Diagnosis Of Organic Disorder Research Articles

Characteristics of older patients in the largest French psychiatric emergency centre.

Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.

To substantiate the functional diagnosis of organic mental disorder in forensic psychiatric practice

The vegetative reactions using functional tests (correlation rhythmography and electronic conduction) were studied in 165 inpatient men with organic brain lesions during forensic and psychiatric examination. These methods can be used in expert practice

Case Report: Organic Hallucinosis in Viral Encephalitis

Introduction : Organic mental disorders are diseases we need to put more attentionon because they are related to systemic disorders or disorders of the brain and cancause high mortality. Organic mental disorders often manifest in the form ofpsychiatric symptoms so that they can be treated too late because the physician isnot able to recognize the symptoms which can be fatal. Sequelae can be found inorganic mental disorders and may affect the patient’s quality of life, so a fast andproper management is needed to get a better outcome. Case presentation: A caseof organic hallucinosis in viral encephalitis had been reported in a 18 year-old malewith a history of sudden changes in behaviour. The symptoms appeared after thepatient had problems during OSPEK and was threatened by someone. The patientwas the only child in the family and often spoiled by his parents. Laboratory andimaging studies showed that there was a cerebritis in the CT scan result, a decreasein CD4 count, and an increase in anti-Rubella IgG titers in which the patient wasfinally diagnosed with viral encephalitis. Conclusion: The diagnosis of organicmental disorders can easily be overlooked in daily clinical practice so that patientsdo not receive proper management

Predictors of physical activity recording in routine mental healthcare

Physical activity (PA) is beneficial for those with mental illness. However, it is unclear what influences clinicians’ decisions to record PA. We conducted the first study to examine PA recording and its predictors in clinical settings, using data from routine mental health records in a secondary mental health service.A retrospective study using anonymised electronic health record data was conducted. Patients with any psychiatric diagnosis who had PA recorded were matched to controls (1:5) who were active in hospital at that time and did not have PA recorded. Multivariable logistic regressions were conducted to examine how sociodemographic factors and health status predict PA recording.5034 patients (839 with PA recorded and 4195 matched controls) with mental disorders were included in the analysis [mean (SD) age = 44 (17) years; 50.0% males]. Being hospitalized in the past year (OR = 8.9; 95%CI = 6.8–11.54) and having hallucinations (OR = 1.75; 95%CI = 1.37–2.24) were significantly associated with higher odds for PA recording. Mental disorder diagnosis of organic mental disorders, neurotic/stress-related disorders and disorders of psychological development were significantly associated with lower odds of PA recording.These results highlight which patients were more likely to have PA recorded. These findings can be used to advocate for more training and resources in mental health care around PA counselling and recording.

Misidentification of mental health symptoms in presence of organic diseases and delirium during psychiatric liaison consulting

Objective: To identify predictors of misidentification of organic mental disorders and delirium in patients undergoing psychiatric liaison consultation.Methods: Data were collected at Santa Casa de São Paulo between July of 2009 and March of 2013. We included in our analysis all inpatients for whom the requesting service judged that a psychiatric consultation was required for a possible mental health condition. Outcomes of interest were the instances of misidentification where a condition was initially deemed to be of a psychiatric nature, whereas the final diagnosis by the liaison psychiatric team was of an organic disease or delirium. Our predictors were the clinical specialty of the requesting service, requester and patient characteristics. A series of generalised linear models were used to evaluate misidentification risks.Results: A total of 947 subjects met our inclusion criteria, 14.6% having a final liaison diagnosis of organic mental disorder and 8.1% of delirium. Older patients were significantly associated with increased risk of misidentification for both organic conditions (OR 3.01 – 95% CI 2.01, 4.5) and delirium (OR 3.92 – 2.4, 6.39).Conclusions: Educational interventions in general hospitals focused on preventing psychiatric misdiagnosis should target in-hospital services where patients tend to be older.

A study of psychiatric referrals for fitness for work.

