Complex Mental Illness Research Articles

Wirksamkeitsanalyse einer stationären psychosomatischen Rehabilitation anhand des Mini-ICF-APP

Medical rehabilitation aims at improving disorders of functions, capacity and participation. The present study investigates the degree to which inpatient psychosomatic rehabilitation improves disorders of capacity. 213 inpatients (149 females, 64 males) from a psychosomatic rehabilitation unit were investigated at the beginning and end of a six-week treatment using the Mini-ICF-Rating for Psychological Disorders (Mini-ICF-APP), an observer-rating instrument for the assessment of disorders of capacity, especially in regard to social functioning. There were significant improvements in all dimensions of disorders of capacity. Patients who were discharged as able to work benefited most from the rehabilitation treatment, whereas patients who were on sick leave at discharge showed only moderate improvement. Those who were able to work at admission but discharged as sick leave had the highest values in disorders of capacity in both measurements. Patients suffering from complex mental illnesses did show only moderate improvement. The greatest changes were seen with respect to "planning and structuring of tasks", "competency" and "non-work activities" while assertiveness did show the smallest changes. The data show that psychosomatic inpatient rehabilitation produces positive effects on disorders of capacity.

Deficits in adult prefrontal cortex neurons and behavior following early post-natal NMDA antagonist treatment

The prefrontal cortex (PFC) is associated with higher cognitive functions including attention and working memory and has been implicated in the regulation of impulsivity as well as the pathology of complex mental illnesses. N-methyl d-aspartate (NMDA) antagonist treatment with dizocilpine induces cell death which is greatest in the frontal cortex on post-natal day seven (P7), however the long-term structural and behavioral effects of this treatment are unknown. This study investigates both the acute neurotoxicity of P7 dizocilpine and the persistent effects of this treatment on pyramidal cells and parvalbumin interneurons in the adult PFC, a brain region involved in the regulation of impulsivity. Dizocilpine treatment on P7 increased cleaved caspase-3 immunoreactivity (IR) in the PFC on P8. In adult mice (P82), P7 dizocilpine treatment resulted in 50% fewer parvalbumin-positive interneurons ( p < 0.01) and 42% fewer layer V pyramidal neurons ( p < 0.01) in the PFC. Double immunohistochemistry revealed cleaved caspase-3 IR in both GAD67 IR interneurons and GAD67 (−) neurons. Following dizocilpine treatment at P7, adults showed reduced time in the center of the open field suggesting increased anxiety-like behavior. These findings indicate that early brain insults affecting glutamatergic neurotransmission lead to persistent brain pathology that could contribute to impulsivity and cognitive dysfunction.

Multimodal Treatments versus Pharmacotherapy Alone in Children with Psychiatric Disorders

Practice guidelines for the treatment of youth with mental health problems tend to endorse integrating psychopharmacologic treatment with psychosocial interventions, such as psychotherapy and parent skills training. However, poor access to pediatric mental health specialists and inadequate training of primary care physicians in psychosocial interventions make it difficult for families to receive this standard of care. Large pediatric randomized, multicenter trials, including the Multimodal Treatment Study of ADHD (attention deficit hyperactivity disorder) [MTA] and the Treatment for Adolescents with Depression Study (TADS), have begun to identify specific advantages of multimodal treatment compared with psychopharmacology alone. Advantages of combined treatment include improvement of both symptoms and family functioning. More research is needed to determine effective and appropriate multimodal interventions for complex and severe pediatric mental illness. Advantages of multimodal treatment must be balanced with the treatment burden on the family system.

Effectiveness of Psychoanalytic Psychotherapy for Adolescents with Serious Mental Illness: 12 Month Naturalistic Follow-Up Study

The aim of this naturalistic longitudinal study was to examine the effectiveness of individual psychoanalytic psychotherapy in reducing symptoms and improving overall functioning for adolescents with severe mental illness beyond the changes observed with treatment as usual. Changes to family functioning were also examined. Participants at 12 month follow up were 55 of an initial group of 80 Child and Adolescent Mental Health Services patients with complex, severe mental illness (32 female, mean age = 15.11 years). At initial assessment 40 participants were offered psychoanalytic psychotherapy when a psychotherapist became available; 23 accepted and received once- or twice-weekly psychoanalytic psychotherapy for 4-12 months. Out of the initial 57 participants who received Child and Adolescent Mental Health Services treatment as usual, 33 were reassessed at 12 months. Self-reported depressive symptoms, parent-reported social and attention problems and researcher-evaluated overall functioning and family functioning were measured at initial assessment and 12 months later. At 12 months, psychotherapy was associated with a greater reduction in depressive, social and attention problems than treatment as usual, alone, if these problems were initially in the clinical range. There was no effect on participant overall functioning or family functioning. This naturally occurring sample of seriously ill adolescents referred to Child and Adolescent Mental Health Services for assessment were suffering complex mental illness and poor mental health. Empirical evidence is presented that psychoanalytic psychotherapy is an effective addition to Child and Adolescent Mental Health Services treatment as usual for mental illness in adolescence, particularly for more severe and complex cases. The naturalistic study design and participant attrition are possible study limitations.

