Changes In Psychiatric Patients Research Articles

The significance of cerebrospinal fluid analysis in the differential diagnosis of 564 psychiatric patients: Multiple sclerosis is more common than autoimmune-encephalitis

The analysis of cerebrospinal fluid (CSF) is an essential tool for the differential diagnosis of psychiatric disorders caused by autoimmune inflammation or infections. Clear guidelines for CSF analysis are limited and mainly available for schizophrenia and dementia. Thus, insights into CSF changes in psychiatric patients largely derive from research.We analyzed the clinical and CSF data of 564 psychiatric patients without pre-existing neurological diagnoses from March 1998 to April 2020. Primary aim was to detect previously undiagnosed neurological conditions as underlying cause for the psychiatric disorder.Following CSF analysis, 8 % of patients (47/564) were diagnosed with a neurological disorder. This was the case in 12.0 % (23/193) of patients with affective disorders, 7.2 % (19/262) of patients with schizophrenia, and 4.0 % (23/193) of patients with anxiety disorders. The predominant new diagnoses were multiple sclerosis (19/47) and autoimmune encephalitis (10/47). Abnormal CSF findings without any implications for further treatment were detected in 17.0 % (94/564) of patients.Our data indicates that CSF analysis in patients suffering from psychiatric disorders may uncover underlying organic causes, most commonly multiple sclerosis and autoimmune encephalitis. Our findings imply that the incorporation of CSF analysis in routine psychiatric assessments is potentially beneficial.

Phenomenological Changes Associated with Deep Brain Stimulation for Obsessive Compulsive Disorder: A Cognitive Appraisal Model of Recovery.

The current scientific enquiry of deep brain stimulation (DBS) does not capture the breadth of DBS-induced changes to an individual's life. Considering that DBS is applied in severe and complex cases, it is ethically and clinically necessary to consider the patient perspective and personally relevant outcomes. This lived experience investigation of people with obsessive compulsive disorder (OCD) undergoing DBS aims to provide a comprehensive evaluation of DBS-induced effects associated with OCD psychopathology. Six patients and six carers completed semi-structured open-ended interviews. A blended approach of interpretative phenomenological, inductive, and thematic analysis techniques was employed. Profound psychopathological changes were expressed; individuals felt more alive, had improved cognitive affective control, greater engagement in the world, and were able to manage their OCD. Through suppression of the condition, self-constructs were able to re-emerge and develop. A framework describing the progression of phenomenological changes, and a theoretical model describing changes in the cognitive appraisal of intrusions influencing recovery are proposed. This is the first identified qualitative investigation of DBS-induced changes in psychiatric patients and carers. Findings have implications for patient education and recovery models of OCD, and scientific understanding of DBS effects.

Body Composition Changes in Psychiatric Patients Treated with Lithium and Valproate

Purpose: To compare the effects of lithium and valproate on the body composition of psychiatric patients. Methods: This prospective cohort study evaluated the effects of lithium and valproate on body composition. Twenty-eight patients with type I bipolar disorder aged 23-54 years who just had started monotherapy were recruited. Body weight, percent body fat (PBF), soft lean mass, body mass index (BMI), and total body water were measured at baseline, one month, and six months. Changes in the body composition parameters between patients taking lithium (n=14) versus valproate (n=14) were compared. Findings: Overall mean age of study participants was 37.21 (±8) years, and 53.5% of patients were female. Average body weight gains in the first month were 1.3 kg and 2.2 kg for the lithium and valproate groups, respectively (p-value = 0.042). Mean body weight gain in the six months compared to the baseline was only 0.6 kg for the lithium group, while it was 4.3 kg for the valproate group (p-value < 0.001). The average increase in PBF at six months among patients treated with lithium versus valproate was 0.07% versus 2.2% respectively (p-value = 0.018). Patients treated with lithium had a smaller increase in their BMI in the sixth month of the study compared to the valproate group, with a mean change of 0.2 versus 2.3 kg/m2, respectively (p-value = 0.019). Conclusions: Our findings suggest that in patients with type I bipolar disorder, valproate leads to greater weight gain, BMI, and increase in PBF compared to lithium.

