Disease In Psychiatric Patients Research Articles

The Evolving Standard of Care for Autoimmune Neuropsychiatric Illness.

In recent decades, there has been increasing biomedical and public understanding of the role of autoimmunity in neuropsychiatric illness. Popular media have highlighted patients with psychiatric illnesses who were eventually diagnosed with autoimmune neuropsychiatric illnesses such as anti- N-methyl-D-aspartate receptor encephalitis. Coverage of these cases has often drawn attention to the effects of misdiagnosis or delayed diagnosis of such diseases in psychiatric patients. Autoimmune encephalitis can have varied presentations and often involves evaluation and management from multiple medical specialties. As a result, there remains considerable uncertainty regarding how courts might gauge the legal standard of care with regard to psychiatric workup of new-onset psychiatric symptoms, and the degree to which autoimmune encephalitis must be considered. In this article we provide a brief overview of autoimmune encephalitis and autoimmune psychosis, including current diagnostic approaches to these conditions. We review case law regarding the standard of care for psychiatric disorders caused by general medical conditions. Finally, we provide a medicolegal perspective on the responsibilities of psychiatrists and other mental health professionals in the evaluation of possible autoimmune encephalitis.

Atypical antipsychotics olanzapine and clozapine increase bone loss in female rats with experimental periodontitis.

Periodontitis is a highly prevalent disease in psychiatric patients, including those undergoing symptomatic treatment with second-generation antipsychotics. Some of these drugs, such as clozapine (CLO) and olanzapine (OLA), have prominent metabolic effects such as weight gain, hyperglycemia, and dyslipidemia, which are risk factors for periodontitis. In addition to the metabolic effects, there are reports of changes in salivary flow, gingival bleeding, and caries. In this context, we aimed to evaluate if the metabolic effects of OLA and CLO alter periodontal parameters in an animal model of periodontitis without the environmental and psychosocial biases inherent to human diseases. In the first set of experiments, male and female adult Wistar rats received oral administration of CLO, OLA, or vehicle for 45 days. They were evaluated for body mass composition and weight gain, blood glucose parameters (fasting and glucose tolerance and insulin resistance tests), and lipid profile (HDL, total cholesterol, and triglycerides). In a second set of experiments, the same measurements were performed in female rats exposed to the antipsychotics for 45 days and ligature-induced periodontitis on the 30th day of treatment. Macroscopic measurements of exposed roots, microtomography in the furcation region of the first molar, and histological evaluation of the region between the first and second molars were evaluated to assess bone loss. Additionally, gingival measurements of myeloperoxidase activity and pro-inflammatory cytokine TNF-α were made. Only females exposed to OLA had more significant weight gain than controls. They also exhibited differences in glucose metabolism. Ligature-induced periodontitis produced intense bone retraction without changing the density of the remaining structures. The bone loss was even higher in rats with periodontitis treated with OLA or CLO and was accompanied by a local increase in TNF-α caused by CLO. These animals, however, did not exhibit the same metabolic impairments observed for animals without periodontitis. The use of clozapine and olanzapine may be a risk factor for periodontal disease, independent of systemic metabolic alterations.

Predicting Cardiovascular Disease in Psychiatric Patients: Machine Learning with Electronic Health Records

