High Prevalence Of Psychiatric Illness Research Articles

Consultation Liaison Psychiatry for Covid-19 Inpatients: A Hospital Based Study

Background The COVID-19 pandemic has had a significant impact on mental health worldwide. The effects of the pandemic on mental wellbeing have been multifaceted and varied from person to person. Neuropsychiatric symptoms have been described in the acute phase of the illness and as long-term consequences. The objective of this study is to describe the characteristics of COVID-19 patients referred to our liaison psychiatry service in College of Medical Sciences and Teaching Hospital, Chitwan, Nepal.MethodsThis is a hospital based cross-sectional descriptive study. This study was carried out within the Department of Psychiatry of College of Medical Sciences and Teaching Hospital, in Chitwan district of Nepal, over a period of 2 months from March 2021 to May 2021. Data from each psychiatric consultation within our consultation-liaison service were consecutively obtained during the study period. Psychiatric diagnosis was made as per the ICD-10/ DCR criteria. Data was analyzed using SPSS.ResultsAmong 35 patients who received psychiatric consultation, the mean age of the patient was 48.91± 13.01. Majority, sixty two percent were male and from Chitwan District. The majority of the patients, around 37%, were diagnosed with anxiety disorder followed by 22.9% delirium, 11.4% acute stress reaction, 8.6% depressive illness and adjustment disorder. Conclusions This study concluded that there was a high prevalence of psychiatric illness among COVID-19 patients. Therefore, by conducting screening for psychiatric symptoms in COVID 19 patients' healthcare professionals can i entify individuals who may require additional mental health support and intervention. Early detection and intervention for psychiatric symptoms can help prevent worsening of mental health conditions, improve overall wellbeing and enhance the effectiveness of treatment.

Psychiatric comorbidities on an inpatient dermatology consultation service: A cross-sectional analysis.

Despite the high prevalence of psychiatric illness in hospitalised dermatology patients, characterisation of psychiatric comorbidities on an inpatient dermatology consultation service in the United States has yet to be performed. To fill this gap in knowledge, we investigated the prevalence of and factors associated with psychiatric illness on the inpatient dermatology consultation service at the University of Southern California. Of the 429 patients seen by the dermatology consultation service between June 2021 to July 2022, 147 (34%) had psychiatric illness (defined as having at least 1 psychiatric diagnosis). Increasing age was associated with a decreased likelihood of psychiatric illness, while housing instability, chronic dermatologic disease, drug reaction, and pruritus without rash were associated with an increased likelihood of psychiatric illness. The high prevalence of psychiatric illness observed in hospitalised dermatology patients emphasises the importance of collaboration between consultant dermatologists and mental health specialists, particularly when specific sociodemographic or disease factors are present.

The Role of Family Factors in the Outcomes of Court-Involved Youth.

Court-involved youth (CIY) comprise a significant portion of the U.S. population and have a high prevalence of psychiatric illness and substance use. Youth delinquency has also been associated with family variables and parenting practices. However, it is not known which family factors are most relevant to behavioral outcomes in CIY mandated to outpatient mental health treatment. Self-report measures from 163 CIY (M = 15.19 years; 58.3% male) starting psychiatric care in two U.S. cities were utilized in a cross-sectional analysis to examine the association of parental monitoring and family functioning with the severity and variety of delinquent acts. Results demonstrate that parental monitoring is significantly associated with the delinquent behavior of CIY in mental health treatment, beyond that of psychiatric symptoms and substance use. Improved understanding of influential family factors can enhance tailoring of existing interventions to ensure that they are relevant to the needs of CIY, especially those in psychiatric treatment.

An Ounce of Prevention is the Only Cure: Nationwide Clinical and Financial Outcomes of Self-Inflicted Firearm Injuries.

