Previous History Of Psychiatric Disorders Research Articles

Post-traumatic stress disorder after weaning from prolonged mechanical ventilation

Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify patients at risk for developing PTSD. A prospective longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation was undertaken: 72 patients were studied 1 week after weaning, and 41 patients were studied again 3 months later. An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD. To assess for the presence of PTSD-related symptoms, the post-traumatic stress syndrome (PTSS-10) questionnaire was administered 1 week after weaning and 3 months later. The psychologist diagnosed PTSD in 12% of patients 3 months after ventilator weaning. Patients who developed PTSD were more likely to have a previous history of psychiatric disorders (P < 0.02). A PTSS-10 score >20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later: sensitivity 1.0; specificity 0.76; area under the receiver-operating characteristic curve 0.91. PTSD was diagnosed in 12% of patients who were weaned from prolonged ventilation. A PTSS-10 score >20 one week after weaning identified patients diagnosed with PTSD 3 months later. This finding suggests that a simple questionnaire administered before hospital discharge can identify patients at risk for developing PTSD.

Psychiatric Morbidity Among Suicide Attempters Who Needed ICU Intervention

Background : Suicide is a tragic and serious but preventable public health problem all over the world including Bangladesh. Committing suicide has become a burning issue and mortality rate increases especially in young females. Psychiatric evaluation is needed in suicide attempted patients for better management plan to reduce such unnatural mortality, as well as the impairment related to suicidal thought and psychiatric disorders. Objectives: To assess the psychiatric disorders and conditions that needed sufficient clinical attention among the suicide attempters who needed ICU intervention. Methods: This cross-sectional study was carried out in an Intensive Care Unit (ICU) of a private hospital of Dhaka City from July 2008 to December 2008. Total forty four subjects of attempted suicide were included in the study and psychiatric diagnosis was made by using Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV by psychiatrists after initial physical problems subsided. Results: The most common psychiatric diagnosis was Major Depressive Disorder. Female suffered more and among them attention-seeking behaviors were frequent. Thirty-four patients (77.3%) had previous history of psychiatric disorder. Chemicals (like; organophosphorous, kerosene, harpic and other medicine overdose) ingestion was the most frequently used method by the suicide attempters. Conclusion: This study may be helpful for further research regarding suicide attempters and its' association with mental problems. In primary health care setting, the physicians may get a clue to design a system for preventing, early recognition and managing suicidal ideas, thoughts and attempts. Psychiatric consultation should be made mandatory for all patients admitted following attempted suicide. DOI: 10.3329/bsmmuj.v2i2.4761 BSMMU J 2009; 2(2): 73-77

Factors predicting drop‐out in community mental health centres

This study aimed to identify treatment, therapist and patient factors associated with dropping out of treatment in four outpatient mental health services. The experimental group comprised all 789 individuals who attended for the first time the mental health services during one year and dropped out of treatment in the same year or during the two following ones. The control group consisted of the same number of individuals, chosen at random from patients who, in the same year, attended for the first time the services and did not subsequently drop out of treatment. The overall drop-out rate was 33.2%. According to logistic regression analysis, the predictive factors of dropping out were: being treated in a particular centre, the involvement of more than one therapist in treatment, having no previous history of psychiatric disorders, being young and being male.

Varenicline may induce psychotic symptoms in subjects without previous history of psychiatric disorders

Varenicline may induce psychotic symptoms in subjects without previous history of psychiatric disorders

Antiepileptic drugs and psychopathology of epilepsy: an update

Anti-epileptic drugs (AEDs) continue to be the mainstay of epilepsy treatment, but the benefits of seizure control need to be weighed carefully against possible adverse effects, which can include behavioral problems and psychiatric disorders. In this paper, the associations between AEDs and psychosis, depression and behavioral changes are reviewed. The concept of forced normalization and its clinical counterpart, alternative psychosis, are also discussed. Depression seems to be linked with AEDs potentiating GABAergic neurotransmission in patients with limbic system abnormalities such as hippocampal sclerosis. Psychoses have been described as associated with several of the new AEDs, and they are often seen in a setting in which previously refractory patients suddenly become seizure-free. In general terms, the use of AEDs in monotherapy, adopting slow titration schedules and low doses when possible, can significantly reduce the occurrence of behavioral adverse effects. A previous history of psychiatric disorder or a familial predisposition are important risk factors and should be always considered when choosing the appropriate AED.

Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics

Objective The principal aims of this study were to examine the prevalence rate, clinical characteristics, and related factors of postpartum obsessive-compulsive disorder (OCD). Method The subjects were a nonclinical sample of 400 postpartum women. They were interviewed from the 2nd up to the 26th week after birth. The Mini International Neuropsychiatric Interview was used for diagnosis of OCD, the Yale-Brown Obsessive-Compulsive Symptom Checklist was used to determine the types of obsessions and compulsions, and the Structured Clinical Interview for DSM-IV Axis I Disorders was used to diagnose comorbid depressive episode. Results Thirty-six (9%) of the sample met the diagnostic criteria for OCD according to the Mini International Neuropsychiatric Interview, and 9 (2.3%) reported postpartum onset OCD. Obsessive-compulsive disorder was more frequent in mothers with personal history of previous psychiatric disorder, somatic disease, or obstetric complication in pregnancy/birth, and who were multiparous. The most common obsessions were aggressive, contamination and miscellaneous, and compulsion for washing/cleaning and checking, and 38.9% have a comorbid depressive episode. Conclusion Women have increased risk of OCD or obsessive-compulsive symptoms in the postpartum period. For this reason, all women, particularly women with previous psychiatric history, somatic disease, or with complications in pregnancy or at the birth should be carefully screened for OCD in the postpartum period.

POSTTRAUMATIC STRESS DISORDER AND RISK FACTORS IN PARENTS OF CHILDREN WITH A CANCER DIAGNOSIS

The purpose of this study was to determine the prevalence of posttraumatic stress disorder (PTSD) in parents of children with cancer. Five questionnaires were administered to 104 parents, including a sociodemographic questionnaire, a traumatic events check list, the Structured Clinical Interview for DSM-IV PTSD and Major Depressive Disorder modules, and the self-rating instrument General Health Questionnaire-12. The prevalence of PTSD was 34.6%. The statistically significant tendency to develop PTSD were found in the female gender, better educational status, death of a loved one, previous history of psychiatric disorder, having a child with poorer prognosis, and the presence of radiotherapy in child's treatment. The vulnerable parents must receive psychosocial support.

Depression and anxiety during pregnancy and six months postpartum: a follow‐up study

To investigate the relationship between antenatal and postpartum depression and anxiety and to explore associated maternal characteristics. From a population-based sample of 1,555 women attending two obstetric clinics in Sweden, all women with an antenatal psychiatric diagnosis (n = 220) and a random selection of healthy women (n = 500) were contacted for a second assessment three to six months postpartum. The Primary Care Evaluation of Mental Disorders was used for evaluation on both occasions. Fewer cases of depressive and/or anxiety disorders were prevalent postpartum compared with the second trimester screening. Depression and/or anxiety were prevalent in 16.5% of postpartal women versus 29.2% of pregnant women. There was a significant shift from a majority of subthreshold diagnoses during pregnancy to full Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnoses during the postpartum period. A history of previous psychiatric disorder, living single, and obesity were significantly associated with a new-onset postpartum psychiatric disorder. The absence of a previous psychiatric disorder was significantly associated with a postpartum recovery of depression or anxiety. Depression and anxiety appear to be less common postpartum than during pregnancy.