IntroductionCardiovascular disease (CVD) causes staggering losses in quality adjusted life years worldwide.1 Among patients in the Danish psychiatric hospital setting, heart disease is associated with a decrease in life expectancy of 5.1 years.2 The causes underlying this association are likely manifold. For example, severe mental illness is associated with unhealthy lifestyle.3 Furthermore, psychiatrists may focus predominantly on the treatment of mental illness and have less emphasis on detection and prevention of physical illness.4 If patients at elevated risk of CVD are pointed out automatically, this may lead to better preventive medicine.ObjectivesTo predict which patients develop cardiovascular disease using machine learning.MethodsWe obtained data on all psychiatric hospital contacts in the Central Denmark Region since the initiation of the current EHR system (MidtEPJ). These span from 2011 to 2021 and cover 120,000 patients, of which 3,000 patients developed severe CVD (stroke or coronary event) follow-up. We will train a variety of models (random forests, SVM, deep neural nets) to predict CVD within one year from a planned contact to hospital.ResultsThe modelling is currently underway, intermediary results are expected in January.ConclusionsWe explore whether predicting CVD is feasible using state-of-the-art technologies and a uniquely detailed dataset. This may pave the way for machine learning to act as a clinical support decision system, since we’re only training on data that is available in a live, clinical context.References1: Khan 20192: Erlangsen 20173: Scott 20114: Fagiolini 2009DisclosureNo significant relationships.

Insomnia disorders are associated with increased cardiometabolic disturbances and death risks from cardiovascular diseases in psychiatric patients treated with weight-gain-inducing psychotropic drugs: results from a Swiss cohort

Study objectivesInsomnia disorders as well as cardiometabolic disorders are highly prevalent in the psychiatric population compared to the general population. We aimed to investigate their association and evolution over time in a Swiss psychiatric cohort.MethodsData for 2861 patients (8954 observations) were obtained from two prospective cohorts (PsyMetab and PsyClin) with metabolic parameters monitored routinely during psychotropic treatment. Insomnia disorders were based on the presence of ICD-10 “F51.0" diagnosis (non-organic insomnia), the prescription of sedatives before bedtime or the discharge letter. Metabolic syndrome was defined using the International Diabetes Federation definition, while the 10-year risk of cardiovascular event or death was assessed using the Framingham Risk Score and the Systematic Coronary Risk Estimation, respectively.ResultsInsomnia disorders were observed in 30% of the cohort, who were older, predominantly female, used more psychotropic drugs carrying risk of high weight gain (olanzapine, clozapine, valproate) and were more prone to suffer from schizoaffective or bipolar disorders. Multivariate analyses showed that patients with high body mass index (OR = 2.02, 95%CI [1.51–2.72] for each ten-kg/m2 increase), central obesity (OR = 2.20, [1.63–2.96]), hypertension (OR = 1.86, [1.23–2.81]), hyperglycemia (OR = 3.70, [2.16–6.33]), high density lipoprotein hypocholesterolemia in women (OR = 1.51, [1.17–1.95]), metabolic syndrome (OR = 1.84, [1.16–2.92]) and higher 10-year risk of death from cardiovascular diseases (OR = 1.34, [1.17–1.53]) were more likely to have insomnia disorders. Time and insomnia disorders were associated with a deterioration of cardiometabolic parameters.ConclusionsInsomnia disorders are significantly associated with metabolic worsening and risk of death from cardiovascular diseases in psychiatric patients.

Comorbidity of somatic diseases in psychiatric patients

To study the prevalence of somatic diseases in patients with mental disorders based on the results of medical examination in Moscow mental health clinics in 2018. A retrospective analysis of the results of the clinical examinations of 6492 outpatients, which accounted for 79.5% of patients who underwent medical examination in this time period. Comorbid somatic diseases were found in 4883 (75%) patients. Hypertension and non-insulin-dependent diabetes mellitus were most frequent with the prevalence higher than in the general population of the Russian Federation. Patients with diagnosed schizophrenia, along with hypertension and diabetes mellitus, have found to be at increased risk of diseases of the endocrine system and metabolic disorders. The incidence of the mentioned diseases is not higher than that reported in literature. The higher prevalence of socially relevant diseases (hypertension, diabetes mellitus) among patients with mental disorders demands the development of strategies for prevention, early detection and treatment of these diseases in psychiatric patients.

The somatic care situation of people with mental illness.