Background:There are very few Indian studies regarding the psychiatric evaluation of state government workers referred for psychiatric fitness for work.Aim:This study aimed to examine the reasons for referral, psychiatric diagnosis, and outcome of psychiatric referrals for fitness for work at a tertiary-level referral government hospital.Materials and Methods:The study evaluated consecutive psychiatric referrals at a tertiary-level referral government hospital with their informed consent utilizing a specially prepared pro forma, Kuppuswamy's Socioeconomic Status Scale and the Mini International Neuropsychiatric Interview plus. Psychiatric diagnoses were based on the International Classification of Diseases 10th Edition Diagnostic Criteria for Research.Results:The study included 67 male and 8 female psychiatric referrals with a mean age of 39.5 years. Most of the psychiatric referrals were married (82.6%), Hindu by religion (97.3%), from urban areas (80%), belonged to upper middle class (46.7%), and had rotating shifts or emergency duties (50%). Psychiatric referrals were usually made for a single reason (57%), most commonly absenteeism (84%) followed by undisciplined behavior (38%). A past history of disciplinary action taken against them was given by 56% of the referrals. The most common psychiatric diagnosis was psychoactive substance-use disorder (21.3%) followed by psychotic disorders (20%) and mood disorders (14.7%). No psychopathology was detected in 18.7% of the referrals. Most of the psychiatric referrals (68%) were fit for work, though 22.67% were declared unfit for work (permanent invalidation). Psychiatric referrals with multiple reasons for referrals, longer duration of psychiatric illness (>5 years), and diagnosis of organic mental disorder or psychotic disorder received invalidation (permanent unfitness) on psychiatric grounds.Conclusions:Psychiatric referral for fitness for work is most commonly for absenteeism. The most common psychiatric diagnosis was substance-use disorder followed by psychoses. The majority (68%) were found fit for work after treatment though 22.6% required invalidment from service.

EPA-1568 - Genital mutilations in psychotic patients: two case reports

The first patient was a 23 years old male and brought by his brother to our psychiatry hospital from urology clinic after the first aid due to removing his right testicles with a knife without any anaesthetic drog. The patient inserted three cherry seeds inside the injury and sewed up the injury and then he ate the removed testicle piece. He vomitted the eaten material when his brother saw what was happening. His life history revealed that the psychiatric disorder began insidiously in his late adolescence, he had taken no treatment up to then, and stayed in prison for three years due to injuring his chief with a knife due to persecutive delusions because his chief was giving harm to him. At admission to our hospital he was diagnosed paranoid schizophrenia. Second case is a 43 year old man, admitted to our hospital with symptoms of anxiety and depression. He had mutilated his penis due to auditory hallusinations and made a fire in his house and brought to emergency with comatous state. Transfusion was necessary for severe blood loss. After discharge from psychiatric hospital he continued drink alcohol heavily. He killed his wife due to auditory hallusinations. He was treated with diagnosis of organic mental disorder due to alcohol abuse. Genital mutilations are usually presented as case reports and seen rarely in young male patients and occur either in psychotic patients especially among schizophrenics or in individuals with impaired ego wholeness as an implication of lower self esteem or guilty feelings.

Оценка риска агрессивного поведения у психически больных женщин с криминальным анамнезом

We present the results of study of illegal actions predictors in individuals with mental disorders and discuss the specific features of female criminality. On a sample of 69 patients with a diagnosis of organic mental disorder and schizophrenia, with criminal histories, we applied clinical and psychological hermeneutic analysis, used questionnaires to determine the self-assessments of patients, self-control diagnosis, self-regulation style features, diagnosis of aggression and hostility, coping strategies, destructive attitudes in interpersonal relationships. It made possible to identify clinical, social and pathopsychological factors of aggressive behavior in forensic patients. These individual psychological characteristics of mentally ill women will improve the prognosis of their aggressive behavior, implement differentiated preventive measures in the hospital and to establish appropriate intervention programs.