The Finnish Clinical Outcome in Routine Evaluation Outcome Measure: psychometric exploration in clinical and non-clinical samples

The Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) is a 34-item self-report measure designed to monitor changes in psychiatric patients. It has been translated into 25 languages, including Finnish. This is the first psychometric exploration of Finnish CORE-OM data. The aim of the study is to examine acceptability, internal consistency and convergent validity of the Finnish CORE-OM scores. Translation of the CORE-OM from English to Finnish was undertaken according to recommended protocols. Psychometric exploration was conducted in two samples: psychiatric patients (N = 201) and non-clinical participants (N = 209). Participation was voluntary and involved completion of all scales. Convergent validity was tested in terms of the mean score differences between clinical and non-clinical samples and correlations against the Beck Depression Inventory (BDI) and the Symptom Checklist (SCL-90). Among the clinical sample, all domains showed good or acceptable internal reliability. In the non-clinical sample, the alphas of domains were good or acceptable, with only the alphas of the Risk domain registering as low. There were no marked gender or age effects. CORE-OM scores correlated strongly with both the BDI and SCL-90, particularly in patients’ data. Some possible effects of Finnish language were found. The Finnish translation of the CORE-OM is psychometrically sound and can be recommended for use in Finnish mental health and clinical settings. However, further investigation in larger and different samples will clarify the generalizability its psychometric properties. Clinical services are encouraged to contribute to the creation of a collaborative Finnish CORE practice research network.

Integrative neuroimaging in mood disorders

Neuroimaging has become a central technique of biological psychiatry and is uniquely suited to assess functional and structural brain changes in psychiatric patients in vivo. In this review, we highlight several recent developments that may enable the transition of psychiatric neuroimaging from laboratory to clinic. We describe recent trends in refining imaging techniques for brain microstructure (diffusion imaging) and neurochemistry (magnetic resonance spectroscopy of neurotransmitters and metabolites) and their application to patients with mood disorders and individuals at risk, such as first-degree relatives. We also survey recent progress in imaging-guided deep brain stimulation (DBS), imaging-based (neurofeedback) therapies and studies looking at their convergent anatomical targets. These new interventional techniques, which aim to modulate brain circuits of emotion and motivation highlighted by functional imaging studies, have shown promising effects in several small studies. The mapping of brain patterns associated with risk to develop mood disorders may pave the way for diagnostic/prognostic applications of neuroimaging. The neuromodulation techniques of DBS and neurofeedback, which target dysfunctional or compensatory circuits identified by functional imaging, may take neuroimaging into a new, therapeutic domain.

Calligraphy therapy: A complementary approach to psychotherapy

Three decades of theory-based research has established the effectiveness of Chinese calligraphic handwriting (CCH) in causing cognitive activation, physiological slowdown, emotional stability and perceptual sharpening. Successful applications of these findings have included (1) behaviour changes in children with autism, ADHD and mental retardation; (2) elderly disorders in Alzheimer's and stroke patients; (3) psychosomatic diseases in hypertension and diabetes; and (4) emotion and conduct changes in psychiatric patients. A general CCH system has been developed for users of Chinese as well as alphabetic writing systems.

Povezanost strukture očekivanja ishoda tretmana i kliničke slike kod psihijatrijskih pacijenata

U ovom radu autori su se zainteresovali da istraže prirodu očekivanja koja razvijaju psihijatrijski pacijenti u odnosu na ishod tretmana, kao i povezanost tih očekivanja sa vrstom i izraženošću problema zbog kojeg se trenutno nalaze na psihijatrijskom tretmanu. Ispitivano je četiri vrste očekivanja koja se odnose na ishod tretmana: specifični lokus kontrole, specifična i generalna self-efikasnost i percepcija kontrole. Od kliničkih varijabli korišćene su dijagnoze poremećaja kao i indeks uznemirenosti (Globalni indeks ozbiljnosti stanja). Istraživanje je sprovedeno na 129 ispitanika koji su u vreme ispitivanja bili uključeni u tretman na psihijatrijskim ustanovama u Vojvodini. Klaster analizom je ustanovljeno postojanje šest interpretabilnih grupa ispitanika u odnosu na profile očekivanja ishoda tretmana: obeshrabreni internalisti, umerenjaci, samouvereni internalisti, bespomoćni eksternalisti, samouvereni eksternalisti i situacioni optimisti. Dalje analize su pokazale da među dobijenim klasterima postoje statistički značajne razlike u pogledu nivoa indeksa uznemirenosti i pripadnosti pojedinoj dijagnostičkoj kategoriji. Rezultati govore u prilog teorijskim prepostavkama da su visoka očekivanja kontrole i efikasnosti povezana sa boljim stanjem ispitanika, ali i da postoji složen odnos među pojedinačnim merama očekivanjima ishoda tretmana. Kao najbolji prediktor se pokazala percepcija kontrole. Uticaj specifičnog lokusa kontrole je, i pored značajne korelacije sa stanjem pacijenta gde promena ka unutrašnjem lokusu prati bolje stanje ispitanika, ipak nejasan, nedosledan i zavistan od ostalih očekivanja ishoda tretmana.

