Occurrence Of Psychiatric Disorders Research Articles

Clinical and sociodemographic characteristics of patients with epilepsy attended at a regional reference psychiatric emergency unit

ObjectiveEpilepsy is one of the most prevalent chronic neurological diseases, presenting a high frequency of psychiatric disorders (PD). This study sought to evaluate the clinical and sociodemographic profile of patients with epilepsy (PWE) attended at a regional reference psychiatric emergency unit. MethodsA retrospective, cross-sectional, and descriptive observational study was conducted utilizing a patient record database of individuals with epilepsy who were attended in a regional reference psychiatric emergency unit between January 2018 and August 2022. ResultsOut of the 31,800 psychiatric emergency visits, 260 (0.8 %) were of patients with epilepsy (ICD-10: G40). The majority were males (63.5 %) with a mean age of 42.11±15.39 years, single marital status (154; 59.25 %) and elementary education (75; 28.9 %). Most of them (203; 78.1 %) presented at least one psychiatric comorbidity at the emergency visit, but 109 (41.9 %) were not receiving any psychiatric follow-up. A total of 106 patients (40.8 %) had experienced at least one past psychiatric hospitalization. ConclusionsThe occurrence of PD is highly prevalent in PWE, and probably with a high frequency of psychiatric emergencies occurring among them. Further studies are needed to assess such patient profile, particularly involving data from psychiatric emergency units.

Association of Chronic Obstructive Pulmonary Disease with Risk of Psychiatric Disorders: A Two-Sample Mendelian Randomization Study.

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder often accompanied by comorbidities. Although the past few years have witnessed significant scientific progress, the potential relationship between COPD and mental illness remains a subject of debate. We retrieved COPD data from the genome-wide association studies (GWAS) directory and data on mental illnesses, including Alzheimer's disease, schizophrenia, panic disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, multiple disabilities, obsessive-compulsive disorder, post-traumatic stress disorder, and schizophrenia, from the Psychiatric Genomics Consortium. A two-sample Mendelian randomization (MR) approach was applied to explore the association between COPD and mental illnesses, with subgroup analyses based on smoking history. Our two-sample MR analysis revealed no causal link between overall COPD and the development of common psychiatric disorders. Subgroup analyses based on smoking history showed no causal association between never-smokers with COPD and the occurrence of psychiatric disorders. However, ever-smokers with COPD were associated with a significantly increased risk of ADHD (OR: 2.303, 95% CI: 1.558-3.403, P = 0.001) and a modestly reduced risk of Alzheimer's disease (OR: 0.994, 95% CI: 0.988-0.999, P = 0.034). COPD patients with a history of smoking face a higher risk of developing ADHD but may experience a slight reduction in the risk of Alzheimer's disease. Conversely, there was no observed causal association between COPD and psychiatric disorders among patients who never smoked.

Psychiatric symptomatology in skin-restricted lupus patients without axis I psychiatric disorders: A post-hoc analysis.

Skin-restricted lupus is a chronic inflammatory disease associated with high rates of depression and anxiety disorders. Patients without psychiatric disorders can experience anxiety and depressive symptoms at a subclinical level, which could be risk factors for progression towards psychiatric disorders. It was decided, therefore, to investigate the presence of specific symptoms in skin-restricted lupus patients without axis I psychiatric disorders and their impact on the occurrence of axis I psychiatric disorders during the study follow-up. Longitudinal data of 38 patients and 76 matched controls without active axis I psychiatric disorders from the LuPsy cohort were used. Depressive, neurovegetative, psychic and somatic anxiety symptom scores were established from the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating scale (HAMA). None of the participants had any current active axis I psychiatric disorders but the patients had personality disorders more frequently and had received more past psychotropic treatments than the controls. They also had higher MADRS and HAMA scores than the controls, in particular neurovegetative, psychic anxiety and somatic symptoms scores. No dermatological factor tested was associated with these scores, whereas being a lupus patient was associated with higher neurovegetative and somatic symptoms scores, having a current personality disorder with higher depressive and neurovegetative scores and receiving more past psychotropic treatments with psychic anxiety and somatic symptoms scores. The occurrence of psychiatric disorders during the study follow-up was associated with an elevated psychic anxiety score at baseline and past psychotropic treatment but not with history of psychiatric disorder. The LuPsy cohort included a large number of patients with axis I psychiatric disorders, the sample without axis I psychiatric disorders is therefore limited. We observed numerous psychiatric symptoms among the skin-restricted lupus patients. They should therefore receive special attention in the management of their subclinical symptoms before they progress towards full psychiatric disorders.

