Improvement In Psychiatric Symptoms Research Articles

Cost-effectiveness of nidotherapy for comorbid personality disorder and severe mental illness: randomized controlled trial

Nidotherapy is the systematic modification of the environment to create a better fit for people. This is the first randomized controlled trial of its efficacy in an assertive community team. Patients in an assertive outreach team with continued management problems together with comorbid personality disturbance and severe mental illness were randomized to nidotherapy enhanced assertive treatment (up to 12 sessions) or to continued assertive outreach care. Use of psychiatric beds over one years (primary outcome) and change from base-line in other health service resources, psychiatric symptoms, social functioning and engagement with services were measured at 6 and 12 months (secondary outcomes). 52 patients were recruited over 13 months, with 49 and 37 assessed at 6 and 12 months. Patients referred to nidotherapy had a 63% reduction in hospital bed use after one year compared with control assertive care (P = 0.13) and showed non-significant improvement in psychiatric symptoms, social functioning and engagement than the control group. The mean cost savings for each patient allocated to nidotherapy was 4,112 pounds sterling per year, mainly as a consequence of reduced psychiatric bed use. Nidotherapy may be a cost-effective option in the management of comorbid serious mental illness and personality disorder, but larger confirmatory trials are necessary.

Pregabalin versus naltrexone in alcohol dependence: a randomised, double-blind, comparison trial

Pregabalin (PRE) acts as a presynaptic inhibitor of the release of excessive levels of excitatory neurotransmitters by selectively binding to the alpha(2)-delta subunit of voltage-gated calcium channels. In this randomised, double-blind comparison trial with naltrexone (NAL), we aimed to investigate the efficacy of PRE on alcohol drinking indices. Craving reduction and improvement of psychiatric symptoms were the secondary endpoints. Seventy-one alcohol-dependent subjects were detoxified and subsequently randomised into two groups, receiving 50 mg of NAL or 150-450 mg of PRE. Craving (VAS; OCDS), withdrawal (CIWA-Ar) and psychiatric symptoms (SCL-90-R) rating scales were applied. Alcohol drinking indices and craving scores were not significantly different between groups. Compared with NAL, PRE resulted in greater improvement of specific symptoms in the areas of anxiety, hostility and psychoticism, and survival function (duration of abstinence from alcohol). PRE also resulted in better outcome in patients reporting a comorbid psychiatric disorder. Results from this study globally place PRE within the same range of efficacy as that of NAL. The mechanism involved in the efficacy of PRE in relapse prevention could be less related to alcohol craving and more associated with the treatment of the comorbid psychiatric symptomatology.

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Reduced plasma nitric oxide metabolites before and after antipsychotic treatment in patients with schizophrenia compared to controls

BackgroundNitric oxide (NO) is believed to have a role in the pathophysiology of schizophrenia. We examined plasma levels of NO metabolites in patients with schizophrenia and normal controls. We also determined the impact of 6-week risperidone treatment on circulating NO metabolites in patients with schizophrenia. MethodPlasma NO metabolite (NOx) levels were measured in 55 schizophrenia patients before and after 6-week treatment with risperidone and in 55 normal controls. Severity of schizophrenia and response to treatment were assessed with the positive and negative syndrome scale (PANSS) for schizophrenia. NOx levels were estimated by the Griess method. ResultsPre-treatment plasma NOx levels in schizophrenia patients (8.97±6.74 µmol/L) were lower than those of normal controls (14.51±6.30 µmol/L) (p<0.01). Schizophrenia patients had lower post-treatment NOx levels (10.99±8.31 µmol/L) than those of normal controls (p<0.01). There was marginal significant change between plasma NOx levels before and after 6-week treatment (p=0.056). Moreover, in 37 treatment responders (≥30% improvement in PANSS score), post-treatment plasma NOx significantly increased in comparison to pre-treatment NOx (p=0.028). ConclusionsPlasma levels of NOx in patients with schizophrenia were significantly lower than normal controls both before and after the treatment. Our findings suggest that the improvement of psychiatric symptoms can lead to partially normalize a deficiency of NO after treatment in schizophrenia patients. Our findings support the hypothesis that the NO system is dampened in schizophrenia.