Background and AimsPeople with mental illness have worse physical health and reduced life expectancy compared to the general population. Nevertheless, their medical care is often insufficient. The present study aimed to investigate the somatic status of people with mental illness with a focus on somatic diagnoses, metabolic risk factors, regular somatic care, and routine check‐ups.MethodsThis study used a 14‐item questionnaire to survey the somatic care situation of psychiatric university hospital patients. Main survey topics were psychiatric and somatic diagnoses, metabolic risk factors, regular somatic care, and routine check‐ups.ResultsFour‐hundred and thirty‐five people with mental illness (48.3% male, mean age 45.4 years) were included. More than three quarters of the participating people with mental illness had access to a general practitioner. People with affective and anxiety disorders reported significantly more contact with medical specialists for somatic diseases, but schizophrenic patients did not receive enough care. Not all people with mental illness and on psychiatric medication received regular somatic care. Somatic diseases increased with number of diagnoses, and the duration of the psychiatric illness was positively correlated with treatment motivation.ConclusionThe observed unmet medical needs in this study might reflect the lack of treatment motivation in people with mental illness, but could also represent their obstacles to access care as well as a suboptimal communication between the treating psychiatrist and the referring general practitioner. Increasing awareness of somatic diseases in psychiatric patients and easier access to somatic care have to be implemented in psychiatric clinical routine. The risk of stigmatization in somatic institutions and the lack of self‐care management in people with mental illness are complicating factors.

A study of dermatological disorders with primary psychiatric illness from South India

<p><strong>Background:</strong> Dermatological disorders are frequent among patients with psychiatric illness. The interaction between skin and mind is complex. Pre-existing skin diseases may be modified in psychiatric illness due to self induced changes which may delay the diagnosis and treatment of skin diseases and result in complications. There are only few published studies about skin diseases in psychiatric patients from south India. We are undertaking this study to highlight the importance of dermatology consultation in psychiatric patients.</p><p><strong>Methods:</strong> 200 patients with primary psychiatric disorders who accepted for the study were subjected to history taking and general examination. Detailed dermatological examination was carried out by visual inspection and clinical examination.</p><p><strong>Results:</strong> Out of 200 patients, 65 were diagnosed with major depressive disorder, 42 patients were with bipolar disorder, 40 with schizophrenia, 30 with obsessive compulsion disorder, 23 with anxiety disorder. 153 (76.5%) patients had dermatological findings, in which 84 (55%) had infectious disease, 35 (22.9%) had parasitic infections, 26 (17%) had fungal infections, 15 (9.8%) had bacterial infections, 8 (5.23%) had viral infections. 56 (36.6%) had non-infectious skin findings, 22 (14.4%) had acne, 15 (9.8%) had pruritis, 12 (7.84%) had eczema, 5 (3.3%) had psoriasis and 2 (1.3%) had vitiligo. 13 (8.4%) patients had psychodermatological problems, 10 (6.53%) had neurotic excoriation, 2 (1.3%) had delusion of parasitosis and 1 (0.6%) had trichotillomania.</p><p><strong>Conclusions</strong>: This study implies that there is a definite association of dermatology and psychiatry.</p>

Dental Medicine and Psychiatry: The Need for Collaboration and Bridging the Professional Gap.

Dental health and mental health are strongly associated. Neglecting either of them can negatively influence on the other and induce many health and communication problems. Association between oral/dental health, self-esteem, quality of life and holistic health has been recognized for a long time. There has been increasing interest in dental health among patients with major mental disorders as well as in mental states and problems among patients with orodental disorders. Despite of huge progress in the field of dentistry psychiatric patients have had poor oral/dental health. Patients with major mental disorders have quite number of the risk factors for oral disease and consequently poorer dental health, but oral/dental problems and diseases are commonly overlooked or neglected. Bad or inappropriate dental care is related to the patients' amotivation, ignorance, fears, low economic status, stigmas and negative attitudes by the medical professionals. It is important to stress that dental diseases in psychiatric patients deserve the same attention as other comorbid somatic diseases. In this review we accentuate the need for more collaboration in order to bridge the professional gap between dentistry and psychiatry.