A gestação eterna: um caso de patogenia da função materna

This article reports the case of W., a young man affected by AIDS, prejudice, by sexual abuse and mental illness. W. presents visual and auditory hallucinations after receiving a diagnosis of AIDS and is treated using antipsychotics after receiving a diagnosis of Organic Mental Disorder with Psychotic Symptoms and then with anti-depressants after a change in diagnosis for Organic Depressive Disorder. This case shows how it is possible, using transference, to achieve effective therapeutic effects that do not need to be attributed to any medication. The fact that stabilizing effects have been obtained in this case does not necessarily means that the patient is not psychotic, but that it was possible to intervene in the position he occupied in relation to the Other, and in particular with his mother. She stands out in the family and reveals itself along the course of the case, as an important factor that nurtured his conflicts and symptoms. Thus, W. exaggerates, gestures, lures, almost begging for an intervention to save him, as he says, your body and your mind, from the shackles of an eternal pregnancy.

A Cross-sectional Descriptive Study of Prevalence and Nature of Psychiatric Referrals from Intensive Care Units in a Multispecialty Hospital

Context:The prevalence of psychiatric comorbidity in general hospital range from 20% to 60%. Presence of psychiatric morbidity compounds the disability and suffering in medical patients. There is a limited literature on the prevalence of psychiatric morbidity in patients admitted in the intensive care units (ICUs).Aims:The aim of the study was to estimate the prevalence and nature of comorbid psychiatric illness in the cases referred from ICUs.Settings and Design:Cross-sectional observational study.Materials and Methods:This study included all the consecutive patients referred from different ICUs to psychiatry department for consultation during the four-year period from January 1, 2000 to December 31, 2003, assessment was done by psychiatrist and diagnosis was made using ICD-10.Statistical Analysis:Descriptive statistics.Results:There were 309 (1.97%) referrals from ICUs to psychiatry department during the period of study. Among the referred patients, diagnosis of organic mental disorders was the commonest psychiatric diagnosis present in 104 (33.65%) patients followed by suicidal attempt in 101 (32.69%); anxiety disorders in 40 (12.94%); depressive disorders in 21 (6.8%); Psychotic illness in 10 (3.24%); other psychiatric illnesses in 28 (9.06%); and nil psychiatric illness in 5 (1.62%) patients.Conclusion:Prevalence of psychiatric referrals from ICUs was low. This could be due to stigma and lack of awareness among physicians. There is increased need for recognition and treatment of comorbid psychiatric illness by the treating physicians which may help to decrease morbidity and overall cost of the treatment.

Psychotropic drug prescription in a psychiatric university hospital in Germany

A retrospective survey on drug prescription over a 5-year period (1998 to 2003) in 1540 inpatients in a psychiatric university hospital in Germany was carried out. The aim was to establish a basis for a monitoring of prescription habits and for pharmacoeconomic considerations. It was established that there was only a slight increase in polyvalent drug use between 1998 and 2003. The results are presented in more detail in relation to the diagnosis of organic mental disorders, drug abuse disorders, schizophrenia, mood disorders and personality disorders. Newer atypical antipsychotics, SSRIs and mood stabilizers were increased across diagnoses while lithium and clozapine were prescribed less frequently. The rare occurrence of monotherapy in general might reflect a common trend in psychiatry fostering polydrug use. Studies of this type are biased by the fact that local habits of prescription do not allow generalisation of the findings. Such surveys should be carried out more frequently and simultaneously in different centers. Critical comparisons could help to optimize treatment.

Patients who benefit from psychiatric admission in the general hospital

Psychiatric hospitalization though burdensome remains a very important therapeutic option for severely-ill psychiatric patients. Hospitalization in general hospital psychiatry units (GHPU) are often regarded as the best option. A study was carried out with the purpose of assessing socioeconomic and medical variables associated with success and failure of hospitalization. A review was performed on sociodemographics and medical data of 1,463 patients admitted to a general hospital's GHPU in the period between 1986 and 1997. Statistical analysis was conducted using univariate and multivariate polythomic logistic regression. In the multivariate analysis three factors were identified as associated to poor hospitalization outcomes (poor condition at discharge and longer hospital stay): age >60 years, poor social functioning, and diagnosis of organic mental disorder. Although 80% of the patients experienced a considerable symptomatic improvement, a small group benefited less from hospitalization. It is suggestive that these patients would benefit more from psychosocial interventions.

