Psychiatric Antecedents Research Articles

Previous and posterior psychopharmacological treatment in bariatric surgery patients

IntroductionBariatric surgery is an effective treatment for obesity. It has been demonstrated that it improves the prognosis of vascular risk factors. However, the long term effect of surgery on psychiatric pathology, as depression, and the treatment adjustment needed is not clear.AimTo describe the previous and posterior psychopharmacological treatment of patients operated of bariatric surgery in Hospital del Mar.Material and methodsWe used a database of 292 bariatric surgery patients who have been operated in Hospital del Mar from January 2010 to November 2015. In this database, sociodemographic information, psychiatric antecedents, and anterior and posterior treatments among other data are included. We have made a descriptive analysis about more used treatments and their evolution.ResultsIn the sample, 27.1% of patients started with some psychiatric treatment the months before the bariatric surgery (16.4% had already a previous treatment prescribed). The medications the most frequently started before the surgery were selective serotonin reuptake inhibitors (SSRI, 11%), second were benzodiazepines and third a combination of the two previous treatments. Among antidepressants, Fluoxetine was the most prescribed (45.5%). Six months after surgery, 72.9% of patients were not taking any treatment.ConclusionThe large variety of psychiatric drugs used in our sample indicates that clearer guidelines are needed about the most appropriated treatments for those patients. Further studies on the impact of this surgery on pathologies and their psychopharmacological treatments are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Report of clinical case: Catatonic symptoms as a result of cerebral venous sinus thrombosis

Clinical caseWe present the case of an 18-year-old woman attending the emergency room due to behavioral disorders that appeared 24 hours ago. The clinic was of restlessness, uninhibited behavior, stereotyped movements, global insomnia, semimutism and negativism. Initially she was diagnosed with catatonia, and was admitted to the Mental Health Hospitalization Unit. There were no previous psychopathological antecedents, although relatives reported that she had several stressors. During admission, she had a partial response to benzodiazepine treatment, and a loss of strength in the left upper limb was evidenced, and venous sinus thrombosis was diagnosed. With the anticoagulant treatment, the psychiatric symptomatology presented was markedly improved.Medical examinationNormal vital signs, afebrile. Absence of focal neurological signs. Stereotyped movements, oral-buccal dyskinesia. Negativism, disinhibition and oppositional behaviour. Supplementary tests with results within the normal range. Cranial MRI: Upper, transverse and sigmoid right sagittal sinus thrombosis.ConclusionsNumerous cases of thrombosis have been documented as a result of a catatonic state, mainly due to the immobilization and the risk involved. However, in this case, sudden onset of psychiatric symptoms, absence of psychiatric antecedents, and excellent response to anticoagulant therapy, leads us to conclude that catatonic symptoms could be considered as a consequence of cerebral edema caused by thrombosis. The presentation of catatonia as the sole cause of a somatic disorder is not common, but would be stimulated by certain factors, such as excessive stress and personality disorders, documented as vulnerability factors for such symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mapeando las opiniones de los franceses sobre la castración química de delincuentes sexuales que abusan de niños y adolescentes

Sex offenses to children or young adolescents have become a growing public concern. Chemical castration is currently considered as the best available societal response to child sex abuse. It abolishes testosterone secretion, its effects are reversible and side effects are minor. It has been argued that offering convicted sex offenders with the possibility to be treated may be in contradiction with the bioethics principle of autonomy because the person has really no other choice -- the alternative is usually a lengthy confinement sentence. In view of this controversy, we explored lay people’s and physicians’ views regarding the acceptability of chemical castration. Fifty participants (among them five physicians) judged the acceptability of castration in each of 36 scenarios consisting of all combinations of four factors: aggressor’s age (21 vs. 41-year old); (b) victim(s)’ age (5, 8, or 14-year old); (c) aggressor’s psychiatric status (no psychiatric antecedents, suffers from sexual deviation, or recidivist); and (d) family’s attitude (hostile to any kind of castration vs. approve castration). Participants’ ratings of acceptability were, on the average, very high, and 68% of participants considered that chemical castration was fully justified in all the cases that were shown. A small minority (8%) considered that first time offenders of young adolescents, without psychiatric antecedents, should not be chemically castrated. Another minority position (24%) expressed doubts regarding chemical castration of first time offenders without antecedents but they never strongly opposed it. Implications for bioethics are discussed.