The Syndrome of Capgras

The delusional belief that a close relative has been replaced by a look-alike impostor was named the Capgras delusion in honor of Joseph Capgras, who described the first case. Capgras's original patient, Mme M., had a complex mental illness with various symptoms in addition to the delusion of substitution. The focus in the literature has always been on her eponymous delusion, ignoring the rest of her condition. However, studying the substitution delusion in isolation from the rest of her illness has led to inadequate conclusions. It is necessary to understand the delusion within the broad context of her illness. Toward that goal, her mental illness is described here in detail. A particular pattern of delusions and illness is identified. This same pattern is noted in other cases of Capgras in the literature. Three new cases are reported here, each with the same overall pattern of illness that Mme M. had. This pattern is labeled the Syndrome of Capgras. A hypothesis is offered to explain the Capgras delusion within the context of this illness.

Understanding schizophrenia: a guide for newly qualified community nurses

Schizophrenia is a complex and severe mental illness affecting 1% of the UK's population. For those affected, interaction with a mental health educated community nurse may prove invaluable in terms of increasing the chance of an early diagnosis and preventing future relapse. NICE guidelines issued in 2002 support this theory, giving recommendations such as getting help early for those suffering and making sure that the community mental health teams work in partnership with patients and carers. The guidelines also advocate the use of atypical antipsychotics for the treatment of schizophrenia, which are available as both oral medication and long-acting injectable preparations. The use of psychosocial interventions has developed alongside medication: discussion of symptoms with a community nurse can be beneficial in identifying early signs of relapse. This information can then be fed back to the wider community mental health team. Considering that 25-40% of long-term mentally ill people refuse specialist care, combined care between mental health specialists and community nurses ensures that individuals are seen more regularly, enhancing the quality of care that they receive. Treating this condition within the community for a group of nurses with little or no experience poses professional challenges. This article is intended to inform and explain in more detail how treatment can be delivered by a broader group of individuals.

Presentation of eating disorders in the news media: What are the implications for patient diagnosis and treatment?

Objective Eating disorder (ED) specialists increasingly see anorexia nervosa and bulimia nervosa as complex mental illnesses with both genetic and social roots. The public, however, tends to view EDs more simply as a manifestation of personal or social problems among female, white, young women. This disconnect potentially prevents timely ED diagnosis and reinforces a stigma that limits treatment availability. We examine the presentation of EDs in daily newspapers, an important contributor to shaping public perception of EDs. Methods We analyze 1 year of coverage about EDs by seven daily U.S. newspapers (252 articles), focusing on the messages conveyed about epidemiology, etiology, severity and treatment. Results The highest proportion of articles about EDs (48%) ran in arts and entertainment sections. Articles primarily covered those who are female, young and white, and mentioned mainly environmental causal factors. Only 8% of patient profiles discussed treatment and recovery within a medical context. Conclusion News coverage rarely presents EDs as complex medical phenomena, but rather simplifies and sensationalizes these conditions. Practice Implications Educators would benefit from recognizing the news media's role in shaping public perceptions of EDs in ways that differ from clinical perspectives, potentially limiting diagnosis and treatment. Three communication improvements are suggested.