Behavioral Intervention Technologies – Historical, Medical, Philosophical, and Ethical Perspectives

In this study, we will analyze, from philosophical, medical and bioethical points of view, the genetic ways in which the biological foundations of human behavior can be identified, as well as the technologies that can contribute to the modification of certain human behaviors, especially aggressive ones. Ideas about the inheritance of a certain behavior have been identified since Greek antiquity, but in the 20th century, along with sequencing and mapping of all genes of the members of our species, the possibility of identifying possible genes for learning and memory has emerged and therefore the ability to act on them through “behavioral genetics” could develop. In the dawn of the 21st century, researchers begin to consider that abnormal behaviors had a certain genetic mutation located on the “X” chromosome or on the “Y” chromosome and the concept of “genetics of intellectual disability” was introduced in the medical literature. After the identification of the genes or the constellation of genes that underlie the occurrence of psychiatric disorders, the researchers developed genetic engineering to be performed on certain groups of neuronal cells, but these activities lead to the question: how useful or dangerous these new genome editing technologies will be, especially in terms of conservation and perpetuation of the human species. We conclude that the chimera-type people, whose genetic structure is artificially constructed, would raise issues primarily about their identity, their integration into traditional societies, but also about the need for a new legislation. However, the future society will have, at some point, to accept the reality of genetic interventions, the purpose of which is to achieve much more radical transformations in human nature.

Occurrence of Psychiatric Disorders, Self-Sufficiency Problems and Adverse Childhood Experiences in a Population Suspected of Violent Extremism.

BackgroundPublic health-inspired programs for Countering Violent Extremism (CVE) have developed internationally in a relatively short period of time. Research into these programs is scarce. There is a need for information that helps drive public health interventions.ObjectivesTo present data on the occurrence of psychiatric disorders, self-sufficiency problems and adverse childhood experiences (ACE) in a population suspected of violent extremism.MethodsA cross-sectional study, with data from screening reports for 34 adult subjects included in a multi-agency case-based approach on violent extremism in Amsterdam, the Netherlands. Subjects were screened in the period between December 2015 to May 2021. Screening reports, which included the Screener for Intelligence and Learning Disabilities (SCIL) and the Dutch version of the Self-sufficiency Matrix (SSM-D), were used to gather information on the main outcome measures.ResultsMajor psychiatric disease categories were found to be mood and anxiety disorders and mild intellectual disability (each 29.4%), substance related disorders (35.3%), personality disorders (41.2%), and psychotic disorders (14.7%). Complex self-sufficiency problems, measured by the number of people who had self-sufficiency problems in 4+ domains and the number of people who had similar self-sufficiency problems as homeless people in Amsterdam, were found in 35.3 and 32.4% of the client sample. The most prevalent ACE were emotional neglect (47.1%), household mental illness (44.1%), and loss of a parent (38.2%), 35.3% had been exposed to 4+ ACE. An association was found between NACE and self-sufficiency problems on two domains, namely “Mental Health” (rho = 0.51, p = 0.002) and “Law and order” (rho = 0.42, p = 0.013).ConclusionsAn accumulation of social and psychiatric problems in people suspected of violent extremism underlines the importance of professionals in health and social care being actively involved in developing CVE approaches.

Anxiety and depression among new cancer patients.

Definitive diagnosis, tedious treatment methods, and long treatment duration are possible factors contributing to psychiatric disorders in cancerous patients, including anxiety and depression. Accordingly, this study aimed to investigate the effective factors on the occurrence of psychiatric disorders in newly diagnosed cancer patients. This descriptive-analytical study was conducted in Semnan, Iran, in 2018, in which 122 patients with cancer were included. In this study, the Hospital Anxiety and Depression Scale questionnaire was used to collect the required data. Frequency comparisons between the sub-groups were performed using the Chi-square test and, if necessary, Fisher's exact test. Moreover, the T-test or Mann-Whitney U test was used to compare numerical variables. In this study, the mean values of total depression and total anxiety among patients were 26.2% and 28.6%, respectively. According to the results, anxiety was observed in 74.3% of low-income people and 80% of females. Gender and income were significantly associated with anxiety in patients with cancer (p < 0/05). However, no significant association was found between depression and the variables of gender, age, level of education, and income (P > 0.05). The inclusion of psychiatric interventions in the treatment program of cancer patients can be effective in controlling psychiatric disorders, especially depression and anxiety.

Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery

Weight regain (WR) after bariatric surgery (BS) is frequent. The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS. Ninety-six patients (77.6% female, age 40.2 ± 10.1years, BMI of 50 ± 8.2kg/m2) from the Obesity and Bariatric Surgery Outpatient Clinic of the Universidade Federal São Paulo completed the Questionnaire on Eating and Weight Patterns-Revised, the Beck Depression Inventory and an anxiety inventory to assess the occurrence of binge eating, depressive symptoms (DS) and anxious symptoms (AS) before and after short-term and long-term BS. Twenty-four months after BS, the prevalence of binge eating, depression and anxiety decreased from 100 to 13%, 100 to 15% and 43 to 4%, respectively. The mean WR of 35.2 ± 17.3% of weight loss occurred in nine patients after 24months and was associated with binge eating (p = 0.002) but not with DS or AS. At long-term follow-up (12 ± 1.5years), 67% had a mean WR of 50.3 ± 24.9%. The prevalence of binge eating, DS and AS were 48%, 46% and 63%, respectively, in this group, and significant associations were observed between WR and binge eating (p = 0.001), DS (p = 0.029) and AS (p = 0.001). Furthermore, the number of psychiatric disorders was inversely associated with the percentage of weight loss (p < 0.05) and positively associated with WR (p < 0.05). Weight regain was associated with the occurrence of binge eating in the short and long term after BS, whereas the occurrence of depressive and anxious symptoms was associated with WR only in the long term. Evidence obtained from well-designed cohort or case-control analytic studies.

Mental Well-being of the First and Final-Year Medical and Dental Students of Kermanshah University of Medical Sciences

Background and Aim:Medical and dental students are predisposed to developing psychiatric disorders owing to heavy physical, intellectual, and emotional activities. This study was conducted to evaluate the mental health status of medical and dental students.Materials and Methods:This cross-sectional study was conducted on the first- and final-year medical and dental students at Kermanshah University of Medical Sciences in 2016. The mental health status was measured by the General Health Questionnaire-28 (GHQ-28) involving somatic, social, anxiety, and depression domains. Scores &gt; 6 (out of 28) and &gt; 2 (out of 7) were considered to show psychiatric disorder for each domain, respectively. Data were analyzed by SPSS-18 using Kruskal-Wallis and Chi-square tests (P&lt; 0.05).Results:The participants consisted of 246 students (39.4% first- and 37.8% last-year medical students; 8.1% first- and 14.6% last-year dental students) aged 18-37 years (22.6 ± 3.3). Psychiatric disorder, somatic symptoms, social dysfunction, anxiety, and depression were experienced by 44.7, 42.7, 46.3, 49.6, and 28.5% of the students, respectively. The prevalence of psychiatric disorder was comparable between the first- and final-year medical students (40.2% and 48.4%, respectively;P= 0.258). The final-year dental students significantly underwent more psychiatric disorder than the first-year dental students (61.1% and 20%, respectively;P= 0.003). There were no significant differences between the medical and dental students in the first (P= 0.089) and final (P= 0.196) years. There was also no significant association between the occurrence of psychiatric disorder and gender and age group (P&gt; 0.05).Conclusion:Psychiatric disorder was common among dental and medical students. Hence, preventive and control measures are suggested to improve their mental health.

Association between haematopoietic stem cell transplantation and distress - anxiety - depression

Introduction: In recent decades, more and more studies indicate that haematopoietic stem cell transplantation triggers numerous mental disorders to the haematological patient. Aim: The aim of the present study was to review the literature on the occurrence of mental disorders, such as distress, anxiety and depression in hematological patients undergoing haematopoietic stem cell transplantation. Material-Method: The method of this study included research of the literature from reviews and researches in «pubmed» and «google scholar» databases, which referred to the association between haematopoietic stem cell transplantation and the occurrence of psychiatric disorders. The search covered the period 2000-2015. Results: According to the literature, the process of bone marrow transplantation is often associated with the onset of distress, anxiety and depression in patients, which may adversely affect their compliance to treatment, the outcome of the procedure, and survival rates. However, many patients are reluctant to express their feelings, and are not questioned by health professionals about their mental worries. As a result, the psychological aspects of their disease may be underestimated. Furthermore, in this group of patients that display numerous physical symptoms, is difficult to diagnose and treat psychological aspects because they often mimic those of their disease. Conclusions: The systematic appraisal of distress, anxiety and depression should be an integral part of the treatment of hematological patients undergoing transplantation.