Comparison of Clozapine Response for Inpatients in the Research Setting Versus Routine Clinical Practice

This study compares patient characteristics and treatment response between inpatients treated with clozapine in a research setting as compared to those initiated on clozapine during routine inpatient treatment. Subjects on clozapine, in clinical trials, were compared with clozapine inpatients receiving routine clinical care. At baseline, patients in routine clinical practice had more negative symptoms (P < 0.001), activation (P < 0.001) and greater total Brief Psychiatric Rating Scale (BPRS) scores (P = 0.022) than those in the research setting. Routine clinical practice subjects had larger decreases in BPRS total scores (P = 0.042) and positive item scores (P = 0.0005) compared to research subjects. Response to clozapine was observed in 15/85 (18%) research subjects as compared to 60/223 (27%) patients in routine care (P = 0.09). Patients treated in routine clinical practice have more severe baseline symptoms, but experience significantly greater improvements in psychiatric symptoms.

Public Sector Group Treatment for Severe Personality Disorder: A 12-month follow-up Study

The results of an evaluation of an innovative pubic sector treatment program for patients with borderline personality disorder (BPD) with a history of unsuccessful treatment attempts and severe self-harm are presented. DSM-IV axis I and axis II diagnoses, psychiatric symptoms, patterns of self-harm, suicidality, coping styles, and quality of life were assessed for 27 women who completed a 6-month residential program. Pre- and post-treatment assessments and a 12-month follow-up were undertaken. At 12-month follow-up, significantly fewer participants met criteria for BPD. Significant post-treatment gains, including reduced levels of depression, anxiety and hopelessness, and improvements in some coping style and quality of life domains, were maintained at follow-up. The results in relation to self-harm indicated considerable within-sample variability. Findings indicating clinically significant improvements in psychiatric symptoms and coping, along with mixed results in relation to self-harm and quality of life, are encouraging for the continued development of treatment services for this challenging patient group.

Efficacy of Cognitive Nursing Intervention for Voice Hearing

Many individuals who hear negative voices are troubled by their voices even when they adhere to prescribed neuroleptic medication regimens. At the same time, recent clinical trials provide evidence that structured, cognitive intervention can reduce distress tied to refractory auditory hallucinations and other psychiatric symptoms. The purpose of this randomized controlled trial was to determine whether usual care (UC), or usual care plus 12, 90-min episodes of cognitive nursing intervention (UC + CNI) led to sustained improvement in the psychiatric symptoms and self-esteem of 65 voice hearers assigned a diagnosis of schizophrenia or schizoaffective disorder. ANALYSIS AND FINDINGS: Analysis of covariance with repeated measures procedures indicate that the 44 participants exposed to UC + CNI, were significantly more likely than the 21 participants exposed to UC only, to sustain significant improvement in psychiatric symptoms and self-esteem 1 year following treatment. These findings provide encouragement for nurses to further develop and investigate cognitive strategies to treat psychiatric symptoms of voice hearers.

Marked Improvement of Psychiatric Symptoms after Parathyroidectomy in Elderly Primary Hyperparathyroidism

