have been mentioned as contributors to psychotic and anxiety symptoms, sleep problems, and loss of appetite. In this placebo-controlled clinical trial, we investigated the effect of the probiotic Lactobacillus Acidophilus in improving psychiatric symptoms among hospitalized patients with chronic methamphetamine use along with psychotic symptoms. 60 inpatients with a history of more than 3 years of methamphetamine use, were randomly assigned to one of two groups receiving either a probiotic capsule or placebo along with risperidone for 8 weeks based on a simple randomization method. In weeks 0, 4, and 8, patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Simple Appetite Nutritional Questionnaire (SANQ), and Body Mass Index (BMI). Compared to the control group, patients receiving probiotics had better sleep quality, greater appetite, and higher body mass index (there were significant interaction effects of group and time at Week 8 in these variables (t = -3.32, B = -1.83, p = .001, d = 0.89), (t = 10.50, B = 2.65, p <.001, d = 1.25) and (t = 3.40, B = 0.76, p <.001, d = 0.30), respectively. In terms of the improvement of psychotic and anxiety symptoms, there was no statistically significant difference between the two groups. The use of probiotics was associated with improved sleep quality, increased appetite, and increased body mass index in patients with chronic methamphetamine use. Conducting more definitive clinical trials with larger sample sizes and longer-term follow-up of cases is recommended.

Self-assessment scale of auditory verbal hallucinations (SAVH): A novel tool for patients with schizophrenia

BackgroundA scale for self-assessment of auditory verbal hallucinations (SAVH) was developed for patients, and this study aimed to validate the scale by investigating its psychometric properties. MethodsForty one patients with schizophrenia or schizoaffective disorders (DSM-5) self-assessed their hallucinations using nine SAVH questions. Each question was scored from 0 to 5, indicating the severity of the symptoms. Patients were also evaluated with the Brief Psychiatric Rating Scale (BPRS), Auditory Hallucination Rating Scale (AHRS), and Birchwood Insight Scale (BIS). The psychometric properties of the SAVH were assessed by the face, internal consistency, construct, convergent and discriminant validities. ResultsSAVH scores were used to examine the psychometric properties. Cronbach's α and Guttman's Lambda-6 were 0.67 and 0.73 respectively. Significant correlations were observed between SAVH and AHRS total scores, as well as BPRS hallucinatory behavior subscores. No significant correlations were found between total SAVH scores and (i) levels of insight or (ii) negative BPRS subscores. Factor analysis on SAVH revealed three factors accounting for 59.3 % of the variance. Most patients found the questions clear, appropriate, and of adequate length. ConclusionsSAVH demonstrated good psychometric properties, suggesting its utility in assessing auditory verbal hallucinations (AVH). This self-assessment could be valuable in evaluating AVH treatment efficacy, monitoring AVH, and empowering patients.

Abstract P321: Clinical Correlates of Medication Adherence to Antihypertensives and Bipolar Medications in Individuals With Hypertension and Bipolar Disorder

Introduction: Individuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality largely from cardiovascular causes. In the current analysis, we examined screening and baseline data from an ongoing randomized controlled trial and assessed clinical correlates of adherence to antihypertensives and BD medications in 55 patients with bipolar disorder and hypertension. Hypothesis: We assessed the hypothesis that adherence to antihypertensives would correlate with systolic blood pressure (SBP) and adherence to BD medication would correlate with psychiatric symptoms. Method: Inclusion criteria were a BD Type 1 or 2 diagnosis, being prescribed antihypertensives, and uncontrolled hypertension (SBP ≥130mmHg). Adherence was measured for the prior week with 1) self-reported Tablets Routine Questionnaire for antihypertensives (TRQ-HTN) and BD (TRQ-BD) with higher percentage reflecting worse adherence and 2) objective electronic monitoring using an eCAP © for one antihypertensive medication. Average SBP was calculated from 12 readings over one week. Symptoms of BD were measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS). Results: Mean age of the sample (N=55) was 53.91±9.97, a majority female (61.8%), 49.1% Black and 45.5% White. Mean years of education was 14.09 ±2.83 and 95% had Bipolar Type I. At screen, TRQ-HTN was 35.80% ± 21.78 (N=55); at baseline, mean TRQ-HTN was 12.94 ± 16.88%. At screen, TRQ-BD was 29.61% ±28.02 (N=55); at baseline, TRQ-BD was 19.43% ±28.54 (N=50). At baseline, eCAP (N=43) was 39.53 ± 35.11%. There was a significant improvement in TRQ-HTN from screen to baseline (t(52) = -6.75 r &lt;0.001) and a trend for TRQ-HTN (t(49) = 1.80, p = 0.078). There was a significant correlation between TRQ-HTN and eCAP at baseline (rs=0.307, p&lt;.05, N= 43) yet eCAP reported more missed days than TRQ-HTN (Mean = -25.581 t(42) = -4.903 p&lt;0.001). TRQ-BD was significantly correlated with BPRS ( r = 0.313, p &lt;.05, N = 50) but not with MADRS. Neither TRQ-HTN nor eCAP were correlated with SBP. SBP significantly decreased from screen to baseline (t(53) = 2.357 p&lt;.05). Conclusion: In conclusion, adherence levels vary widely and objective measurement identified rates of missed medications that were approximately 26% higher than self-report. Self-reported BD adherence was related to global psychiatric symptoms but not depression while antihypertensive adherence did not relate to SBP. Greater BD symptom severity may be a clinical indicator to assess for adherence problems and medication and BP monitoring alone may improve adherence and SBP.