Medical Comorbidity in Schizophrenia

To the Editor: We read with interest the article by Carney et al.1 on the association of schizophrenia with other medical illnesses. In reality, the migration of psychiatric patients into general Internal Medicine practice has been progressively increasing since the deinstitutionalization of the severely mentally ill over 40 years ago. At Denver Health, a large vertically integrated public safety net hospital system, we responded to this phenomenon almost 10 years ago by establishing clinics within our Internal Medicine practices, specifically geared to caring for the complex medical comorbidities of severely mentally ill patients.2,3 A key component to our clinics is having 1 provider with interest in the population who can bridge communication with mental health providers and facilitate care coordination. This initiative was also spawned because we often treated these patients when their disease process had advanced beyond when it should have been treated. These patients are often reticent to seek timely medical care caused by their inherent paranoia, the stigma they have perceived when seeking care previously, and as the editorial on Carney’s article points out, “for patients with schizophrenia, negotiating a separate complex, medical health care system can be challenging...”4 Although there is an increasing need for General Internists to became more familiar with prescribing psychiatric medication, as services for mental health patients continue to shrink,5 this perhaps should be limited to the care of the less complex mental health patient who also has medical comorbidities. However, for those patients with severe and persistent complex mental illness, our model of designating some Internists, with a special interest in these patients and clinic times solely for the care of these patients, may ultimately be the most efficient and tenable manner to attend to their mental health and medical needs. This in turn may avert the impediments that challenge the health of these patients and minimize the impact on health care systems, which by default must provide the care. Philip S. Mehler, MD, Denver Health Medical Center, 660 Bannock Street, MC 0278, Denver, CO 80204, USA; (e-mail: David.bekelman@UCHSC.edu);Cynthia K. Crews, MD, Thomas Mackenzie, MD,Department of General Internal Medicine, Denver Health Medical Center, Denver, CO, USA.

Unravelling the genome: a review of molecular genetic research in schizophrenia

Schizophrenia is a common and complex mental illness that affects approximately 1% of the population worldwide. Despite intensive research over the years, the aetiology and pathogenesis of schizophrenia is poorly understood. However, it has long been recognised that schizophrenia is highly familial suggesting a possible genetic aetiology. To review recent molecular genetic research in schizophrenia. Medline and Embase search. Over the past decade, with the completion of the Human Genome Project, molecular genetic research has now identified a number of genes that are very likely to predispose to schizophrenia. This article discusses the methodologies that have been used to identify schizophrenia susceptibility genes and provides a review of recently identified genes thought to play a role in the pathogenesis of this illness.

An Introductory Clinical Core Course in Psychiatric Management: An Innovative Lifespan Course Blending All Nurse Practitioner Majors

The prevalence of anxiety, depression, substance abuse, and suicidal ideation is significant in primary care settings across the country. Nonpsychiatric nurse practitioners must be able to recognize symptoms of common psychiatric disorders, know how to treat less complex mental illnesses, and know when to refer to psychiatric mental health nurse practitioners (PMHNPs). This article describes the course content, assignments, and teaching strategies used in a clinical core course in the nurse practitioner (NP) curriculum that is required for all NP majors at the University of Texas at Arlington. Psychiatric Management for Advanced Practice provides the foundation for later PMHNP major specific clinical courses. Development of the course content was based on NONPF Domains and Competencies for the NP, input from graduate NP faculty using a modified Delphi approach, NP student feedback, review of curriculum from other schools, and review of the literature on depression, suicide, anxiety, and substance abuse disorders in primary care settings. Since 1999, students from the eight different NP programs at the University of Texas at Arlington have been required to take this course. Student, faculty, and graduate feedback about this course have been consistently positive. Many NP students comment on feeling much more comfortable assessing for depression, suicide, and substance use.

Bipolar disorder: historic perspective, current pharmacologic treatment options and a review of quetiapine

Bipolar disorder is a complex mental illness that is frequently both under-diagnosed and under-treated. The symptoms of bipolar disorder can be confused with other medical illnesses or drug effects or may even be overlooked entirely as extreme character traits. The consequences of delayed diagnosis or misdiagnosis are potentially devastating, including loss of employment, impaired relationships and a severely impaired quality of life. This article will review the historic perspectives of bipolar disorder, the diagnostic criteria for the phases of the illness, and the pharmacologic options available to treat this condition. Quetiapine, an atypical antipsychotic, will be reviewed indepth. Based on extensive trial data, reviewed in this article, quetiapine is approved by the US Food and Drug Administration for use as monotherapy or as adjunctive therapy with other mood stabilizers for the treatment of acute manic episodes of bipolar I disorder. Clinical trials describing the efficacy of quetiapine in other phases of bipolar disorder and in other patient populations are also reviewed. A discussion of the drug profile of quetiapine includes its chemistry, availability, pharmacodynamics, pharmacokinetics and metabolism. Preclinical studies, postmarketing surveillance, safety, tolerability and regulatory issues are also evaluated. Finally, potential future directions for quetiapine are discussed, together with a review of key issues in bipolar disorder management and details of the information resources used in preparing this article.

Animals Can Model Psychiatric Symptoms

Animals Can Model Psychiatric Symptoms

Economic grand rounds: Prevalence and cost of treating mental disorders among elderly recipients of Medicare services.

Economic grand rounds: Prevalence and cost of treating mental disorders among elderly recipients of Medicare services.