Psychosomatic symptoms in primary hyperparathyroidism (PHPT) are various and include such conditions as obsessive-compulsive disorder, depression, anxiety, and paranoia. In the elderly the clinical features of the disease are often non-specific and difficult to diagnose. To quantify subjective symptoms of patients with hyperparathyroidism in the elderly, we determined whether these clinical manifestations resolved after surgical parathyroidectomy (PTX) in three PHPT patients over eighty years old. They were diagnosed with hypercalcemia, hypophosphatemia, high PTH concentrations, and osteoporosis. A single parathyroid adenoma was confirmed in each patient by Tc-MIBI scintigram, neck ultrasonography and computed tomographic scanning. PTX was performed in these three patients. Assessments of psychologic symptoms, using the Hamilton Rating Scale for Depression (HAM-D), serum calcium, and intact PTH were obtained before and after PTX. Mean weight of the resected adenomas was 438 +/- 138 mg (mean +/- SD). After PTX, serum calcium decreased from 11.1 +/- 0.5 to 9.2 +/- 0.5 mg/dl and intact PTH from 160.0 +/- 25.2 to 45.3 +/- 22.2 pg/ml. Total HAM-D scores in each patient decreased from 45 to 9, 17 to 1 and 15 to 5, respectively. Especially, there were marked improvements in depressive mood, psychomotor inhibition, anxiety and somatic symptoms after PTX. The quality of life in those patients was also improved by PTX. We propose here that PTX in elderly PHPT patients with psychiatric symptoms should be considered instead of oral administration, such as anti-depressants or bisphosphonates.

Drug dependent parents: Childcare responsibilities, involvement with treatment services, and treatment outcomes

Relatively little is known about the treatment of drug dependent parents. This study of drug misusers ( n = 1075) investigates the involvement of parents with treatment services, childcare arrangements before and during treatment, and outcomes at 1-year follow up. Almost half the sample (46%) were parents. Women were more likely to be responsible for the care of children. Parents, and especially women, who looked after children, were less likely to receive residential treatment. Illicit drug use and psychiatric symptoms were reduced at 1 year. Outcomes did not differ by gender or parenting status, but there was an interaction effect for psychiatric symptoms: for women, looking after children during treatment was associated with less improvement in psychiatric symptoms at follow up. Such women face special difficulties in access to services and would benefit if treatment services were able to offer improved access and childcare support.

Exacerbation of Psychiatric Symptoms During Substance Use Disorder Treatment

This study examined psychiatric symptom exacerbation (or deterioration) among patients treated for substance use disorders. The study examined several questions. What is the prevalence of deterioration during residential treatment? Compared with patients who show improvement in psychiatric symptoms, do those with deterioration of symptoms report poorer functioning during treatment and one year after treatment entry? Do patients who experience deterioration of symptoms one year after treatment entry enter treatment with more problems and poorer coping skills? Is the prevalence of deterioration associated with treatment orientation, and do patients whose psychiatric symptoms deteriorate view the treatment environment more negatively than patients whose symptoms improve?A total of 3,322 male patients were recruited at 15 residential substance abuse treatment programs in the Department of Veterans Affairs health care system between 1992 and 1995. On the basis of changes in psychiatric symptoms during treatment, these patients were categorized as having either deteriorated or improved psychiatric symptoms. Patients whose symptoms deteriorated were compared with a matched group of patients with improved symptoms.A total of 426 patients (13 percent) reported a worsening of psychiatric symptoms during treatment. Compared with patients in the improved group (N=426), patients in the deteriorated group reported more psychiatric problems and substance use one year after treatment. Patients in the deteriorated group were more likely to have a psychotic diagnosis, lower self-efficacy, and more reliance on coping by expression of emotions and to view the treatment experience more negatively.Thirteen percent of the patients experienced an exacerbation of psychiatric symptoms during residential substance use disorder treatment. Improved monitoring procedures, such as regular assessments for changes in psychiatric symptoms, are needed to routinely obtain information about declines in psychiatric conditions during treatment.

Remission of Psychiatric Symptoms Among Drug Misusers After Drug Dependence Treatment

The study investigates changes in psychiatric symptoms after drug dependence treatment, and relationships between pretreatment problems, illicit drug use, treatment retention, and changes in psychiatric symptoms. The sample comprised 662 drug-dependent adults recruited at admission to treatment in residential rehabilitation programs (15 agencies) or outpatient methadone treatment (16 methadone maintenance programs and 15 methadone reduction programs). Using a longitudinal, prospective cohort design, data were collected by structured interviews at intake to treatment and at 1-month and 6-month follow-ups. Reductions were found in a range of psychiatric symptoms after admission to drug dependence treatment and among patients treated in outpatient and in residential programs. These reductions occurred rapidly (during the first month) and were maintained at subsequent follow-up. At intake to treatment, 39% of the residential sample met criteria for psychiatric caseness. This figure dropped to 3% at both 1-month and 6-month follow-up. Among methadone patients, 15% met criteria for psychiatric caseness at intake, and this dropped to 5% at 1 month and 3% at 6 months. Improvement in psychiatric symptoms was positively related to treatment retention. Some of the psychiatric symptoms presented by drug-dependent patients at admission to treatment are associated with drug misuse and show rapid remission after substance misuse treatment.

