Non-organic Psychiatric Disorders Research Articles

Assessing decisional capacity for research participation in psychiatric patients and their relatives.

A cross-sectional study among adult inpatients with non-organic psychiatric disorders, and among their key relatives, assessed their comprehension and recall of key information in consent forms. It also assessed their capacity to consent to participate in two hypothetical randomised controlled trials (RCTs) with different potential risks and burdens, using structured questionnaires and recorded interviews. Of the 24 participants (12 patient-key relative dyads), seven patients (58%) and three key relatives (25%) were clinically judged to lack the capacity to consent. Of the remaining 14 participants s, less than half the patients (2/5; 40%) or relatives (3/9; 33%) accurately recalled 50% of the key information on both trials. Among the eight participants (3 patients, 5 relatives) independently assessed on the MacArthur Competence Assessment Tool for Clinical Research, the proportions judged competent for each trial varied with the criteria for defining competence. No one fulfilled the stringent competence criteria for both trials. Routine assessments of the capacity of psychiatric research participants, and of relatives providing proxy consent, appear to be warranted. However, neither suboptimal understanding of consent forms, nor incompetence determined by the use of formal assessment tools, necessarily denote an incapacity to consent to research if detailed clinical assessments indicate otherwise. Research into incorporating participants' health literacy and clinical status in formal assessments may help determine the optimal standards for defining competence.

Participation in randomised controlled trials: perspectives of psychiatric patients and key relatives.

This study assessed the perspectives of adults who had acute nonorganic psychiatric disorders and were admitted in a private, not for- profit medical college hospital, and also of their key relatives, on randomised controlled trials (RCTs). Structured questionnaires and audio-recorded interviews were used for the purpose. We explored their willingness and motivation to participate in two hypothetical RCTs with different risks and burdens. The transcripts of the interviews were analysed using the principles of grounded theory and framework analysis. Of the 24 consenting participants (12 patient and key-relative dyads), the 20 who completed the interviews had largely positive attitudes towards research and RCTs. However, 50% of those interviewed declined to participate in either of the hypothetical RCTs. The refusal to participate seemed to be influenced by a lack of education; forgetfulness, which impeded the process of making informed decisions; unfavourable benefit-risk-burden ratios; practical difficulties; dependence on treating doctors and relatives for decision-making; and the wish to exercise one's choice regarding treatment options. The factors that motivated the patients and relatives were trust in doctors and organisations, altruism, expectation of personal benefits and favourable risk-benefit ratios. These observations indicate that while the respondents in this study valued research, they were discerning about whether or not to participate in the trials; their decision-making was influenced by individualised assessments of risks and burdens and pragmatic considerations, rather than only by the benefits they would obtain.

Duloxetine in the Treatment of Depression: An Overview

Depression is a disorder that can be classified in the categories of non-organic psychiatric disorders and mood disorders. Mood tone is an important psychic function involved in the adaptation to both our internal and external world. It is flexible, that is, it goes up when we are in positive and favorable conditions, but it goes down when we are in negative and unpleasant states. We can define depression as a condition when mood tone loses its flexibility, it goes down and it's no longer influenced by favorable external events. In fact, depression is characterized by changes in the way how the affected individual thinks, feels and acts. Even if this change occurs gradually, a depressed subject is not the same as before. For example, a brilliant student could be persuaded to be not able to finish his studies; an affectionate mother could start to neglect her sons; an enterprising worker could lose every interest for his activity. Moreover, a depressed person doesn't care of his aspect or of himself. The surviving instinct could leave place to the desire to stop his own life. The most evident characteristic of depression in the adulthood is a sad mood, a gloomy solitary and apathetic attitude. A depressed subject could cry also with no apparent reason, he could have difficulty falling asleep or he could wake up very early in the morning and no longer returns to sleep. Or, instead, he could sleep more than usually and he could feel tired persistently. He could lose appetite and weight, or, in some cases, he could eat much more than usually and he could gain weight. Typically, a depressed person feels himself in a extremely negative way, he could think to be hopeless and helpless and he often condemns himself for small guilty. A depressed subject is pessimistic about himself and his own future; he loses interest in all what happens around him and he gets no satisfaction from the activities that before were pleasant. Some persons can be depressed also if they don't show evident signs of depression, but they complain for physical symptoms or they abuse of alcohol or other substances. It has been estimated that in the industrialized Western world one to six persons has a depressive episode at least once during his life; at present, the incidence of depression in the general population is around 5% with clear cut prevalence in the female sex. This leads to high social costs: behind the short-term inability, we have to consider also the long term inability (it has been estimated that, in 2020, depression will represent the second most frequent cause of permanent inability) as well as the suicide risk, the proved major susceptibility of depressed subjects to various non-psychiatric pathologies and the increased rate of premature deaths of depressed individuals as compared to the general population. The present work not only evaluates the drugs used for the treatment of depression, but it focuses also on those studies that investigated the efficacy of a second generation drug: Duloxetine that has a higher selectivity of action and a better tolerability profile as compared to first generation medications. These characteristics make Duloxetine the most effective therapeutic choice to improve both psychological and somatic symptoms of depression in order to get higher rates of symptomatic remission on depressive episodes.

Psychiatric morbidity in epilepsy: a case controlled study of adults receiving disability benefits

OBJECTIVETo compare the prevalence of non-organic psychiatric disorders among disabled patients of normal intelligence with epilepsy with the prevalence of similar psychiatric disorders among age and sex matched disabled patients...

The general population prevalence of non-organic psychiatric disorders in subjects aged 85 years and over.