The TNF-α System: Functional Aspects in Depression, Narcolepsy and Psychopharmacology

Changes of the tumor necrosis factor-alpha (TNF-α) system have been shown to be involved in the development of psychiatric disorders and are additionally associated with changes in body weight as well as endocrine and metabolic changes in psychiatric patients. TNF-α might, for example, contribute to the pathogenesis of depression by an activation of the hypothalamo-pituitary-adrenocortical (HPA) axis, an activation of neuronal serotonin transporters and the stimulation of the indoleamine 2,3-dioxygenase which leads to tryptophan depletion. On the other hand, during an acute depressive episode, an elevated HPA axis activity may suppress TNF-α system activity, while after remission, when HPA axis activity has normalized the suppression of the TNF-α system has been shown not to be apparent any more.In narcoleptic patients, soluble TNF receptor (sTNF-R) p75 plasma levels have been shown to be elevated, suggesting a functional role of the TNF-α system in the development of this disorder.Additionally, psychotropic drugs influence the TNF-α system as well as the secretion and the effect of hormones which counteract or interact with the TNF-α system such as the intestinal hormone ghrelin. However, only preliminary studies with restricted sample sizes exist on these issues, and many open questions remain.

Changes in psychiatric patients' thoughts about quitting smoking during a smoke-free hospitalization

Though exempted from national bans of tobacco smoking in hospitals, some psychiatric facilities have voluntarily gone 100% smoke free with little reported difficulty in clinical management. The impact of smoking restrictions on psychiatric patients' thoughts about quitting smoking, however, is not known. This study investigates changes in thoughts about quitting smoking for patients hospitalized in a smoke-free psychiatric inpatient facility. Participants were 100 smokers recruited from a university-based adult inpatient psychiatry unit. The present study focused on participants' reported desire to quit smoking, their expectancy of success and anticipated difficulty with quitting, and their smoking abstinence goal. Assessments were conducted at hospital intake and shortly before hospital discharge. Follow-up assessments were conducted by phone at 1 week, 1 month, and 3 months post-hospitalization to measure smoking behavior. Although no cessation treatment was provided in this observational study, from admission to discharge, participants reported an increased expectancy of success with quitting and a decreased expectancy of difficulty with staying quit. They also were more likely to endorse a smoking-related goal. Psychiatric diagnosis was not related to thoughts about abstinence. Furthermore, participants' thoughts about abstinence at discharge were significantly related to their subsequent smoking behavior. Hospitalization in a smoke-free environment is associated with increases in patients' expectancies about quitting and staying smoke free.

Patterns of clinical use of antipsychotics in hospitalized psychiatric patients

The ways of using antipsychotic drugs have greatly changed over the last 10 years. The aim of this study was to evaluate such changes in psychiatric patients admitted to the Psychiatric Department of Milan's Ospedale Maggiore in 1989 ( n = 350), 1999 ( n = 718) and 2002 ( n = 628). The medical records of the hospitalized patients were evaluated by analyzing the anamnestic and clinical data with particular reference to age, gender, diagnosis and medication use. In 2002, atypical antipsychotics were more frequently prescribed as monotherapy upon discharge than typical antipsychotics (32.64% vs. 30.10%). Combinations of two or more antipsychotic drugs were prescribed upon discharge for 20.63% of the patients in 1989, 31.24% in 1999 and 23.09% in 2002. The combinations of one typical and one atypical drug increased from 4.04% in 1999 to 13.06% in 2002. The mean (± S.D.) daily antipsychotic drug dose (expressed in chlorpromazine equivalents) was significantly higher in 2002 than in 1999 and 1989. The results of this study confirm the trend to use combinations of one typical and one atypical antipsychotic, and higher doses.