Self-inflicted gunshot wounds (SIGSWs) remain a leading, preventable cause of death in the United States. The present study evaluated patient demographics, operative characteristics, in-hospital outcomes, and resource utilization between patients with SIGSW and other GSW. The 2016-2020 National Inpatient Sample was queried for patients ≥16years old admitted following gunshot wounds. Patients were categorized as SIGSW if they were injured through self-harm. Multivariable logistic regression was used to evaluate the association of SIGSW on outcomes. The primary endpoint was in-hospital mortality with complications, costs, and length of stay secondarily considered. Of an estimated 157,795 surviving to hospital admission, 14,670 (9.30%) were SIGSW. Self-inflicted gunshot wounds were more commonly female (18.1 vs 11.3%), insured by Medicare (21.1 vs 5.0%), and white (70.8 vs 22.3%) (all P < .001) compared to non-SIGSW. Psychiatric illness was more prevalent in SIGSW (46.0 vs 6.6%, P < .001). Additionally, SIGSW more frequently underwent neurologic (10.7 vs 2.9%) and facial operations (12.5 vs 3.2%) (both P < .001). After adjustment, SIGSW was associated with greater odds of mortality (AOR: 12.4, 95% CI: 10.4-14.7). Length of stay (β: +1.5days, 95% CI: .8-2.1) and costs (β: +$3.6K, 95% CI: 1.4-5.7) were significantly greater in SIGSW. Self-inflicted gunshot wounds are associated with increased mortality compared to other GSW, likely due to the increased proportion of injuries in the head and neck region. This lethality, coupled with the high prevalence of psychiatric illness in this population, indicates that efforts must be made to intervene through primary prevention, including enhanced screening and weapon safety considerations for those at risk.

Clinical, psychological and demographic factors in a contemporary adult cohort with diabetic ketoacidosis and type 1 diabetes.

Diabetic ketoacidosis (DKA) is a potentially life-threatening but often preventable acute complication of type 1 diabetes (T1D). Understanding clinical and psychosocial characteristics of people with DKA, particularly those with multiple presentations, may aid the development of prevention strategies. To describe clinical, psychological and demographic factors in adults with DKA and particularly those factors associated with recurrent admissions. A retrospective analysis was performed of all admissions with DKA in people with T1D over a 4-year period from 1 November 2013 to 31 October 2017 at a metropolitan tertiary hospital in Australia. Potential cases were identified by International Classification of Diseases-10th Revision coding data. Data were then manually extracted by clinicians from the electronic medical record. There were 154 clinician-adjudicated admissions for DKA among 128 people with T1D. Of these, 16 (13%) had multiple DKA admissions. Forty-one (32%) had a history of depression. The most common factors contributing to presentation included insulin omission (54%), infection (31%), alcohol excess (26%) and new diabetes diagnosis (16%). Compared to people with single admissions, those with recurrent DKA were more likely to smoke (69% vs 27%, P = 0.003), be unemployed (31% vs 11%, P = 0.04) and use illicit substances (44% vs 17%, P = 0.02). There is a high prevalence of psychiatric illness, illicit substance use and social disadvantage among people admitted with DKA, particularly those with recurrent presentations. Insulin omission, often due to inappropriate sick day management, was the most common reason for DKA occurrence. Innovative multidisciplinary models of care are required to address these challenges.

Prevalence and associated factors of mental disorders among prisoners in Mbarara municipality, southwestern Uganda: a cross-sectional study

BackgroundResearch in high income countries reports higher prevalence of mental disorders among prisoners than in the general population. Lack of published data from low resource settings affects planning and eventual service provision to the prisoners. This study aimed to determine the burden of mental disorders and associated factors among prisoners in Mbarara municipality in southwestern Uganda.MethodsThis was a prison facility based cross sectional study among 414 inmates in Mbarara municipality. We consecutively enrolled them by simple random sampling from 3 prison facilities. Participants completed a sociodemographic and clinical factor questionnaire, and the M.I.N.I. Version 6.0. Data were analyzed using STATA 12.0. Univariate, bivariate and multivariate logistic regression analyses were conducted to determine the prevalence, and associated factors using the individual odds ratios with their 95% Confidence Intervals and P-values as a measure of association, clinical and statistical significance respectively.ResultsA total of 354 (86%) prison-inmates met criteria for a psychiatric disorder. Of these, 338 (95%) had one or more diagnoses. Major depression was the most common diagnosis (44%). Factors associated with mental disorders included history of traumatic brain injury (OR = 2.57; 95% CI = 1.22–5.42; P-value = 0.01), low income status (OR = 0.32; 95% CI = 0.16–0.63; P-value = 0.001) and authoritarian parenting (OR = 0.37; 95% CI = 0.18–0.75; P-value = 0.006).ConclusionsThere is a high prevalence of psychiatric illness among prisoners in Mbarara municipality with most of them having more than one diagnosis. Majority of the prisoners with mental illness go undiagnosed and untreated.