Admixture Analysis of Age of Onset in Bipolar Disorder and Impact of Anxiety Comorbidity.

The present study aimed to examine clinical differences between subjects with early-onset (<21 years) and adult-onset (>30 years) bipolar I disorder, in particular, in relation to anxiety comorbidity. Subjects were selected from a cohort of 161 consecutive patients with bipolar disorder type I as diagnosed by the Structured Clinical Interview for DSM Disorder(SCID-I). Clinical characteristics and axis I comorbidity were compared between those whose illness first emerged before the age of 21 years (n=58) and those whose first episode occurred after the age of 30 years (n=27). Psychopathology was assessed using the 18-item version of the Brief Psychiatric Rating Scale (BPRS). The frequency of delusions, hallucinations, and formal thought disorders was evaluated with the SCID-I. Overall, social and occupational functioning was assessed by the Global Assessment of Functioning (GAF). Most subjects with early-onset bipolar disorder were males, had panic disorder and substance abuse comorbidity, longer duration of illness, exhibited mood-incongruent delusions, and presented with a mixed episode at onset more frequently than the later adult-onset subjects. Mixed mania at the first episode of illness and lifetime panic disorder comorbidity predicted mixed polarity at the first hospitalization episode in the early-onset subjects. Overall, early age at onset seems to delineate a distinct bipolar I disorder subtype characterized by a greater likelihood of mixed episodes, lifetime panic disorder comorbidity, and schizophrenia-like delusions.

Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis.

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.

Efficacy of whole system ayurveda management protocol in major depressive disorder- A randomized controlled clinical trial

BackgroundMajor Depressive Disorder (MDD) is one of the common depressive disorder. MDD has high comorbidity and has greater implications on quality of life. Whole system Ayurveda management protocol (WSAP) is explored for it's possible role in management of MDD. ObjectiveTo evaluate the efficacy of Whole system Ayurveda management protocol on Major Depressive Disorder. Material and MethodsStudy was a randomized controlled trial. Total 50 patients of MDD meeting the DSM V criteria, age group 20–70 years of either sex participated in the study. They were randomly divided into two groups, control group received Escitalopram 10 mg twice a day and Ayurveda group was on WSAP. Interventions were for 60 days. Assessments were done through various clinical parameters like Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Brief psychiatric rating scale (BPRS), Pittsburgh Sleep Quality Index (PSQI), WHO Quality of Life- BREF (WHOQOL-BREF), Clinical Global Improvement scale (CGI), UKU Side effect scale. Assessments during intervention was on every 15th day. ResultsStudy showed that Ayurveda group produced significant outcome improvement compared to control group in HDRS (p = 0.01), HARS (p = 0.03), PSQI (p = 0.03), WHOQOL-Bref (p < 0.001) and UKU side effect scale (p = 0.02). Both the group showed improvements in all the parameters except in WHOQOL-Bref where Ayurveda group only showed improvements (p < 0.001). Effect size showed large effect in WHOQOL-Bref. Mild side effects were reported in control group and none in Ayurveda group. ConclusionWSAP was effective in management of MDD and had better side effect profile. Further studies needed.