Metabolic risk during antipsychotic treatment

Background: Compared with the general population, individuals with schizophrenia demonstrate an increased prevalence of obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD). Increased adiposity is associated with decreases in insulin sensitivity, leading to an increased risk of hyperglycemia and hyperlipidemia. Antipsychotic medications can increase adiposity, and a range of evidence from case reports, observational studies, retrospective database analyses, and controlled experimental studies (including randomized clinical trials) suggests that treatment with antipsychotic medications may be associated with an increased risk for insulin resistance, hyperglycemia, dyslipidemia, and T2DM. Objective: This article reviews current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and T2DM, and examines the relationship of adiposity to medical risk. Methods: Relevant publications were identified through a search of MEDLINE from 1975 to the present using the primary search parameters “diabetes or hyperglycemia or glucose or insulin or lipids” and “antipsychotic.” Meeting abstracts and earlier nonindexed articles concerning antipsychotic-associated weight gain and metabolic disturbance were also reviewed. Key studies in this emerging literature were summarized, including case reports, observational studies, retrospective database analyses, and controlled experimental studies. Results: Individual antipsychotic medications are associated with different degrees of treatment-induced increases in body weight and adiposity, ranging from modest effects (<2 kg) with amisulpride, ziprasidone, and aripiprazole to clinically significant increases with olanzapine (4–10 kg). In addition to strong evidence concerning the effect of adiposity on insulin sensitivity in nonpsychiatric populations, increased adiposity in patients with schizophrenia has been associated with decreases in insulin sensitivity; this and other effects may contribute to increases in plasma glucose concentrations and lipid levels. Conclusion: Metabolic changes in psychiatric patients who receive antipsychotic agents can contribute to the development of the metabolic syndrome and increase the risk for T2DM and CVD.

Clinical significance of focal topographic changes in the electroencephalogram (EEG) and evoked potentials (EP) of psychiatric patients.

The relationship between psychiatric symptoms that respond to anticonvulsants and epileptic activity is still debated. Evidence linking electroencephalographic changes to treatment response is scarce and controversial, partly because of the poor scalp representation of limbic electrical activity. We studied the clinical relevance of focal topographic changes in the resting EEG, the visual evoked potential and the P300 response in 90 psychiatric patients, by evaluating response to anticonvulsants and development of neurological complications. The group with focal changes was compared to a group with epileptiform activity but no focal changes and a group with normal or diffusely altered EEG. Focal EEG and EP changes predicted good response to anticonvulsants, while the presence of epileptiform activity did not. Clinical seizures developed only in patients with focal changes and no anticonvulsants medication. Structural abnormalities and selective neuropsychological deficits were seen only in the focal group. There was an association of symptom type and the site of focus. We concluded that focal EEG and EP changes in psychiatric patients have important theoretical as well as practical implications.

Weight gain during neuroleptic treatment

It has long been noted that patients being treated with neuroleptic medications (major tranquilizers) tend to gain weight. There is a growing awareness that significant weight gain presents several difficulties for the patient. As the patient improves and begins to re-establish relationships with others, he finds that his obesity makes him less physically attractive and as a result less socially desirable. A number of our patients have discontinued their medication in order to reverse the weight gain and end the resulting social ostracism. Weight gain thereby functions as an important source of resistance to effective treatment. Finally, it is well established that obesity predisposes and/or exacerbates a number of medical illnesses, including adult onset diabetes, essential hypertension, cholelithiasis, and atherosclerotic cardiovascular disease. Since chemotherapy remains central to the treatment of the major psychoses, we chose to study the most commonly employed and newer neuroleptic agents to ascertain their, effects on patient weight. We hoped to discover that some neuroleptics would cause relatively less weight gain or ideally that in our population certain medications might be associated with weight loss. We conducted an extensive review of the scientific literature from January 1966 to January 1980, for all references to weight change in psychiatric patients treated with neuroleptics. Our search uncovered varying and conflicting reports, most of which were anecdotal. Many early authors, including Kraepelin, noted that schizophrenic patients lose weight as their condition deteriorates and gain weight as they improve (Gordon and Groth, 1964). This was observed well before the introduction of neuroleptic medication. A psychodynamic explanation of this phenomenon was proposed: that a slimmer patient had greater opportunity for intimacy, which could be experienced as a threat and intensify the need for psychotic defenses. With clinical improvement the patient gained weight and diminished his chances for interpersonal closeness. Some authors maintained that the weight gain associated with medication was really the weight gain previously identified with clinical improvement. Other authors argued that the weight gain was pharmacologically caused by neuroleptics and would mask any weight change formerly used as a clinical indicator of remission.