The prevalence of psychiatric disorders was investigated in all inhabitants over 85 years of age (N = 1259), residing in Leiden, The Netherlands. The study design consisted of two phases. In the first phase the Mini-Mental State Examination (MMSE) and the 12-item version of the General Health Questionnaire (GHQ-12) were used to screen for potential cases; in the second phase all potential cases and a sample of the non-cases were interviewed with the Geriatric Mental State Schedule (GMS). DSM-III diagnoses were made based on the GMS and on information obtained from caregivers. There was a high prevalence of organic disorders of 31% (95% CI: 27-35%). The estimated overall prevalence rate for functional disorders was 8% (95%) CI: 4-12%). This is an underestimate because organic and functional disorders are mutually exclusive in DSM-III. The prevalence rate estimated for the population at risk for functional disorders (i.e. the total population minus the organic cases) was 12% (95% CI: 6-18%). This is very similar to prevalence rates for functional disorders found in population based surveys in younger age groups. Therefore, in contrast with the dementias, there appears to be no increase with age for the functional disorders.

Variation in cognitive functioning in nonorganic psychiatric disorders

Level of cognitive function is usually conceptualized as a feature of organic psychiatric disorders. Classically, its assessment is part of the mental status examination. Standardized tests, such as the Folstein battery, are used to screen for organic disorders by measuring level and possible impairment of cognitive function through the stipulation of cutoff points. However, contemporary definitions of psychiatric disorders do not embrace such a categorical view of cognitive function. It is important to measure the level of cognitive function in all types of psychiatric disorders in relation to demographic characteristics. Consequently, it is better to view cognitive function as a continuous variable. The Cognitive Function Inventory (CFI), which can also yield a Folstein score, was used to assess cognition in patients diagnosed as having nonorganic psychiatric disorders. A number of different parameters of cognitive function are examined. Differences associated with demographic background and type of disorder are reported. The implications of these results are discussed.

The long-term psychiatric consequences of accidental injury. A longitudinal study of 107 adults.

One hundred and seven accidentally injured adults were studied while in hospital and assessed prospectively twice more in a mean period of 28 months. The patients were studied by means of taped clinical interviews, including the Comprehensive Psychopathological Rating Scale (which includes the Montgomery-Asberg Depression Rating Scale), and several self-report measures of distress (Schedule of Recent Life Events, General Health Questionnaire, Impact of Event Scale and State Anxiety Inventory) at the three assessments. The total incidence of psychiatric disorders considered to be caused by the accident during the follow-up period was 22.4%. The incidence of non-organic psychiatric disorders caused by the accident was 16.8% at the first follow-up and 9.3% at the final follow-up. Depressive disorders of different severity were most often seen. Only one patient suffered from a post-traumatic stress disorder during the follow-up, and none at the final follow-up (DSM-III). Organic mental disorders were diagnosed in 9.3% of the patients. In 5.6% of the patients this was the only disorder.

Visual evoked potentials (VEPs) in senile dementia (Alzheimer type) and in non-organic behavioural disorders in the elderly; Comparison with EEG parameters

Forty-two patients with senile dementia of the Alzheimer type were compared with normal subjects (51) and with elderly patients with non-organic psychiatric disorders (40). All were examined by EEG (routine visual inspection and power spectrum density analysis) and VEP (pattern reversal) testing. In dementia the late components (N130, P165, N220) of the VEP are delayed, but the EEG was abnormal more often than the VEP.

Prosopo‐Affective Agnosia as a Symptom of Cerebral Organic Disease

A previously described test for prosopo-affective agnosia (impairment of facial affect recognition) had been applied in 14 disoriented elderly patients with chronic organic brain syndrome, 14 fully oriented elderly patients with non-organic psychiatric disorders, and 14 normal volunteers. In this re-test study of 37 of the 42 subjects, after a six-month interval, the test was found to be reliable (r = .75, p less than .001). The test was also more sensitive in detecting organic disorders than were other frequently applied neuropsychiatric tests. Prosopo-affective agnosia (PAA) appeared unrelated to prosopo-agnosia (PA) (r = .082, ns). Some patients who had the ability to recognize famous faces and faces of ward personnel were severely impaired in the ability to recognize facial affect. The deterioration was more pronounced for the recognition of sadness and anger than for happiness, indicating that patients with this impairment had reverted to an infantile mode of facial-affect recognition. This reversal is another example of the neurologic regression that characterizes dementia.

Neuropsychological test results associated with psychiatric disorders in adults.

This review addresses the question of whether neuropsychological tests can be used to discriminate between cerebral dysfunction and nonorganic psychiatric disorders. Considered are 94 studies that compared test scores of psychiatric patients with scores of brain-damaged patients or with established norms for organicity. Despite methodological inconsistencies and deficiencies across studies, most studies found that psychiatric diagnostic groups other than chronic or process schizophrenics performed better than organics on testing. Organic versus functional discrimination rates reported in these studies are similar to discrimination rates obtained by the tests when organics are compared with normal or general medical controls. Considered together with organicity base rate and error cost estimates, these discrimination rates are high enough to justify the use of most popular neuropsychological tests in psychiatric settings that do not have high proportions of chronic or process schizophrenics. The possibility is discussed that groups of chronic or process schizophrenics may look organic on neuropsychological tests because a significant proportion of such patients are organic.

The relation between neurosis and psychosis: a reanalysis.

Recently D. S. Trouton and A. E. Maxwell (7) reported the results of a factorial analysis of 45 variables derived from an Item Sheet used at the Bethlem Royal and Maudsley Hospitals. Their sample consisted of 819 male hospitalized patients aged 16-59 having non-organic psychiatric disorders. The variables included the major symptoms and past history notations of psychotic and neurotic patients. Their analysis yielded six factors, the first two of which were identified as “psychoticism” and “neuroticism”. The authors conclude that their findings support the view that the varied symptom patterns of mental illness can be accounted for by these independent components.