The use of Sections 2 and 3 of the Mental Health Act (1983) with older people: A prospective study

The use of the UK Mental Health Act (MHA) is under scrutiny with older people, especially in those with dementia and other organic mental disorder. Whilst research into use of the MHA with this group has been sparse, the small body of existing research suggests that the MHA is applied differently to older adults (i.e. those over 65 years). This multi-centre study identified all MHA assessments conducted over a prospective three-month period, and obtained detailed data on the circumstances behind assessment. The findings highlighted that older people assessed under the MHA tend to exhibit different behaviour patterns, circumstances and core characteristics to those under 65; older people were more likely to be detained because of self neglect and physical illness and also more often had a diagnosis of an organic mental disorder. Younger people were unlikely to have a diagnosis of organic mental disorder and were more likely to be judged as a risk to other people. Risk of suicide was particularly highlighted with the under 65 age group. Implications for legislative reform are discussed.

Evaluations of competency of patients with organic mental disorder.

The authors retrospectively reviewed the charts of all patients (N = 903) seen by the Psychiatric Consultation Service from January 1, 1989 through December 31, 1991. A total of 74 patients had a diagnosis of organic mental disorders (delirium, dementia, or both). Of these, 32 patients were evaluated for competency (Study group), while the remaining 42 were evaluated for reasons other than competency (Comparison group). Patients in the Study group were more likely to be African American and less likely to be prescribed psychotropic drugs than the Comparison group. The majority of patients with organic mental disorder (87.5%) evaluated for competency were judged to be incompetent.

EVALUATIONS OF COMPETENCY OF PATIENTS WITH ORGANIC MENTAL DISORDER

The authors retrospectively reviewed the charts of all patients (N = 903) seen by the Psychiatric Consultation Service from January 1, 1989 through December 31, 1991. A total of 74 patients had a diagnosis of organic mental disorders (delirium, dementia, or both). Of these, 32 patients were evaluated for competency (Study group), while the remaining 42 were evaluated for reasons other than competency (Comparison group). Patients in the Study group were more likely to be African American and less likely to be prescribed psychotropic drugs than the Comparison group. The majority of patients with organic mental disorder (87.5%) evaluated for competency were judged to be incompetent.

Psychiatric consultations in obstetric inpatients.

The purpose of this study was to investigate the psychiatric consultation condition in the obstetric ward with particular attention paid to the reasons for referral, psychiatric diagnoses and recommendations. This study was conducted in a medical center with 73 obstetric beds. All psychiatric consultations of obstetric inpatients during a 3-year period were included in this study. Data were derived from clinical charts and consultation records that included demographic data, reasons for referral, psychiatric diagnoses and treatment recommendations. Within the 3-year period, 28 patients were referred for psychiatric consultation, or 0.3% of the 9,972 obstetric admissions. The obstetric group represented 0.7% of all the psychiatric consultations. The most common reason for the referral was anxiety. Many obstetric problems, medical histories and psychiatric histories were found in these 28 patients. The most common diagnoses were depression or dysthymia, and schizophrenia. The diagnosis of organic mental disorders was rarely found. The vast majority of the psychiatric consultants were likely to recommend medication and psychological intervention. Even though there is a low psychiatric consultation rate among the obstetric inpatients, it does not mean that the prevalence rate of mental disorders is low in the obstetric patients. Psychiatric problems may be neglected or happen after patients are discharged. Organic mental disorders were rarely found in the obstetric patients which suggested a different pattern of mental disorders in the obstetric patients compared to other patients. The stress during child delivery needs further study for it may exacerbate or predispose a mental disorder. It is suggested that collaboration between obstetric staff and the consultation-liaison psychiatrists may provide better care for pregnant women patients.

Factors related to emergency commitment of chronic mentally ill patients who are substance abusers.