ASSESSMENT OF MEDICATION EFFICACY ON DETERMINANTS OF PSYCHIATRIC ILLNESS AMONG DIABETES MELLITUS PARTICIPANTS

Introduction: The prevalence of Diabetes Mellitus (DM) among adults has been increased considerably across the globe, and has contributed a substantial proportion in annual mortality rate. Diabetes and psychiatric disorders are having such an interface that they both influence each other in several ways.&#x0D; Objectives: The study was conducted to assess the prevalence, determinant factors, prescription pattern, efficacy and adverse reactions in diabetic patients associated with psychiatric illness in a tertiary care hospital.&#x0D; Materials and Methods: A prospective observational study was carried out for a period of ten months in General Medicine and Psychiatric Department, Basaveswara Medical College Hospital and Research centre, Chitradurga.&#x0D; Results: In this study, a total of 101 diabetic patients with or without co-morbidities were enrolled in the study. Among them, 27 in-patients were associated with psychiatric illness which was considered as co-morbid condition. The prevalence of psychiatric illness with diabetes mellitus was found to be 26.7% which is highly significant with the p-value (0.00). A higher prevalence was noticed with age group 41-50 years and with male gender. The common determinant factors of psychiatric illness in diabetic patients were being women, having no income, being at the age of menopause, having no physical activity, being illiterate and being single or widowed. Among the anti-diabetic drug prescriptions, there was a higher percentage of use of insulin and the most commonly prescribed drug was combination of Glimepride + Metformin (sulfonylurea and biguanide). The most commonly prescribed anti-psychotic drugs were chlordiazepoxide and alprazolam. Conclusion: The study reveals a high prevalence of psychiatric illness in diabetic patients with determinant factors of psychiatric illness in diabetic patients were being women, having no income, being at the age of menopause, having no physical activity, being illiterate and being single or widowed.&#x0D; Key Words: Prevalence; Determinant factors; Diabetes mellitus; Psychiatric illness

Prevalence of psychiatric illnesses after major limb amputation and early recognition and treatment in economically lower income group patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There is high prevalence of psychiatric illness after major limb amputation and need for early recognition and treatment should be the goal but often is overlooked. Psychological support by the treating physician and the surgeon can help in adaptation to the disability but unfortunately is often overlooked.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 120 patients were screened for psychiatric disorder using HADS criteria Anxiety was found to be in 38 (32%) patients and depression was found to be in 27 (23%) (Table 1) (Figure 1) 55 patients had no psychiatric illness. Psychiatric illness either depression or anxiety was found to be in 65 patients.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our state which is a zone of conflict between two countries prevalence of anxiety was 32% and depressive symptoms were 23%, respectively. Causative factors associated with high prevalence of psychological symptoms included unmarried young females, lower socioeconomic status, single earning member, lack of social support, unemployment, traumatic amputation. These findings were confirmed by a significant reduction of anxiety and depression scores in patients who received social support, patients with amputation due to disease, and patients with above the knee amputation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study showed higher prevalence of psychological symptoms in association with lower socioeconomic status, single earning member, lack of social support, unemployment, traumatic amputation vs amputation secondary to chronic disease. Extensive rehabilitation with the use of an interdisciplinary team approach is one of the most successful ways to return the amputee to the work place. Surgeons should give proper attention to the psychological state of amputees. Because of high prevalence of psychiatric illness after major limb amputation. It is suggested that psychiatric evaluation and adequate rehabilitation should form a part of treatment.&lt;/p&gt;

Drug-drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs.

Psychotropic medications are frequently co-prescribed with antiretroviral therapy (ART), owing to a high prevalence of psychiatric illness within the population living with HIV, as well as a 7-fold increased risk of HIV infection among patients with psychiatric illness. While ART has been notoriously associated with a multitude of pharmacokinetic drug interactions involving the cytochrome P450 enzyme system, the magnitude and clinical impact of these interactions with psychotropics may range from negligible effects on plasma concentrations to life-threatening torsades de pointes or respiratory depression. This comprehensive review summarizes the currently available information regarding drug-drug interactions between antiretrovirals and pharmacologic agents utilized in the treatment of psychiatric disorders-antidepressants, stimulants, antipsychotics, anxiolytics, mood stabilizers, and treatments for opioid use disorder and alcohol use disorder-and provides recommendations for their management. Additionally, overlapping toxicities between antiretrovirals and the psychotropic classes are highlighted. Knowledge of the interaction and adverse effect potential of specific antiretrovirals and psychotropics will allow clinicians to make informed prescribing decisions to better promote the health and wellness of this high-risk population.