The evaluation of frequency and predictors of delirium and its short-term and long-term outcomes in hospitalized older adults’

BackgroundDelirium is a common complication in hospitalized older adults with multifactorial etiology and poor health outcomes. AimTo determine the frequency and predictors of delirium and its short-term and long-term outcomes in hospitalized older adults. MethodsA prospective observational study was performed in patients aged ≥60 years consecutively admitted to geriatric ward. Potential risk factors were assessed within 24 hours of hospital admission. Delirium screening was performed on admission and daily thereafter throughout the hospital stay using Confusion Assessment Method (CAM). Patients were followed up at 1-year post-discharge. ResultsThe study included 200 patients with mean age 73.1 ± 8.83 years. Incidence and prevalence rate of delirium were 5% and 20% respectively. Multivariable regression analysis revealed emergency admission (OR= 5.12 (1.94–13.57), p=0.001), functional dependency (Katz index of Independence in Activities of Daily Living (Katz-ADL) score <5) 2 weeks before admission (OR= 3.08 (1.30–7.33), p=0.011) and more psychopathological symptoms (higher Brief Psychiatric Rating Scale (BPRS) total score) (OR=1.12 (1.06–1.18), p=0.001) to be independently associated with delirium. Patients in delirium group had significantly high in-hospital mortality (OR= 5.02 (2.12–11.8), p=0.001) and post-discharge mortality (HR= 2.02 (1.13–3.61), p=0.017) and functional dependency (Katz-ADL score <5) (OR= 5.45 (1.49–19.31), p=0.01) at 1-year follow up. ConclusionDelirium is quite frequent in geriatric inpatients and is associated with high in-hospital and post-discharge mortality risk and long-term functional dependency. Emergency admission, pre-hospitalization functional dependency, and more general psychopathological symptoms are independently associated factors. Hence, earliest identification and treatment with early implementation of rehabilitation services is warranted.

A Double Truncated Binomial Model to Assess Psychiatric Health through Brief Psychiatric Rating Scale: When is Intervention Useful?

A double truncated binomial distribution model with ‘u’ classes truncated on left and ‘v’ classes truncated on right is introduced. Its characteristics, namely, generating functions; and the measures of skewness and kurtosis have been obtained. The unknown parameter has been estimated using the method of maximum likelihood and the method of moments. The confidence interval of the estimate has been obtained through Fisher’s information matrix.&#x0D; The model is applied on cross sectional data obtained through Brief Psychiatric Rating Scale (BPRS) administered on a group of school going adolescent students; and the above-mentioned characteristics have been evaluated. An expert, on the basis of the BPRS score values, suggested an intervention program. The BPRS scores of the students who could be administered the intervention program lied in a range (which was above the lowest and below the highest possible values) suggested by the expert. Whereas the complete data suggested the average number of problem areas is four (which was not in consonance with the observations given by the expert), the double truncated model suggested the number of such areas as five which was consistent with the observations made by the expert. This establishes the usefulness of double truncated models in such scenarios.

Risperidone plasma level, and its correlation with CYP2D6 gene polymorphism, clinical response and side effects in chronic schizophrenia patients

BackgroundTo explore the influence of CYP2D6 genetic polymorphism on risperidone metabolism, thereby affecting risperidone’s effects and safeties in patients with chronic schizophrenia.MethodsSixty-nine subjects with chronic schizophrenia treated with risperidone were recruited. CYP2D6 genotypes was determined using targeted sequencing and translated into phenotype using activity system. Risperidone plasma concentrations were measured using HPLC. Positive and Negative Symptom Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) were used to evaluate the existence and severity of psychiatric symptoms, Barnes Akathisia Scale (BAS) and Extrapyramidal Symptom Rating Scale (ESRS) for neurological side effects. Metabolic and endocrine status assess were also included.ResultsThe plasma drug concentrations varied hugely among individuals. Intermediate metabolizer (IM) group had higher plasma levels of RIP and dose corrected RIP concentration, RIP/9-OH-RIP ratio and C/D ratio than normal metabolizer (NM) group (p < 0.01). There was no statistic difference between responders and non-responders in dose-adjusted plasma concentrations and ratios of RIP/9-OH-RIP and C/D. The occurrence of EPS was related to active moiety levels in 4th week (p < 0.05). The prolactin (PRL) levels in two follow-ups were both significantly higher than baseline (p < 0.01). PRL change from baseline to week 4 and week 8 were both positively associated with active moiety concentration detected in week 4 (p < 0.05).ConclusionsThe risperidone plasma levels have great inter- and intraindividual variations, and are associated with the CYP2D6 phenotypes, as well as the changes in serum prolactin in patients diagnosed with chronic schizophrenia.