Effects of chronic prednisone therapy on mood and memory

Background In animals, stress and corticosteroids can be associated with both reversible and irreversible changes in the hippocampus. Changes in memory and hippocampal structure, perhaps in part due to cortisol elevations, are reported in some patients with mood disorders. Minimal data are available on the effects of long-term exposure to corticosteroids on the human hippocampus. We previously reported greater depressive symptom severity, poorer memory and smaller hippocampal volumes in patients with asthma or rheumatic diseases receiving long-term prednisone therapy than in controls. Methods In this report, patients and controls were assessed a mean of 4 years after the first assessment to determine if depressive and manic symptoms and cognition remained stable, improved or worsened. Seven prednisone-treated patients and six controls were identified and agreed to reassessment with psychiatric symptom and neurocognitive measures. Follow-up MRIs for hippocampal volume analysis were available for two prednisone-treated participants. Results With the exception of an increase in depressive symptoms in those receiving prednisone, participants and controls did not show significant change in mood or cognition from the initial assessment. One participant discontinued prednisone and showed improvement in psychiatric symptoms and cognition. Hippocampal volumes were available in two prednisone-treated participants and showed inconsistent findings. Limitations A limitation is the small sample size. Conclusions Our findings, although preliminary in nature, suggest that long-term prednisone therapy is associated with initial changes in mood, memory and hippocampal volume that appear to stabilize over time.

Acetylsalicylic acid accelerates the antidepressant effect of fluoxetine in the chronic escape deficit model of depression

Evidence has accumulated suggesting that major depression is associated with dysfunction of inflammatory mediators. Moreover, antidepressants show an anti-inflammatory action possibly related to their clinical efficacy. An improvement in psychiatric symptoms has been recently reported in patients treated with anti-inflammatory drugs for other indications. These data imply that inflammation may be involved in the pathogenesis of depression and that anti-inflammatory drugs may be used as an adjunctive therapy. The aim of the present study was to evaluate the behavioural effect of the co-administration of acetylsalicylic acid (ASA, 45 mg/kg or 22.5 mg/kg) and fluoxetine (FLX, 5 mg/kg) in the chronic escape deficit model of depression. The chronic escape deficit model is based on the modified reactivity of rats to external stimuli induced by exposure to unavoidable stress and allows evaluation of the capacity of a treatment to revert the condition of escape deficit. In this model, FLX alone needs to be administered for at least 3 weeks to revert this condition. Our results show that combined treatment of fluoxetine and ASA completely reverted the condition of escape deficit by as early as 7 days, the effect being already partially present after 4 days. The effect was maintained after 14 and 21 days of treatment. ASA alone was ineffective at any time tested and the effect of fluoxetine was significant only at 21 days. These results, together with clinical data from preliminary results, suggest that ASA might accelerate the onset of action of selective serotonin reuptake inhibitor antidepressants.