Prevalence of Psychiatric Diagnoses in Pediatric Chiari Malformation Type 1

This cross-sectional study investigates the prevalence and risks for psychiatric diagnoses in a large cohort of children with Chiari malformation type 1 (CM1) presenting for neurosurgical evaluation. Children between the ages of 6 and 17 years who were evaluated and diagnosed with CM1 at a neurosurgery clinic were identified. Eighty-six participants were recruited for this study with an average age of 11 years. Parents of participants completed a pediatric medical history questionnaire and a semistructured interview regarding the child’s psychiatric, developmental, medical, and family history. A review of medical records was completed to complement interview data. Elevated rates of psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD) (22.1%), anxiety (12.8%), and depression (10.5%), were identified in the study population when compared to published norms in the general population documented by the American Psychiatric Association in 2013. In addition, elevated rates of psychiatric diagnoses in first-degree relatives of study participants were also identified. A 2-step binary logistic regression analysis revealed that maternal complications during pregnancy (Wald = 6.52, p = 0.01) increased the risk of a psychiatric diagnosis 9-fold. Premature birth (Wald = 6.79, p = 0.01) also significantly predicted a psychiatric diagnosis amongst participants. The current findings suggest a high prevalence of psychiatric illness in children with CM1. Pregnancy complications were associated with a high risk of a psychiatric diagnosis. Early CNS developmental disturbance may explain this relationship. Prematurity only slightly improved the prediction model. Limitations and future directions are discussed, including the cross-sectional nature of the present study, possible self-selection bias, and the importance of future investigation of other causative and/or associative factors of CM1, such as cognitive, psychiatric, and medical influences on health status.

Pattern of Psychiatric illness among Tuberculosis Patients

Background: The incidence of tuberculosis is very high in Bangladesh. There is a high prevalence of psychiatric illness among tuberculosis patients. But primary care physicians and specialists do not screen this association. The aims of this study were to evaluate the incidence and pattern of psychiatric illness in tuberculosis patients.Methodology: The study population included those patients who were coming for treatment in DOTs corner of Rajshahi Medical College Hospital between July 2014 - February 2015 (Eight months). Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Details included socio-demographic data, psychiatric diagnosis and treatment outcome. All data was tabulated and analyzed using SPSS-16.Result: Among the total 350 tuberculosis patients, total 108 patients (31%) were diagnosed with psychiatric problems. Most of them are male (71%), less than 40 years of age (70%) with no previous psychiatric illness (98%). Depression (n=43, 40%) and Anxiety (n=33, 31%) were the commonest psychiatric illness diagnosed. Fear of disease outcome was the commonest precipitating factor found (66%). After the psychiatric treatment, 94% improved clinically.Conclusion: Detecting the level of psychiatric illness among tuberculosis patients at early stage will improve continuation and adherence to treatment. A referral system` to psychiatrists by physicians needs to develop to screen the mental disorder symptoms to treat these co morbidities.Anwer Khan Modern Medical College Journal Vol. 6, No. 2: July 2015, P 25-29

Psychiatric morbidity, pain perception, and functional status of chronic pain patients in palliative care

Context:Psychological factors, such as that exist when we experience pain, can profoundly alter the strength of pain perception.Aim:The study aims to estimate the prevalence of psychiatric disorders, and its association with perception of pain and functional status in chronic patients in palliative care.Materials and Methods:The sample was selected via simple randomisation and post consent were assessed using (1) a semi- structured questionnaire to elicit socio-demographic information and medical data (2) Brief Pain Inventory (3) ICD-10 Symptom Checklist (4) ICD-10-Diagnostic Criteria for Research (DCR) (5) Montgomery Asberg Depression Rating Scale (MADRS) (6) Covi Anxiety Rating Scale (7) Karnofsky Performance Status Scale. Data was analysed using independent sample t test and chi square test.Results:The psychiatric morbidity was 67% with depression and adjustment disorders being the major diagnosis. There was a significant association between psychiatric morbidity pain variables (P = 0.000). Psychiatric morbidity significantly impaired activity, mood, working, walk, sleep, relationship, and enjoyment. There was no association between aetiology of pain, type of cancer, treatment for primary condition and treatment for pain and psychiatric morbidity. The functional status of cancer patients was also poorer in patients with psychiatric morbidity (P = 0.008).Conclusion:There is a high prevalence of psychiatric illness in chronic pain patients of any aetiology. Psychiatric morbidity is associated with increased pain perception, impairment in activity and poor functional status.