Akut REM Uyku Yoksunluğu Oluşturulan Sıçanlarda Uzun dönem Ilımlı Egzersizin Depresif/Anksiyete Benzeri Davranış Üzerine Etkisi

Uyku iç ve dış faktörlerden etkilenen, belli dönemlerinde beynin uyanıklıktaki kadar aktif olduğu fizyolojik bir süreçtir. REM uyku yoksunluğunda psikiyatrik bozuklukların daha sık görülmesi nedeniyle ruhsal dinlenmeyi sağlayan bir dönem olduğu ve depresyon/anksiyete benzeri durumlara sebep olduğu literatürde belirtilmiştir. Fiziksel egzersizin depresif/anksiyete üzerine yararlı olabileceğine dair literatürde çalışmalar bulunmaktadır. Ama uygulanan fiziksel egzersizin ve uyku yoksunluğunun süresi ve şiddeti sonuçları etkilemektedir. Bu nedenle çalışmamızda uzun dönem egzersizin akut REM uyku yoksunluğu oluşturulmuş sıçanlarda depresyon/anksiyete davranışına olan etkisi incelenmiştir. Sıçanlar kontrol (K), egzersiz (E), REM uyku yoksunluğu (UY) ve egzersiz + REM uyku yoksunluğu (E+UY) olmak üzere (n=7) bölünmüştür. REM uyku yoksunluğu oluştururken sıçanlar 48 saatlik bir dönemde uyku yoksunluğu düzeneğinde barındırılmışlardır. Egzersiz uygulaması 15, 30, 45 ve 60 dakika olmak üzere 4 hafta boyunca treadmill ile gerçekleştirilmiştir. Depresif /anksiyete davranışları açık alan ve yükseltilmiş plus maze ile değerlendirilmiştir. Uyku yoksunluğu grubunun açık alan testinde daha az mesafe kat ettiği gösterilmiştir. Yükseltilmiş plus maze testinde yine uyku yoksunluğu grubundaki sıçanların diğer gruplara göre açık kolda daha az süre geçirdikleri ve bu kola giriş çıkış sayılarının da azaldığı gözlemlenmiştir. Davranış testi bulguları, uyku yoksunluğunun oluşturduğu depresif/anksiyete benzeri etkilerin ılımlı treadmill egzersizi tarafından azaltıldığını göstermektedir.

Sterile Inflammation of Brain, due to Activation of Innate Immunity, as a Culprit in Psychiatric Disorders.

Evidence has accumulated that the occurrence of psychiatric disorders is related to chronic inflammation. In support of this linkage, changes in the levels of circulating pro-inflammatory cytokines and chemokines in the peripheral blood (PB) of psychiatric patients as well as correlations between chronic inflammatory processes and psychiatric disorders have been described. Furthermore, an inflammatory process known as “sterile inflammation” when initiated directly in brain tissue may trigger the onset of psychoses. In this review, we will present the hypothesis that prolonged or chronic activation of the complement cascade (ComC) directly triggers inflammation in the brain and affects the proper function of this organ. Based on the current literature and our own work on mechanisms activating the ComC we hypothesize that inflammation in the brain is initiated by the mannan-binding lectin pathway of ComC activation. This activation is triggered by an increase in brain tissue of danger-associated molecular pattern (DAMP) mediators, including extracellular ATP and high-mobility group box 1 (HMGB1) protein, which are recognized by circulating pattern-recognition receptors, including mannan-binding lectin (MBL), that activate the ComC. On the other hand, this process is controlled by the anti-inflammatory action of heme oxygenase 1 (HO-1). In this review, we will try to connect changes in the release of DAMPs in the brain with inflammatory processes triggered by the innate immunity involving activation of the ComC as well as the inflammation-limiting effects of the anti-inflammatory HO-1 pathway. We will also discuss parallel observations that during ComC activation subsets of stem cells are mobilized into PB from bone marrow that are potentially involved in repair mechanisms.