Atypical Antipsychotic Agents in the Treatment of Violent Patients With Schizophrenia and Schizoaffective Disorder

Violent behavior of patients with schizophrenia prolongs hospital stay and interferes with their integration into the community. Finding appropriate treatment of violent behaviors is of primary importance. To compare the efficacy of 2 atypical antipsychotic agents, clozapine and olanzapine, with one another and with haloperidol in the treatment of physical assaults and other aggressive behaviors in physically assaultive patients with schizophrenia and schizoaffective disorder. Randomized, double-blind, parallel-group, 12-week trial. Physically assaultive subjects with schizophrenia or schizoaffective disorder who were inpatients in state psychiatric facilities were randomly assigned to treatment with clozapine (n = 37), olanzapine (n = 37), or haloperidol (n = 36). Number and severity of physical assaults as measured by the Modified Overt Aggression Scale (MOAS) physical aggression score and the number and severity of all aggressive events as measured by the MOAS overall score. Psychiatric symptoms were assessed through the Positive and Negative Syndrome Scale (PANSS). Clozapine was superior to both olanzapine and haloperidol in reducing the number and severity of physical assaults as assessed by the MOAS physical aggression score and in reducing overall aggression as measured by the MOAS total score. Olanzapine was superior to haloperidol in reducing the number and severity of aggressive incidents on these 2 MOAS measures. There were no significant differences among the 3 medication groups in improvement of psychiatric symptoms as measured by the PANSS total score and the 3 PANSS subscales. Clozapine shows greater efficacy than olanzapine and olanzapine greater efficacy than haloperidol in reducing aggressive behavior. This antiaggressive effect appears to be separate from the antipsychotic and sedative action of these medications.

Home treatment for children and adolescents with psychiatric disorders

The study examines the effectiveness of home treatment in 70 children and adolescents (aged 6-17 years) with heterogeneous psychiatric disorders. Home treatment was offered to parents/children as an alternative to inpatient treatment (no randomized group assignment). Interventions were carried out by psychiatric nurses (n = 38) and medical students (n = 32) under the supervision of experienced child psychiatrists. Assessment of treatment effects was based on a structured parent interview and parents', children's and therapists' ratings of various aspects of psychosocial functioning. Pre- or post-treatment comparisons indicate significant improvement of psychiatric symptoms, severity of the disorder, and psychosocial adjustment after three months of home-based interventions. Outcome of behavioral interventions carried out by experienced nurses was superior, compared to treatment effects achieved by advanced medical students. Post-treatment comparison of home-based (n = 70) and inpatient-based (n = 35) treatment effects suggests that inpatient treatment all in all was more effective. At one-year follow-up, however, the effects of home treatment were maintained in a higher number of patients, compared to the stability of effects seen after psychiatric hospitalization. Thus, home treatment appears to be an effective treatment setting. Motivation and compliance of patient and parents, and high skills of the therapists are key ingredients for the success of a home-based treatment program.

Training patients with schizophrenia with the community re-entry module

There is increasing evidence indicating that the Community Re-entry Module (CRM), a brief, structured instrument, could guide an effective intervention for patients with schizophrenia. This study evaluated the effectiveness of the Chinese version of the CRM with respect to improvement in psychiatric symptoms, social functioning as well as relapse and re-hospitalization rates in comparison with a supportive counseling (SC) intervention. Ninety-six outpatients with DSM-IV schizophrenia were randomly allocated to either CRM (N=48) or an equally intensive intervention of SC (N=48). The CRM was composed of 16 one-hour sessions, which were conducted with groups of 6-8 patients on a twice-a-week schedule. The two groups received routine psychiatric outpatient care during the intervention. Participants were assessed on an intention-to-treat basis with the Positive and Negative Syndrome Scales (PANSS), with the Social Disability Screening Schedule (SDSS) by two independent raters before and immediately after intervention, and at 6-month follow-up. The number of relapse and re-hospitalization were also documented. The CRM group significantly improved in terms of psychiatric symptoms and social functioning compared with the SC group. Rates of relapse and re-hospitalization in the CRM group were lower although the difference between the two groups was not statistically significant. The study supports the feasibility and effectiveness of the Chinese version of the CRM as an effective psychosocial intervention for Chinese patients with schizophrenia to improve psychopathology, social functioning and relapse and re-hospitalization rates.