A Validated Tool for Psychiatric Comorbidity in the Patients With Functional Dyspepsia: Author's Reply

TO THE EDITOR: tudies on psychometric properties of screening questionnaires in chronic medical conditions are often criticized for their limited generalizability.1 The reason is obvious, as most studies are conducted in referral centres where referral bias is unavoidable.2 This might contribute to the high prevalence of psychiatric illness in our sample.3 This suggestion could be also observed by similar results in other studies.4-6 On the other hand, it is often difficult to make confirmed diagnosis of functional dyspepsia in primary care setting where endoscopic examination is not widely available. In addition, gold standard Structured Clinical Interview is difficult to be implemented in large scale, because as trained clinicians are needed to conduct this lengthy assessment in this process. In order to tackle this dilemma, one of the solutions is to conduct a population-based study, using 12-item General Health Questionnaire by general practitioners and family physicians before they refer their patients with functional dyspepsia for thorough psychiatric assessment. We hope to audit the appropriateness of this 12-item General Health Questionnaire as a screening tool in primary care setting.

Psychiatric illness in the next of kin of patients who die in the intensive care unit*

To determine the rates of psychiatric illness in next of kin following the death of a relative in a medical intensive care unit. Cross-sectional survey. A university teaching hospital, New Haven, CT. Forty-one next of kin who had served as primary surrogate decision makers before the death of their loved one in the intensive care unit 3-12 months previously. Structured Clinical Interviews for DSM-IV and the Inventory of Complicated Grief-Revised were used to determine prevalence of psychiatric illness. Formal questionnaires were used to evaluate key features of the intensive care unit experience. Bivariate statistics were used to identify factors associated with the presence of psychiatric illness. Following 107 patient deaths, 51 next of kin were successfully contacted and 41 (80%) agreed to study participation. Thirty-four percent (95% confidence interval, 20% to 51%) met criteria for at least one psychiatric illness: major depressive disorder (27%), generalized anxiety disorder (10%), panic disorder (10%), or complicated grief disorder (5%). Disorders were more common in spouses than other kinship relations (63% vs. 16%, p = .002), those experiencing additional stressors after the loss (53% vs. 21%, p = .03), those who said the patient was ill <5 yrs (45% vs. 8%, p = .03), and those who said the patient's physician was not comforting (71% vs. 23%, p = .02). In a cohort of bereaved next of kin of patients who died in the intensive care unit, we identified a high prevalence of psychiatric illness, particularly major depressive disorder. More work is needed to identify those at risk for psychiatric illness so that appropriate interventions may be targeted.

Treating hepatitis C in methadone maintenance patients: an interim analysis

Objective: This study evaluates the safety, tolerability, and efficacy of interferon/ribavirin combination therapy in methadone maintenance (MM) patients with active hepatitis C (HCV). End-of-treatment results are presented as an interim analysis of efficacy. Methods: Fifty eligible MM patients with active HCV and concomitant liver fibrosis were treated with interferon/ribavirin combination therapy using standard dosing regimens. Patients with active drug or alcohol use at the start of treatment, severe or untreated psychiatric illness, and/or decompensated liver disease were excluded. Results: Treated MM patients were older, had a longer history of HCV infection, a high prevalence of psychiatric illness, and had substantially more liver fibrosis than in previous studies of HCV treatment in non-opioid-dependent populations. Seventy-eight percent completed the 6–12 month course of treatment. The end-of-treatment virologic response rate was 64% in patients completing treatment and 54% on an intent-to-treat basis. Conclusion: Methadone maintenance patients exhibit a number of factors that make HCV treatment more difficult: they are older, have a higher prevalence of psychiatric illness, and show evidence of more advanced liver disease. Despite this, their end-of-treatment response rate to interferon/ribavirin combination therapy is similar to that of patients without a history of IDU. Further analysis of the sustained virologic response (SVR) rate is planned at the study's completion. These preliminary results show that MM patients are in need of timely HCV diagnosis, and should be considered good candidates for referral and HCV treatment.

Suicidal Behaviour in People with HIV/AIDS: A Review

To review the existing literature on suicidal behaviour in people with HIV/AIDS infection. A search on the Index Medicus/MEDLINE database was performed, for articles that investigated and/or reviewed suicidal behaviour in people with HIV at any stage of the illness. Only articles written in English were used in this review. Most studies have been done on homosexual/bisexual groups, with little data available for heterosexual populations or women. Studies show an increased rate of suicidal ideation, suicide attempts and completed suicide in individuals with HIV/AIDS. Of note, there is a high prevalence of psychiatric illness and substance abuse in those with suicidal behaviour. The increased rate of suicidal behaviour in HIV-infected persons is consistent with findings in other medically ill groups with chronic, life-threatening disorders. However, assessment of any possible direct effect of HIV/AIDS on suicidal behaviour is confounded by methodological limitations of many of the studies. More longitudinal studies encompassing other affected groups including heterosexual populations and women are needed to elucidate the relationship between suicidal behaviour and HIV/AIDS.