Psychiatry 2019: A study of dental diseases in psychiatric patients: Is there a relationship? - Ayman A Elhadad - Menoufia University

Psychiatry 2019: A study of dental diseases in psychiatric patients: Is there a relationship? - Ayman A Elhadad - Menoufia University

SU76 - INCREASED FREQUENCY OF RARE GENETIC DISEASE VARIANTS IN LARGE SCHIZOPHRENIA, BIPOLAR, AND DEPRESSION POPULATIONS

Background Genetic diseases are individually rare but collectively common. Many genetic conditions can mimic mental health disorders, with psychiatric symptoms that are difficult to treat with regular medications. Treatment of the underlying genetic disease can cure the associated psychiatric symptoms or help regular medications work better. Discovery of rare genetic diseases in psychiatric patients would reveal specific treatment options, and give information about the chances of other family members being affected. In this study, we test the hypothesis that psychiatric populations are enriched for pathogenic variants associated with selected treatable genetic disorders. Methods Using targeted exome sequencing, we screened 2,046 schizophrenia, bipolar and major depressive disorder patients for variants in genes associated with Niemann-Pick disease type C (NPC), Wilson Disease (WD), Homocystinuria (HOM), and Acute Intermittent Porphyria (AIP). Results Our study is the first to explore the prevalence of NPC, WD, HOM and AIP gene variants in well-defined psychiatric populations. We found carrier rates of 0.88%, 0.88% and 0.20% for NPC, WD and HOM, respectively. Furthermore, an AIP affected rate of 0.20% was observed across the entire psychiatric cohort, a 200X enrichment in comparison to what is expected in the general population. Discussion Discovering genetic diseases in psychiatric patients will shift how health care is delivered to these vulnerable patients by addressing underlying conditions rather than masking symptoms with medications and will especially help patients who don't respond to regular medications. This will lead to significant cost savings to the health care system.

Discrepancies between clinical and autopsy diagnosis of cause of death among psychiatric patients who died due to natural causes. A retrospective autopsy study

Background/Aim. Autopsy studies rarely investigate the causes of natural death in psychiatric population. The aim of this study was to examine the causes of death among the subjects with various psychiatric disorders in whom a clinical (pathoanatomical) autopsy was requested. Methods. The study group included 118 patients (65% men, 35% women, mean age 58.2 ? 13.6 years) with a psychiatric diagnosis, in whom a clinical autopsy was performed. We compared the distribution of causes of natural death among psychiatric patients and other patients, representatives of the general population who died of natural causes. We also analyzed the difference between clinical diagnoses of cause of death and the autopsy findings in psychiatric patients. Results. Psychiatric patients died earlier than the control group (58 vs. 69 years), usually due to the respiratory (46%) and cardiovascular diseases (37%). The most common diagnoses in psychiatric patients were organic psychoses and dementias (F00-F09) and schizophrenia and schizoaffective disorders (F20-F29). Majority of the patients (55%) died in general hospitals vs. specialized psychiatric hospitals (45%) due to somatic diseases. There was a significant difference in the distribution of causes of death compared to the control group in which the cardiovascular diseases dominated. Even in 64% of psychiatric patients there was a discrepancy between the clinical diagnosis of the cause of death and definite autopsy findings. Conclusion. The assessment of somatic diseases in psychiatric patients is insufficient, especially in specialized psychiatric hospitals. That leads to a significant discrepancy between clinical diagnosis of the cause of death and autopsy findings. Therefore, it is necessary to pay additional attention in diagnostics and treatment of somatic diseases in these patients to improve their health care.