Major depression with psychosis after resection of a giant middle fossa hemangiopericytoma

Background Postoperative onset of acute major depression in a patient with no previous history of psychiatric disorder is highly unexpected after skull base surgery. Case Description A 38-year-old woman with no previous physical or mental illness presented with a 3-month history of left ear pain, short-term memory disturbance, and motor dysphasia. Magnetic resonance imaging revealed a large extraaxial tumor in the left middle fossa. Left temporal craniotomy was performed, achieving complete tumor resection. The patient showed signs of confusion, disorientation, and severe depression 3 days after the surgery. She developed insomnia and auditory hallucinations along with expressed suicidal ideation, then deteriorated rapidly, necessitating a transfer to a psychiatric unit. In spite of the intensive treatment with antidepressive and antipsychotic medications, she continued to have prolonged psychotic symptoms and depression for several months after surgery. Conclusion Although the incidence is rare, psychiatric complications should be anticipated in patients undergoing resection of a large skull base tumor affecting the temporal lobe. The exact mechanism in this process is not clear; however, it is important to clinically differentiate treatable etiologies such as steroid-induced psychosis and postoperative delirium.

Dietary Folate and Depressive Symptoms Are Associated in Middle-Aged Finnish Men

Several cross-sectional studies have focused on the low blood folate levels of depressed patients. However, no published studies have examined the association between dietary folate and current symptoms of depression in a general population. We investigated the association between dietary folate, cobalamin, pyridoxine and riboflavin and current symptoms of depression in a cross-sectional general population study. We recruited 2682 men aged between 42 and 60 y from eastern Finland. Those who had a previous history of psychiatric disorder were excluded (n = 146, 5.6% of the cohort). Depressive symptoms were assessed with the 18-item Human Population Laboratory Depression Scale. Those who scored 5 or more at baseline were considered to have elevated depressive symptoms (n = 228, 9.3% of the cohort). The participants were grouped into thirds according to their dietary folate intake. Those in the lowest third of energy-adjusted folate intake had a higher risk of being depressed [odds ratio (OR) 1.67, 95% CI = 1.19-2.35, P = 0.003] than those in the highest folate intake third. This increased risk remained significant after adjustment for smoking habits, alcohol consumption, appetite, BMI, marital status, education, adulthood socioeconomic status and total fat consumption (OR = 1.46, 95% CI = 1.01-2.12, P = 0.044). There were no associations between the intake of cobalamin, pyridoxine or riboflavin, and depression. These results indicate that nutrition may have a role in the prevention of depression.

Safety and Tolerance of Efavirenz in Different Antiretroviral Regimens: Results from a National Multicenter Prospective Study in 1,033 HIV-Infected Patients

Purpose: To evaluate the incidence and severity of adverse events (AEs) and treatment interruption (TI) with efavirenz in a population with a high rate of intravenous drug use (IVDU). Method: This was a national, multicenter, and observational study of HIV-infected adult patients who were starting an efavirenz-containing regimen. Evaluations of AEs were made in routine clinical practice at baseline and at least 3 months later. A total of 1,033 patients were included from 60 participating hospitals; 20% were antiretroviral naive. The risk factor for HIV infection was IVDU in 62.3%, and 6.6% of participants were on methadone. Results: AEs affected 29.3% of participants, and treatment was interrupted in 8.23%. The most frequent AEs were CNS disturbances that affected 24.1% participants; these AEs were considered related to efavirenz in 18.5% patients. AEs were not severe, and treatment had to be interrupted in 6% of patients. Other AEs were cutaneous rash (incidence of 5.9%; 2.4% of TI), gastrointestinal disturbances (1.45%; no TI), and elevation of liver function test (0.68%; no TI). Patients taking methadone had more AEs (39.7%), mainly CNS disturbances, and TI (19.1%). Cutaneous rash was more frequent among women. Psychoactive drug consumption, previous history of psychiatric disorders, antiretroviral experience, or previous nevirapine intolerance were not associated with higher incidence of AEs. Conclusion: Safety and tolerance of efavirenz is good in most patients, even in a population with a high rate of IVDU. The most common AEs are CNS disturbances; they are not severe and rarely lead to TI.