Early-adult outcome of child and adolescent mental disorders as evidenced by a national-based case register survey

BackgroundMental disorders show varying degrees of continuity from childhood to adulthood. This study addresses the relationship of child and adolescent mental disorders to early adult psychiatric morbidity. MethodsFrom a population at risk of 830,819 children and adolescents aged 6-16 years, we selected all those (n=6043) who were enrolled for the first time in the Danish Psychiatric Register with an ICD-10 F00-99 diagnosis in 1995-1997, and identified any mental disorder for which they received treatment up to 2009. ResultsNeurodevelopmental and conduct disorders were the principal diagnostic groups at 6-16 years and exhibited a characteristic male preponderance; while affective, eating, neurotic, stress-related and adjustment disorders were more common in girls. Over a mean follow-up period of 10.1 years, 1666 (27.6%) cases, mean age 23.4 years, were referred for treatment to mental health services, and they had a markedly higher risk than the general population (RR 5.1; 95% CI 4.9-5.4). Affective, eating, neurodevelopmental, obsessive-compulsive and psychotic disorders had the strongest continuity. Heterotypic transitions were observed for affective, eating, neurodevelopmental, personality and substance use disorders. ConclusionsThese findings suggest that individuals with psychiatric antecedents in childhood and adolescence had a high risk of being referred for treatment in early adulthood, and many mental disorders for which they required treatment revealed both homotypic and heterotypic continuity.

Depressão, Ansiedade e Stress em doentes deprimidos: Estudo com a EADS-21

O presente estudo pretende analisar e comparar os níveis de ansiedade, depressão e stress em pacientes exclusivamente acompanhados em consultas psiquiatria e em pacientes exclusivamente acompanhados em consultas de psicologia. A amostra é constituída por 60 pacientes diagnosticados com depressão de um hospital público português, 30 exclusivamente acompanhados em consultas de psiquiatria e 30 apenas seguidos em consultas de psicologia, com idades compreendidas entre os 15 e os 74 anos. Os dados foram recolhidos através da Escala de Ansiedade, Depressão e Stress (EADS-21 validada para a população portuguesa por Pais-Ribeiro et al., 2004; original DASS de Lovibond & Lovibond, 1995) e de um questionário sociodemográfico. Os resultados mostraram que os níveis de stress, ansiedade e depressão dos pacientes acompanhados exclusivamente em psicoterapia foram significativamente inferiores aos dos pacientes acompanhados exclusivamente em psiquiatria. Discutem-se os resultados atendendo ao tipo de intervenção terapêutica, assim como a algumas variáveis sociodemográficas e clínicas, nomeadamente as respeitantes às perdas significativas e aos antecedentes psiquiátricos. Palavras-chave: Depressão; Stress; Ansiedade; Pacientes; Psicologia; Psiquiatria.

Biological and psychological predictors of posttraumatic stress disorder onset and chronicity. A one-year prospective study

BackgroundFew studies have prospectively examined risk factors for posttraumatic stress disorder (PTSD) in the aftermath of a traumatic exposure. The aim of this study is to identify the concurrent influence of psychological and biological diatheses on PTSD onset and maintenance, taking into account socio-demographic factors and psychiatric antecedents. MethodsA total of 123 civilians (61.8% of women) recruited in emergency units, were assessed using validated instruments during the first week and then at 1, 4, and 12 months post-trauma. Baseline assessment included evaluation of the psychological diathesis (i.e. psychiatric history and peritraumatic distress and dissociation), and the biological diathesis [i.e. cortisol, norepinephrine, epinephrine, c-reactive protein, total cholesterol, HDL cholesterol, glycosylated haemoglobin, waist-to-hip ratio (WHR), body mass index, diastolic and systolic blood pressure (SBP), and heart rate]. ResultsMultivariate logistic regression analyses demonstrated both psychological and biological diatheses to be independent risk factors for PTSD. Peritraumatic distress and dissociation predicted onset (1-month) and mid-term PTSD (4-months), respectively. PTSD risk was associated positively with SBP and negatively with WHR, throughout the follow-up. In addition, a higher level of 12 h-overnight urinary norepinephrine independently predicted mid-term PTSD (4-months). ConclusionsThis prospective study shows that peritraumatic psychological and biological markers are independent predictors of PTSD onset with specificities according to the stage of PTSD development; the psychological diathesis, i.e. peritraumatic distress and dissociation, being a better predictor of short-term dysfunction whereas biological diathesis was also predictive of development and maintenance of PTSD.