Drug-induced toxic hepatitis associated with the combination of quetiapine and fluphenazine: A case report

Toxic hepatitis is an inflammation of the liver that occurs in response to various substances, such as alcohol, drugs and various chemicals. It may develop either within hours or days, or after several months or years of exposure to a toxic agent. Schizophrenia is a chronic and progressive disease with a high risk for the development of various somatic diseases. Previous studies have shown that all generations of antipsychotics can cause a variety of somatic disturbances, visible in laboratory parameters, which can lead to serious physical disorders. Therefore, during long-term treatment with antipsychotics we must pay attention to the impact of drugs on the development of certain physical disturbances. In our case, the long-term treatment of schizophrenia with quetiapine and fluphenazine led to the development of mild toxic hepatitis. Our goal was to pay attention to the risks of prescribing a combination of antipsychotics in order to prevent the development of physical disease in psychiatric patients.

Prevalence of Infectious Skin Diseases in Psychiatric Patients

Psychodermatology is an underappreciated field that studies psychocutaneous disorders, which are conditions that have both dermatologic and psychiatric characteristics. Underlying psychiatric comorbidity is estimated to occur in up to one-third of dermatologic patients, and psychiatric illness may either be the cause or the consequence of dermatologic disease. The present work aims to identify the type and frequency rate of infectious skin diseases among patients with psychiatric diseases. 500 patients with primary psychiatric disorders and 199 healthy controls from the Benha City, Qalyubia Governorate, Egypt were included in the study and were diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders (DMS V) Criteria. A specially designed questionnaire including socio-demographic data , dermatological and general medical examination was applied. The data were statistically analyzed. There was a significant statistical increase in the prevalence of infectious skin diseases in psychiatric patients compared with non-psychiatric patients. Health education of psychiatric patients and/or of their caregiver and periodic monthly inspection of psychiatric patients are highly indicated for the prevention and control of infectious skin diseases in these patients.

F195. ENRICHMENT OF PATHOGENIC VARIANTS ASSOCIATED WITH TREATABLE GENETIC DISEASES IN LARGE SCHIZOPHRENIA, BIPOLAR AND DEPRESSION COHORTS

BackgroundGenetic diseases are individually rare but collectively common. Many genetic conditions can mimic mental health disorders, with psychiatric symptoms that are difficult to treat with regular medications. Treatment of the underlying genetic disease can cure the associated psychiatric symptoms or help regular medications work better. Discovery of rare genetic diseases in psychiatric patients would reveal specific treatment options, and give information about the chances of other family members being affected. In this study, we test the hypothesis that psychiatric populations are enriched for pathogenic variants associated with selected treatable inborn errors of metabolism (IEMs).MethodsUsing targeted next-generation sequencing, we screened schizophrenia (n=1132), bipolar (n=719) and major depressive disorder (n=195) patients for variants in genes associated with Niemann-Pick disease type C (NPC), Wilson disease (WD), homocystinuria (HOM) and acute intermittent porphyria (AIP), and compared the frequency of known and predicted pathogenic variants found to 123 136 samples from the gnomAD consortium.ResultsOur study is the first to explore the prevalence of NPC, WD, HOM and AIP gene variants in well-defined psychiatric cohorts. Among 2046 cases (male, n=1106; female, n=940), carrier rates of 0·93%, 0·98% and 0·20% for NPC, WD and HOM were seen, respectively. The carrier rate for NPC was marginally enriched in the SCZ cohort (1·15%) compared to general (95% CI, 0·007 – 0·021; p=0·084) and comparison (95% CI, 1·967 – 5·272; p=5·16e-05) populations. AIP affected rate of 0·29% was observed across the entire psychiatric cohort relative to the general (95% CI, 0·001 – 0·006; p=3·47e-13) and comparison (95% CI, 1·572 – 10·044; p=0·012) populations, an almost 300x enrichment in comparison to what is expected in the general population.DiscussionAn enrichment of known and predicted pathogenic variants associated with NPC and AIP was found in the psychiatric cohort, especially in SCZ patients. The results of this proof-of-principle study support that rare genetic disease variants, such as those associated with treatable IEMs, may contribute to the pathogenesis and treatment responsiveness of psychiatric disorders. Discovering genetic diseases in psychiatric patients will shift how health care is delivered to these vulnerable patients by addressing underlying conditions rather than masking symptoms with medications, and has the potential to especially help patients who don’t respond to regular psychotropic medications. Further studies screening large psychiatric cohorts for pathogenic variants in a large panel of treatable IEM genes will reveal the full impact of such disorders for psychiatric patients.