A total of 247 chronic mentally ill patients committed for emergency involuntary hospitalization in a public intensive treatment unit were grouped on the basis of positive or negative urine toxicology screens for psychoactive substances at admission. Patients whose screens were positive for substance abuse were more likely to live alone or to be homeless, to be committed for making threats, and to have a diagnosis of organic mental disorder or substance abuse disorder. Patients who screened negative were more likely to live in a supervised setting, to be committed for actions such as assaults and suicidal behavior, and to have a diagnosis of schizophrenia or other psychotic disorder.

Quantifying Undiagnosed Organic Mental Disorder in Geriatric Inpatients

Organic mental disorder often goes undetected in geriatric patients who have coexisting psychiatric symptoms. To determine the prevalence of organic mental disorders in geriatric patients admitted to a large metropolitan psychiatric inpatient service, charts for 95 patients over the age of 60 were reviewed, and diagnoses at admission and discharge were compared. Despite the facility's admission policy of excluding patients with only organic mental disorder, 32 patients required evaluation for organic mental disorder during hospitalization, and on reevaluation 15 patients received a primary diagnosis of organic mental disorder. The author discusses the mental health care and fiscal considerations of accurately assessing geriatric patients, especially in the context of the new federal regulations prohibiting most nursing home admissions for mentally ill patients.

AIDS patients compared with others seen in psychiatric consultation

To identify similarities and differences between AIDS patients and non-AIDS patients, all psychiatric consultations done in one year in a large voluntary general hospital were reviewed. A total of 93 consultations were done on 67 AIDS patients and 138 consultations were done on 121 comparably aged patients without AIDS. The most common AIDS risk factor was intravenous drug use. The AIDS patients were more likely to be Hispanic and male than were the non-AIDS patients. The AIDS group was also more likely to have a diagnosis of organic mental disorder, particularly dementia. There were no other differences in Axis I diagnoses, including depression, substance abuse, and adjustment disorder. Suicidal risk was no greater in the AIDS patients than in the non-AIDS patients. Axis II diagnoses were made more often in the non-AIDS patients, who also required more one-to-one nursing supervision. Consultation in AIDS patients took more staff time, and AIDS patients were more likely to have required one or more repeat consultations within the period of the study, thus creating a heavier burden on consultation staff. Although these predominantly heterosexual, Hispanic, and drug-using hospitalized AIDS patients do not show significantly higher rates of psychiatric morbidity than other, non-AIDS patients, except for more organic mental disorders, AIDS seems to create a much higher demand for psychiatric consultation services.

Five years of experience with the DSM-III system in clinical work and research: some concluding remarks.

The reliability of the DSM-III is superior to other classification systems available in psychiatry. However, reliability depends on proper knowledge of the system. Some pitfalls reducing reliability of axis 1 diagnosis which commonly are overlooked are discussed. Secondly, some problems of validity of axis 1 and 2 are considered. This is done by discussing the differential diagnosis of organic mental disorders and other psychiatric disorders with concomittant physical dysfunction, and the diagnoses of post-traumatic stress disorders and adjustment disorders among others. The emphasis on health care seeking behaviour as a diagnostic criteria in the DSM-III system, may cause a social, racial and sexual bias in DSM-III diagnoses. The present discussion of the DSM-III system from a clinical point of view indicates the need for validation studies based on clinical experience with the DSM-III. These studies should include more out-patients and patients with psychopathology who do not seek psychiatric treatment. Such studies must also apply alternative diagnostic standards like the ICD-9 and not only rely on structured psychiatric interviews constructed for DSM-III diagnoses. The discussion of axis 4 points to the problem of wanting to combine reliable rating with clinically meaningful information. It is concluded that the most important issue to be settled regarding axis 4 in the future revisions is the aim of including this axis. The discussion of axis 5 concludes that axis 5 is biased toward poor functioning and thus may be less usefull when applied on patients seen outside hospitals. Despite these problems of the DSM-III, our experiences indicate that the use of the DSM-III is fruitful both for the patient, the clinician and the researcher. Thus, the cost of time and effort needed to learn to use the DSM-III properly are small compared to the benefits achieved by using the system.