Safety and Tolerance of Efavirenz in Different Antiretroviral Regimens: Results from a National Multicenter Prospective Study in 1,033 HIV-Infected Patients

Purpose: To evaluate the incidence and severity of adverse events (AEs) and treatment interruption (TI) with efavirenz in a population with a high rate of intravenous drug use (IVDU). Method: This was a national, multicenter, and observational study of HIV-infected adult patients who were starting an efavirenz-containing regimen. Evaluations of AEs were made in routine clinical practice at baseline and at least 3 months later. A total of 1,033 patients were included from 60 participating hospitals; 20% were antiretroviral naive. The risk factor for HIV infection was IVDU in 62.3%, and 6.6% of participants were on methadone. Results: AEs affected 29.3% of participants, and treatment was interrupted in 8.23%. The most frequent AEs were CNS disturbances that affected 24.1% participants; these AEs were considered related to efavirenz in 18.5% patients. AEs were not severe, and treatment had to be interrupted in 6% of patients. Other AEs were cutaneous rash (incidence of 5.9%; 2.4% of TI), gastrointestinal disturbances (1.45%; no TI), and elevation of liver function test (0.68%; no TI). Patients taking methadone had more AEs (39.7%), mainly CNS disturbances, and TI (19.1%). Cutaneous rash was more frequent among women. Psychoactive drug consumption, previous history of psychiatric disorders, antiretroviral experience, or previous nevirapine intolerance were not associated with higher incidence of AEs. Conclusion: Safety and tolerance of efavirenz is good in most patients, even in a population with a high rate of IVDU. The most common AEs are CNS disturbances; they are not severe and rarely lead to TI.

Behavioral and Psychological Symptoms of Dementia and Caregiver Burden

Most patients with Alzheimer's disease (AD) are cared for in their own homes. The costs of this care can be documented in several different ways—financial, time spent in the caregiving role, and strain or burden on the caregiver. This strain and burden on caregivers can manifest in a variety of ways, including increased use of prescribed medication and more primary care visits (Haley, 1997). Vulnerability to strain is heightened by a previous history of psychiatric disorder in the caregiver (Baumgarten et al., 1992; Hooker, 1992). Depression is a particularly common accompaniment to the caregiving role, affecting between 25% and 70% of caregivers (Dura et al., 1990; Teri, 1994). Physical manifestations of caregiving burden include impaired immune function, elevated blood pressure, abnormal plasma lipid levels, and poor self-care (e.g., sleeplessness and lack of exercise) (Haley, 1997).

Clinical correlates of early-onset and late-onset poststroke generalized anxiety.

The authors' goal was to determine if generalized anxiety diagnosed while a patient was hospitalized for stroke (early onset) had the same clinical correlates as anxiety beginning 3 months or more after the stroke (late onset). Patients with acute stroke (N = 142) were examined while they were in the hospital and 3, 6, 12, and 24 months later for the presence of anxiety symptoms. Patients underwent a structured psychiatric interview as well as assessment of cognitive, physical, and social function at each visit. Patients with early-onset and late-onset poststroke generalized anxiety were identified and compared to patients without poststroke generalized anxiety. The frequency of early-onset poststroke generalized anxiety was 27% and that of late-onset poststroke generalized anxiety was 23%. Three-quarters of the anxious patients had comorbid major or minor depression. Patients who developed early-onset or late-onset poststroke generalized anxiety were no more socially, cognitively, or physically impaired than patients who did not develop anxiety. Early-onset but not late-onset anxiety was associated with a previous history of psychiatric disorder. The median duration of late-onset anxiety was 3.0 months, and that of early-onset anxiety was 1.5 months. The presence of anxiety was significantly associated with depression; onset of depression and onset of anxiety occurred at approximately the same time. These findings suggest that although early-onset and late-onset poststroke generalized anxiety are phenomenologically similar, they may be the result of different pathophysiological mechanisms.