Evaluation of symptomatic change in psychiatric patients treated by medical students.

Evaluation of symptomatic change in psychiatric patients treated by medical students.

A rating scale of the mental state: for use in the chronic population of the psychiatric hospital.

The assessment of change in psychiatric patients is never easy. The problem is accentuated in the chronic inhabitants of psychiatric hospitals, since the period of treatment and observation may have to be prolonged, and the changes found may be small and gradual. A rating scale can be of value, in recording findings in a uniform manner and in preserving the observations from selective amnesia, so making comparison possible over a long period. In the present communication we report a scale devised by two of us (F.J.J.L. and A.D.H.) for use with chronic patients. This scale summarizes the relevant parts of the examination of mental state found in standard text books of psychiatry, and we have tried to avoid presuppositions about the meaning or distribution of symptoms.

Eye and skin changes in psychiatric patients treated with chlorpromazine.

Eye and skin changes in psychiatric patients treated with chlorpromazine.

THE EVALUATION OF CHANGES IN PSYCHIATRIC PATIENTS DURING AND AFTER HOSPITALIZATION.

Journal of Clinical PsychologyVolume 20, Issue 2 p. 272-279 Psychotherapeutic Processes The evaluation of changes in psychiatric patients during and after hospitalization Peter M. Lewinsohn, Peter M. Lewinsohn Larue D. Carter Memorial Hospital and Indiana University Medical CenterSearch for more papers by this authorRobert C. Nichols, Robert C. Nichols Larue D. Carter Memorial Hospital and Indiana University Medical CenterSearch for more papers by this author Peter M. Lewinsohn, Peter M. Lewinsohn Larue D. Carter Memorial Hospital and Indiana University Medical CenterSearch for more papers by this authorRobert C. Nichols, Robert C. Nichols Larue D. Carter Memorial Hospital and Indiana University Medical CenterSearch for more papers by this author First published: April 1964 https://doi.org/10.1002/1097-4679(196404)20:2<272::AID-JCLP2270200223>3.0.CO;2-FCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume20, Issue2April 1964Pages 272-279 RelatedInformation

Therapeutic changes in psychiatric patients following partial sensory deprivation. A pilot study.

A number of reports have been published on the effects of drastic and prolonged reduction of normal environmental stimuli on human beings. Dramatic phenomena, such as depersonalization, thought disturbances, and other symptoms customarily associated with mental illness, have occurred under such conditions. Many investigators have regarded conditions of sensory deprivation as inherently stressful, and their published observations have placed great emphasis on the pathological consequences of prolonged sensory deprivation for normal subjects. In a representative study, Wexler, Mendelson, Leiderman, and Solomon 9 (1958) subjected normal subjects to perceptual and sensory deprivation for periods up to 36 hours. They observed a variety of pathological events in these subjects, such as pseudosomatic delusions, illusions, or hallucinations, and noted that all subjects showed impaired ability to concentrate, distortions in time judgment, and degrees of anxiety. Further, they described sensory deprivation procedures as useful in inducing stress and in producing psychotic-like symptoms. In

Reduction of symptoms by pharmacologically inert substances and by short-term psychotherapy.

The advent of the newer drugs, especially tranquilizers, has brought forth a large number of studies involving the use of so-called placebos as a means for determining the effectiveness of presumably potent chemical agents in emotional illness. Those of us conversant with these experiments have been impressed repeatedly by the magnitude of change effected by alone. As a consequence, we have wondered about the extent of such change in psychiatric patients, especially as compared with that associated with the experience of psychotherapy, and have been particularly concerned about the meaning of placebo in a psychiatric setting. During the course of follow-up studies on patients who participated in an extensive outpatient, short-term psychotherapy research project, conducted in the Henry Phipps Psychiatric Clinic, the opportunity presented itself for the investigation of the response to brief trials on placebo in certain members of this population. In addition, this clinic has carried on