Association between the variability of the ABCA13 gene and the risk of major depressive disorder and schizophrenia in the Han Chinese population

Objectives: The ATP-binding cassette transporter superfamily is one of the largest membrane protein families, which is responsible for transportation of substances across the membranes by utilising energy. Some research has bridged the variations in ABCA13 with occurrence of psychiatric disorders. To investigate the overlapping risk conferred by ABCA13 for both major depressive disorder and schizophrenia, we analysed tag single nucleotide polymorphisms (tag SNPs).Methods: We used TaqMan® technology to genotype 1045 major depressive disorder patients, 1235 schizophrenia patients and 1235 healthy controls of Han Chinese origin.Results: We found that rs7789493 (Pallele = 7.23E-04, Pgenotype =.001) was associated with major depressive disorder, while rs17132388 (Pallele = 1.63E-04, Pgenotype = 7.50E-04) and rs6583476 (Pallele = 5.50E-04, Pgenotype =.002) showed statistically significant association with schizophrenia.Conclusions: Our results indicate that the ABCA13 gene may contain overlapping common genetic risk factors for both major depressive disorder and schizophrenia in the Han Chinese population. The study on variants conferring overlapping risk for multiple psychiatric disorders could be tangible pathogenesis support in clinical or diagnostic references.

Thyroid Hormone Levels in Chronic Schizophrenic Patients: Association with Psychopathology.

Thyroid disorders are highly prevalent in patients with schizophrenia. Changes in the levels of thyroid hormones cause the occurrence of psychiatric disorders and affect the response to treatment. The aim of this study was to investigate the changes in thyroid hormone levels in patients with chronic schizophrenia, and to demonstrate any association between psychiatric symptoms and hormones. Sixty-three patients with schizophrenia and 53 controls were included in this study. The serum levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) in patients and controls were tested by using the chemiluminescence immunoassay. Symptoms were assessed via the Positive and Negative Syndrome Scale (PANSS). The level of FT4 in the schizophrenia group was statistically significantly lower than the control group (p = 0.045). There was no significant difference between the clinical subtypes of schizophrenia and thyroid hormone levels. There was a mild negative correlation between PANSS negative subscale scores and levels of TSH (p = 0.023). These findings suggest that the subclinical hypothyroidism observed in the chronic schizophrenic patients may be associated with the treatment of neuroleptics. The possible alterations of thyroid hormones should be considered in chronic schizophrenic patients for treatment with neuroleptics.

Bipolar disorder preceding the onset of multiple sclerosis

Multiple sclerosis (MS) is the most common inflammatory demyelinating brain disease. The occurrence of psychiatric disorders, especially for major depression, in the course of MS is high. Reports concerning bipolar disorder (BD) remain rather scarce although early descriptions were found in the old neurological literature. The purpose of this article is to provide a critical review of the epidemiology, comorbidity, and treatment findings regarding BD preceding the onset of MS.

Analysis of psychiatric heredity in patients with agoraphobia and panic disorder

Introduction: The previous studies report high prevalence of psychiatric disorders among family members of patients with agoraphobia and panic disorder. In our country there have been no studies that examine psychiatric heredity in patients with agoraphobia and panic disorder. Objective: The objective of the research is to investigate the presence of heredity in patients with agoraphobia and panic disorder, and to compare the clinical and demographic characteristics of patients with agoraphobia and panic disorder with and without psychiatric heredity. Method: The sample included 40 patients with panic disorder and agoraphobia. Data were obtained from the questionnaire for the assessment of panic disorder NIMH-PQ, which included questions about the occurrence of psychiatric disorders in families of the patients, as well as 44 questions about the severity and frequency of panic disorder symptoms. Results: The results indicate that the majority of patients (62.5 %) have the positive psychiatric heredity. The most frequent were depression and alcoholism. The results, also, showed that there are no significant differences in the characteristics of the main symptoms of panic disorder of patients with and without psychiatric heredity. Conclusion: The results of the study indicate high prevalence of psychiatric heredity in patients with panic disorder and agoraphobia but more studies are needed to conclude that there is a direct link between family history of psychiatric disorders and occurrence of panic disorder and agoraphobia.