A study of dental diseases in psychiatric patients: is there a relationship?

Background Oral health is an integral part of general health. There is evidence that patients suffering from mental illness are more vulnerable to dental neglect and poor oral health. Patients and methods All patients attended the dental clinic in the Abha Psychiatric Hospital from the inpatient departments or the out patient department (OPD) clinics for adult psychiatry, and child and adolescence psychiatry clinics are registered through the computer system and the data were collected for the Hijri year of 1437. Results Male patients were more in number compared with female patients (444 vs. 110). In addition, the age group between 25 and 45 years was more affected by dental problems than other groups. Also, the chronic psychiatric patients with a long stay at the psychiatric hospital were more affected than the newly admitted ones. Conclusion Better coordination between medical, dental, and psychiatric unit administration is required to serve the needs of this group of patients.

Associated infectious diseases in psychiatric patients who are hospitalized for long periods in a hospital in Braila

Background Adult patients with severe psychical diseases are hospitalized in a separate building (ward) for very long periods of time (years). This ward has 140 beds and belongs to the Psychiatric Hospital “Sf.Pantelimon” in Braila. Sometimes they live here for their entire life. In this situation they can develop several diseases, infectious and non-infectious, which need a special medical survey to prevent epidemics or complicated diseases.

Asenapine increases nitric oxide release and protects porcine coronary artery endothelial cells against peroxidation

Changes in endothelial function and peroxidation could play a significant role in the pathophysiology of cardiovascular disease in psychiatric patients. In particular, endothelial nitric oxide (NO) could either exert a beneficial or detrimental effect depending on the involvement of NO synthase (NOS) subtype. Therefore, we planned to examine the effects of asenapine on NO release and protection against oxidative stress in porcine coronary endothelial cells (CEC). The Griess system and Western blot were used for NO detection and to examine changes in protein activation and expression. In addition, cell oxidative/antioxidant status and mitochondrial membrane potential were measured by specific fluorescent dyes. Asenapine caused a concentration-dependent increase of NO production (p<0.05) by the involvement of cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA), phospholipase C (PLC), β2-adrenoceptor-related pathway, Akt, extracellular-signal-regulated kinases 1/2 (ERK1/2) and p38 mitogen-activated protein kinases (p38 MAPK). Furthermore, asenapine protected CEC against oxidative stress by preventing reactive oxygen species production and glutathione reduction, mitochondrial membrane potential collapse and apoptosis, and by modulation of the inducible NOS (iNOS). In conclusion, in CEC asenapine induced eNOS-dependent NO production through an intracellular signaling leading to Akt, ERK1/2 and p38MAPK activation. Moreover, asenapine protected CEC against oxidative stress by modulation of antioxidant system, apoptosis, cell survival signaling and mitochondria functioning.

Psychosocial characteristics of oromucosal diseases in psychiatric patients: observational study from Indian dental college.