Psychiatric Problems among Medical Admissions

The prevalence, nature, associations and outcome of psychiatric morbidity among four hundred and fifty severe general medical admissions are described. Affective disorder was diagnosed in 13 percent of men and 17 percent of women. It was associated with a history of previous psychiatric disorder and current social problems. Persistent affective disorder after discharge was associated with continuing medical and social problems. Alcohol problems were common in men, especially in those with social problems, and often went unrecognized by medical staff. Cognitive impairment was confined to the elderly and was associated with longer hospital stay and high mortality. Patients with emotional and cognitive disorder make considerable demands on medical, social and psychiatric services during and following admission. The implications for improved recognition and management of psychiatric morbidity in general medical patients are discussed.

Life events and social stress in puerperal psychoses: absence of effect

Thirty-three patients admitted to hospital with severe early onset puerperal psychiatric disorders were compared with matched normal puerperal controls. Interviews, which were administered after recovery, covered life events in the previous thirteen months and detailed assessment of previous and personal history, pregnancy and labour, other aspects of stress, social support, and marital relationships. No differences, except for previous history of psychiatric disorder, were found between patients and controls or between patients with depressive and with other diagnoses. These findings of absence of social stress contrast with previous studies of milder post-partum depression and of disorders with onset during pregnancy, and suggest that the aetiology of severe post-partum disorders is predominantly biological.

Opisthotonus and other unusual neurological sequelae after outpatient anaesthesia

Four patients who developed unusual neurological sequelae after outpatient anaesthesia are described. Propofol is strongly implicated as the cause. All four patients were female with no previous history of psychiatric disorder or neurological disease, unpremedicated, and had procedures of duration less than 20 minutes. Hyperreflexia and hypertonicity were present postoperatively and the reactions appeared to be triggered by an external stimulus. Three patients were examined by a neurologist and had a normal electroencephalograph. Two patients were on the same operating list; quality control was carried out on the anaesthetic agents used, and blood samples sent for toxicology showed no abnormalities. Mechanisms underlying these reactions are discussed.

Maternity Blues

One hundred and six women were assessed psychiatrically in the 14-16th and 36-38th weeks of pregnancy and the 12th week after childbirth. They also completed a maternity blues questionnaire daily in the ten days after delivery. Blues scores were significantly associated with: neuroticism; anxiety and depressed mood during pregnancy; fear of labour; poor social adjustment; and retrospective severity of pre-menstrual tension. Blues scores were not associated with obstetric factors, with previous history of psychiatric disorder, or with case status on the PSE in pregnancy or 12 weeks after delivery.

Mood Disorder Following Cerebrovascular Accident

Depression appears to be common after stroke, and therefore may have a bearing upon rehabilitation. To examine whether the depression is due to a specific brain lesion, or is reactive to the consequent disability, this study looked at the frequency and associations of depressed mood in a stroke rehabilitation unit in-patient population, unselected for site of lesion. Depression affected 50% of the patients; history of previous psychiatric disorder and cerebrovascular accident appeared to be important risk factors. There were hemispheric differences in the relationships between measures, with both the site-of-lesion and reactive viewpoints being upheld.

Life events and social support in puerperal depression.

A 20 per cent prevalence of mild clinical depression was found in 120 women assessed at about six weeks postpartum. The strongest associated factor was occurrence of recent stressful life events. Previous history of psychiatric disorder, younger age, early postpartum blues, and a group of variables reflecting poor marital relationship and absence of social support were also notable. Poor marital support acted as a vulnerability factor, only producing an effect in presence of stressful life events. Previous psychiatric history produced a strong independent effect, both with and without life events. Postpartum blues were only associated with depression in the absence of life events, suggesting a small hormonal sub-group. Overall the findings indicate the importance of social stress in puerperal depression.