Acute psychosis following diabetic ketoacidosis in an 11-year-old, management challenges in a resource-limited setting

Diabetes mellitus (DM) is the most common endocrine disorder in children and type 1 DM is the most common; however increasing incidence of type 2 DM is being reported, especially in western societies. Occurrence of psychiatric disorders has been associated with type 2 DM but is rare in those with type 1 DM; therefore the case of an 11-year-old girl who was treated for diabetic ketoacidosis, but suddenly developed acute psychotic symptoms shortly after regaining consciousness is reported. Atypical antipsychotic medications were avoided in this case for concerns of their risk of causing abnormal glucose metabolism.

Evaluation of the psychoneurotic tendencies risk using the woodworth mathews personality inventory in non-institutionalized persons.

INTRODUCTION: Multiple factors of vulnerability may lead to development of abnormal social behaviour and to important psychiatric diseases. The psychopathological characteristics present at individual level can lead to a pattern of population groups that are subject to developing mental illness risks. MATERIAL AND METHODS: Multidisciplinary study (2009-2011) to assessing the current situation of mental health and identifying population risk groups for developing psychiatric disorders in a non-institutionalised population. We used the Woodworth Mathews Inventory (76 items) to a randomly selected sample of 1,200 men and women, residents in urban and rural areas. RESULTS: The extreme scores for emotiveness had a frequency more than triple for women, and we found a similar situation for obsessive-neurasthenic and depressive tendencies. People aging over 35 years had a double score (limit and poignancy) for depression than younger people, meanwhile correlation between age under 35 years and instability and antisocial tendencies is highly statistically significant (p<0.001), the frequency of extreme scores being almost double than in the older people. CONCLUSIONS: Female gender has a vulnerability for develop depressive and emotional disorders and age over 35 is also significant correlated with depressive tendencies. Younger people (under 35 years) are predisposed for pathological antisocial behaviour, fact revealed by the high scores for instability and antisocial tendencies. It is necessary to develop a program focused on the two risk categories to prevent the possible occurrence of psychiatric disorders.

Traumatic Brain Injury: Why Psychiatrists Matter

Back to table of contents Previous article Next article From the ExpertsFull AccessTraumatic Brain Injury: Why Psychiatrists MatterJonathan Silver, M.D.Jonathan SilverSearch for more papers by this author, M.D.Published Online:7 Dec 2012https://doi.org/10.1176/pn.47.23.psychnews_47_23_26-bEach year in the United States, almost 2 million people sustain a traumatic brain injury (TBI); it is the second most common neurologic disorder (after headache), and more common than stroke and Alzheimer’s disease. The “signature injury” of our wounded warriors from Iraq and Afghanistan, athletes who sustain concussions, and former Rep. Gabrielle Giffords’ traumatic brain injury has increased the awareness of the extent of this disorder.While attention is often focused on physical and cognitive sequelae, the occurrence of psychiatric disorders is significant and complicates functioning and treatment. While neurologists, physiatrists, and internists see many individuals with TBI, psychiatrists have a critical role to play in the treatment of these patients. We need to know the common physical sequelae (such as vestibular and visual problems, headaches), as well as the appropriate evaluation and treatment of emotional and behavioral problems (irritability, depression, anxiety, fatigue, sleep disorders).There are several important facts that psychiatrists should know when evaluating a patient who has sustained a mild TBI. First, one does not have to lose consciousness to sustain a concussion: any alteration in sensorium (including feeling dazed, seeing stars, and so on) is sufficient for the diagnosis of TBI. Second, medical records are often inaccurate (up to 50 percent of concussions are missed in the emergency room). Third, patients confuse “posttraumatic amnesia” (where they do not remember what happened for a period before and after the injury) with being unconscious. Unless there is a witness, the patients know only that they have no recall—not whether they were unconscious. Fourth, imaging modalities (MRI, CT) are most often normal. Newer techniques such as DTI (diffusion tensor imaging) are promising, but “not ready for prime time.” Lastly, the vast majority of individuals with a concussion have significant or complete recovery within a few months. Thus, it is important to be optimistic regarding recovery. In fact, the presence of psychiatric disorders is a major factor in impairing ability to function following injury.After TBI, there is an increased risk of developing almost every psychiatric disorder, especially depression and anxiety. In patients who have suffered trauma, the presence of TBI increases the likelihood of posttraumatic stress disorder (PTSD), panic disorder, agoraphobia, and social phobia; and it is the psychiatric disorder, not TBI, that increases the likelihood of self-reported functional impairment. Multiple studies have shown that coexistent anxiety or depression increases the severity of postconcussive symptoms, and psychological distress and results in poorer outcome as well as impaired performance on neuropsychological tests.In soldiers who have returned from Iraq and Afghanistan, the presence of PTSD is more strongly correlated with “postconcussive” symptoms and health and psychosocial outcomes than is the occurrence of a mild TBI. Symptoms of PTSD overlap with symptoms following concussion, and PTSD may occur in situations where a mild brain injury also occurs. It is important, but difficult, for clinicians to sort out when symptoms are due to PTSD and not the lingering effects of brain injury.Because those who have sustained a traumatic brain injury almost, by definition, have experienced a traumatic event, the emotional and psychological repercussions of the event must be explored. Depression, anxiety, irritability, in addition to problems with concentration, memory, fatigue, and sleep, can improve with appropriate and informed treatment, including pharmacologic modalities. Psychiatrists need to be aware of the evidence substantiating the treatment options to provide patients the best care possible. Lastly, since TBI is one of the few preventable neuropsychiatric disorders, we need to counsel our patients regarding appropriate interventions, including the dangers of cell phone use (even hands free) while driving or walking. To provide a professional example, I suggest that physicians should not call our patients while either we or they are driving. Jonathan Silver, M.D., is a clinical professor of psychiatry at the New York University School of Medicine. He is a past president and fellow of the American Neuropsychiatric Association and a diplomate in behavioral neurology and neuropsychiatry from the United Council for Neurologic Subspecialties. He is a coauthor of the Textbook of Traumatic Brain Injury, Second Edition, by American Psychiatric Publishing. Members can purchase the book at a discount at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62357. ISSUES NewArchived