Improvement of Psychiatric Symptoms after Electroconvulsive Therapy in Young Adults with Intractable First-Episode Schizophrenia and Schizophreniform Disorder

Schizophrenia is a serious psychiatric disorder that develops mainly in young adults. Electroconvulsive therapy (ECT) is known to be effective and safe in patients with schizophrenia with acute psychotic exacerbation. Because of the shortage of systematic studies, we conducted a prospective naturalistic study to examine the short-term effects of acute ECT and its safety in young adults with medically intractable first-episode schizophrenia. Subjects were seven consecutive patients, 15-35 years of age, with first-episode schizophrenia or schizophreniform disorder (Diagnostic and Statistical Manual of Mental Disorders, 4th edition; DSM-IV), who had failed to respond to neuroleptics. The seven patients were treated with a first course of ECT, and their clinical symptoms were evaluated on the basis of the Brief Psychiatric Rating Scale (BPRS) (18 items, rated 0-6) and Global Assessment of Functioning (GAF) Scale. The GAF Scale is presented in DSM-IV as a means of assessing global functioning of a psychiatric patient. Scores range from 1-100; the higher GAF score indicates the higher global functioning. Adverse effects resulting from acute ECT were also evaluated. The total BPRS score 1 week after the final session improved significantly compared to the total pre-ECT BPRS score. The GAF score also improved significantly compared to the pre-ECT GAF score. There were no adverse effects during the acute ECT course, except for mild delirium. We conclude that ECT may be an effective and safe treatment option for young adults with intractable first-episode schizophrenia.

Efficacy and Tolerability of Low-Dose Donepezil in Schizophrenia

There have been many advancements in the pharmacologic treatment of schizophrenia; however, negative symptoms and cognitive impairment remain an intractable part of this illness. Donepezil is an anticholinesterase inhibitor with cognitive enhancing effects approved for the treatment of Alzheimer disease that has shown some benefit in the treatment of schizophrenia. In this study, 15 inpatients at a state hospital with a history of schizophrenia were administered donepezil in a randomized, double-blind, crossover design. Neurocognitive testing and psychiatric ratings were completed at baseline and at regular intervals for 18 weeks. Results indicated that donepezil treatment was associated with modest improvements in psychiatric symptoms and improved verbal learning. These results suggest that donepezil may be helpful as adjunctive therapy for the treatment of psychiatric symptoms and cognitive impairment in a subgroup of schizophrenic patients.

Use of Ziprasidone in Parkinsonian Patients With Psychosis

Twelve patients with Parkinson disease and psychosis were included in an open-label 12-week trial of ziprasidone. Two patients withdrew from the treatment because of adverse effects. The remaining 10 patients reported a significant improvement in psychiatric symptoms. Altogether, there was no deterioration of motor symptoms (UPDRS III score: basal 40.4 +/- 11.1, first month 41.1 +/- 10.8; final visit, 37.7 +/- 13.3). Two patients (20%) suffered a slight deterioration in motor symptoms and another patient suffered deterioration of gait. No analytic alterations or serious adverse effects that could limit the use of ziprasidone were observed. Although controlled trials are needed, the findings suggest that ziprasidone may be effective in parkinsonian patients with psychosis.

Clinical comparison of extended-release divalproex versus delayed-release divalproex: pooled data analyses from nine trials

Divalproex sodium is an effective anticonvulsant, antimanic, and migraine prophylaxis agent. Recently, a new extended-release (ER) formulation of divalproex sodium has become available, which allows for once-daily dosing and provides prolonged therapeutic serum levels. Using data pooled from nine open-label trials involving 321 epilepsy and psychiatry patients, we compared the efficacy and tolerability of divalproex ER with preceding treatment with the older delayed-release (DR) formulation, based on patient reports and analysis by McNemar’s test for within-subject paired data. Divalproex ER was associated with superior tolerability with less frequent tremor, weight gain, and gastrointestinal complaints (all P < 0.001), but not less hair loss. Divalproex ER also yielded improved seizure control and greater improvement of psychiatric symptoms, and was greatly preferred by patients over divalproex DR. Although the results of the current analyses must be considered highly tentative due to the open-label nature of the trials included, the findings do suggest broad clinical superiority of the new ER preparation.