Do the homeless get a fair deal from general practitioners?

Many studies have indicated the health status of homeless people to be typically poorer than that of the general population, with various studies indicating a high prevalence of psychiatric illness, drug or alcohol misuse and associated socio-medical problems. The Bristol Primary Healthcare Project is an agency which was established to provide a local health care service tailored to the needs of people who are homeless. The present study was carried out as part of an evaluation of the service offered locally to homeless people by General Practitioners (GPs). A postal questionnaire survey of 155 general practices within the Avon FHSA area was carried out. Both fundholding and non-fundholding practices were included, within an area including inner city, urban and rural/semi-rural locations. One hundred and seventeen completed questionnaires were returned, providing a response rate of 75%. Twenty-seven percent of practices would fully register a homeless person who seeks to register at the practice, 24% would treat as immediate and necessary and 33% would treat as a temporary resident. Four percent of fundholding practices surveyed would fully register homeless persons and 55% of inner city practices would do so. Seventy-nine percent of doctors indicated that homeless patients were more difficult to treat than other patients. The most frequent problems associated with registering homeless persons were perceived to be the associated social problems (90% of respondents agreed), the lack of medical records (88% agreed), the complex health problems (79% agreed) and the associated alcohol or substance misuse (78% agreed). The study has highlighted a need for government to consider providing incentives to GPs to register homeless people without resulting in adverse effects on their contract targets. The reluctance of some practices to register these patients varied by area and type of practice with doctors at fundholding practices being the most reluctant. There is an identified need for further health education and promotion work and initiatives exemplified by the Bristol Primary Healthcare Project for people who are homeless.

PSYCHIATRIC ILLNESS AND SYNCOPE

Studies have reported a high prevalence of psychiatric illness in patients with syncope, particularly among those with syncope of unknown etiology. Although mortality rates for patients with syncope and psychiatric disorders tend to be lower than for patients with cardiac cause for syncope, treatment of these psychiatric illnesses appears to result in lower rates of recurrence of the symptoms. The authors recommend an assessment for psychiatric illness in those patients in whom the initial evaluation does not suggest an organic cause for syncope. Further studies are needed to elucidate the pathophysiologic mechanisms for syncope and the effects of treatment of psychiatric illness on recurrence of syncope.

Milieu Issues in the Treatment of a Person With Chronic Fatigue Syndrome on an Inpatient Psychiatric Unit

The name "chronic fatigue syndrome" (CFS) was officially introduced in 1988 to de scribe a complex of symptoms that include debilitating fatigue that worsens with physical activity, flulike symptoms, immune dysfunction, and cognitive problems. A high prevalence of psychiatric illness, particularly depression, has also been ob served in patients with CFS. Because the treatment needs of a depressed person with CFS differ from the needs addressed by traditional treatment of depression, psychi atric nurses must modify their approach to patients with CFS. Management of the milieu in an inpatient psychiatric unit can be an effective strategy in the treatment of a person with CFS. (J AM PSYCHIATR NURSES Assoc [1995]. 1, 12-15)

Dual Diagnoses: Psychiatric Disorders in Developmental Disabilities

A high prevalence of psychiatric illness exists in persons with mental retardation. Among children with mild to moderate retardation, psychiatric illnesses resemble those seen in the general population. Major affective disorders, ADHD, and conduct disorder are common and respond to the same interventions used in children without mental retardation. Persons with severe to profound retardation are more likely to engage in stereotypies and self-injurious behaviors. In addition, certain specific syndromes associated with mental retardation present with particular neurocognitive, behavioral, and psychiatric profiles. Common examples are fetal alcohol syndrome, Down syndrome, fragile X syndrome, and Rett syndrome. Specific challenges exist for pediatricians who diagnose and treat patients with mental retardation and psychiatric illness. The child's impaired ability to communicate his or her thoughts and feelings with words makes clinical history taking difficult. The clinician must frequently rely on the observation of family members and teachers. An understanding of developmental profiles and interpersonal, peer, and family dynamics is important. Specific behaviors must be targeted and realistic objectives set in treatment planning, which may include psychotherapy, medication, behavior management techniques, and rehabilitation therapy.