Prevalence and Effects of Violence Against Women in a Rural Community in Minia Governorate, Egypt*

This study was carried out to investigate prevalence and the characteristics of domestic violence (DV) against women in a rural area in Minia governorate, Egypt, as well as its physical and psychological consequences. Seven hundred and seventy-two women were interviewed. Sociodemographic data were collected; the WHO questionnaire was used to identify the abuse; the Structured Clinical Interview for DSM IIIR (SCID) to detect psychiatric disorders. Abused females constituted 57.4% of the total sample. There were significant relationships between DV and low education, low income, higher number of children, and husband's education. Psychiatric disorders occurred in 18% of the sample. There were statistically significant relationships between psychological and physical abuse of women and the occurrence of psychiatric disorders. In conclusion, DV against women was related to various negative health outcomes, and it is recommended to be given its real importance in both Forensic Medicine Council and in psychiatric assessment.

Pregnancy is associated with psychiatric symptoms in a low-income countryside community of Brazil

BackgroundPsychiatric symptoms during pregnancy induce an increase in morbidity and also in the mortality levels among women and children. However, the real association between pregnancy and psychiatric disorders and the peculiarities of the phenomenology of symptoms in underprivileged countryside communities remain uncertain.ObjectiveTo verify the association between psychiatric disorder, symptoms, and pregnancy among women from a low-income countryside community and to determine the specific cutoff points for major depression diagnosis according to Beck Depression Inventory for the different trimesters of pregnancy in this population.MethodsNinety-four pregnant women and 38 healthy women from the Conceição do Mato Dentro health service, a rural low-income community in Brazil, participated in the present study. Psychiatric examination included a structured clinical interview for psychiatric disorders according to Mini International Neuropsychiatric Interview and psychometric scales such as the Yale–Brown Obsessive Scale, the Beck Depression Inventory, and the Hamilton Anxiety Scale. The cutoff points for Beck Depression Inventory were determined through the application of receiver operating characteristic curves considering the diagnosis of major depression according to Mini International Neuropsychiatric Interview.ResultsThe pregnant women had a higher frequency of psychiatric disorders and depression and anxiety symptoms. All cutoff points of Beck Depression Inventory were equal or higher than 12 with high sensitivity and specificity. Although the modified cutoff was selected based on both high sensitivity and high specificity, they were lower than when the cutoff was applied to nonpregnant women.ConclusionPregnancy was associated with the occurrence of psychiatric disorders and depressive and anxiety symptoms. In comparison to the literature, the present results indicate that there are different cutoff points in the Beck Depression Inventory for pregnant women from different cultures and in different pregnancy trimesters.