Background:Psychiatric diseases like anxiety, depression, schizophrenia and bipolar disorders can affect the mental and physical statuses of an individual.Aim:The study was to investigate the different oromucosal diseases (OMD) in psychiatric patients and to evaluate the correlation between these OMD to severity of anxiety and depression.Materials and Methods:A cross-sectional study was carried out during a six-month period. Patients reporting to psychiatry department with anxiety, depression, schizophrenia and bipolar disorder as diagnosed by an experienced psychiatrist, were subjected to complete oral examination by a skilled oral diagnostician to check for OMD like oral lichen planus (OLP), aphthous stomatitis (AS) and burning mouth syndrome (BMS). During the above mentioned time interval, 1320 patients with any of the above mentioned psychiatric diseases were included in this study. Of these, 278 had anxiety, 398 had depression, 295 had schizophrenia and 349 had bipolar disorder. Equal number of individuals reported to the Oral Medicine and Radiology department for routine oral screening with no mucosal diseases were included as control group.Results:In this study, statistically significant increase in the OMD of the psychiatric patients was recorded when compared with the control group. The OMD were significantly higher in patients with anxiety (20.86%) followed by patients with depression (9.04%), schizophrenia (7.7%), bipolar disorder (7.4%) and control group (5.17%), respectively. Most prevalent OMD in patients with anxiety was AS (12%) followed by OLP (5.7%), and BMS (2.87%) respectively. Patients with moderate to severe anxiety and depression showed significantly higher prevalence of these OMD compared to the ones with mild anxiety and depression. The AS and OLP were significantly more in the younger age group (18-49 year) and BMS was higher in 50-77 year age group in both the study and control groups.Conclusion:A positive association was established between psychological alterations and OMD. Emotional alterations may act as a precipitating factor that could influence the initiation and development of different OMD. Hence, better harmonization is essential between dentist and psychiatrists for comprehensive management of psychosomatic disorders of the oral mucosa.

Prevalence of bucco-dental pathologies in patients with psychiatric disorders

Introduction: Oral diseases in psychiatric patients are usually a result of bad oral hygiene and psychopharmaceutical side-effects. Objective: The aim of this study was to detect the most prevalent oral lesions in patients hospitalized in a psychiatric institution in Caracas, Venezuela with the confirmed diagnosis of psychiatric illness. Material and Methods: A transversal study consisted of 65 hospitalized patients with psychiatric disorders out of whom 50 were males and 15 females. Patients were aged from 19 to 80 years, mean age 50.2 years. Data on oral lesions were obtained within history and clinical examination of the oral cavity. Other medical data were collected from medical documentation. Statistical analysis was performed by SPSS version 17.0. Results: 56.92% of patients had caries in at least one tooth, 29.23% presented gingivitis and 56.92% periodontal disease. In relation to Temporomandibular joint, 36.92% presented articular sounds and 10.76% muscular pain. Between the most prevalent parafunctional habits were found cigarette habit, bruxism, onychophagia and cheek bite. Conclusion: Results imply that psychiatric patients are more frequently involved with oral lesions than healthy persons. It is necessary to organize specific preventive and educational oral health programmes with these patients, in a multidisciplinary group. Key words:Phychiatric patients, schizophrenia, medication, periodontal diseases.

Skin diseases in patients with primary psychiatric conditions: A hospital based study

BackgroundAlthough the relationship between skin diseases in patients with primary psychiatric conditions is important for patient management, studies on this issue are limited. ObjectiveTo detect the frequency and type of cutaneous disorders among patients with primary psychiatric conditions. Subjects and methodsThis analytic cross-sectional study was conducted on a total of 400 subjects – 200 patients with primary psychiatric disorders and 200 age and sex matched individuals free from primary psychiatric disorders. Patients included in the study were diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders (DMS IV) Criteria. A specially designed questionnaire including socio-demographic data, medical history, family history and dermatological examination was applied. The data were statistically analyzed. ResultsThere was a significant statistical increase in the prevalence of skin diseases in general and infectious skin diseases in particular in psychiatric patients compared with non-psychiatric patients (71.5% versus 22%, P<0.001) and (48% versus 11%, P<0.001), respectively. Parasitic infestations (42.7%) were the most common infectious skin diseases in psychiatric patients (P<0.001). Infectious skin diseases in psychiatric patients were seen most in patients diagnosed with schizophrenia (83.6%) and least in obsessive compulsive disorders (30%)(P<0.001). Psychogenic skin disorders were found in 8.4% of psychiatric patients with skin diseases; delusional parasitosis was the most common (50%). ConclusionHealth education of psychiatric patients and/or of their caregiver and periodic monthly inspection of psychiatric patients are highly indicated for the prevention and control of infectious skin diseases in primary psychiatric patients.