Socio-demographic and clinical predictors of treatment resistant depression: A prospective European multicenter study

BackgroundFew studies investigated socio-demographic and clinical predictors of non response and remission in treatment resistant depression (TRD) in the case of failure of more than two adequate antidepressant (AD) trial. The primary aim of this study was to investigate socio-demographic and clinical predictors of TRD defined as the lack of response to at least three adequate AD treatments, two of which prospectively evaluated. As secondary aims, we also investigated predictors of non response and remission to: (1) at least two adequate AD treatment (one of which prospectively assessed); (2) at least one adequate and retrospectively assessed AD treatment. MethodsIn the context of a European multicenter project, 407 major depressive disorder (MDD) patients who failed to respond to a previous AD treatment were recruited for a 2 stage trial, firstly receiving venlafaxine and then escitalopram. MINI, HRSD, MADRS, UKU, CGI-S and CGI-I were administered. ResultsNinety eight subjects (27.61%) were considered as resistant to three AD treatments. Clinical predictors were: longer duration and higher severity of the current episode (p=0.004; ES=0.24; p=0.01; RR=1.41, respectively), outpatient status (p=0.04; RR=1.58), higher suicidal risk level (p=0.02; RR=1.49), higher rate of the first/second degree psychiatric antecedents (MDD and others) (p=0.04; RR=1.31, p=0.03; RR=1.32 respectively) and side effects during treatments (p=0.002; RR=2.82). Multivariate analyses underlined the association between TRD and the severity of the current episode (p=0.04). As for secondary outcomes, predicting factors were partially overlapping. LimitationsThe limited sample size and specific drugs used limit present findings. ConclusionSubjects with a high degree of resistance to AD treatments show specific features which may guide the clinicians to the choice of more appropriate therapies at baseline.

Gray matter characteristics associated with trait anxiety in older adults are moderated by depression.

Structural gray matter characteristics of anxiety remain unclear. The aim of this study was to assess the influence of current depressive symptoms and history of depression on the gray matter characteristics of trait anxiety. Structural magnetic resonance imaging (MRI) data from 393 individuals aged 65 years or older were used. Regions of interest (ROIs) included the amygdala, anterior cingulate cortex (ACC), insula, orbitofrontal cortex (OFC), and temporal cortex. Trait anxiety was measured by the State-Trait Anxiety Inventory (STAI). Depression and depressive symptoms were measured using DSM-IV criteria and the Center for Epidemiological Studies Depression Scale (CESD). After adjustments for sociodemographics and health-related variables, anxiety had a significant influence on the gray matter characteristics in all cortical ROIs. First, in participants without depression antecedents, higher trait anxiety was associated with a larger cortical thickness in all cortical ROIs. Second, in participants with a previous history of depression, higher trait anxiety was associated with a smaller cortical thickness in all cortical ROIs. These results suggest that anxiety is related to cortical thickness differently in healthy older adults and in older adults with psychiatric antecedents. Anxiety associated with thinner cortical areas could reflect symptoms of a specific type of depression or a vulnerability to develop depression.

Influencia de las características demográficas y variables clínicas en la percepción de apoyo social en pacientes con cáncer

The purpose of this study was to evaluate how socio-demographic and clinical variables were related to the different dimensions of perceived social support in cancer patients receiving oncology treatment. The sample included 740 cancer out-pa- tients. Socio-demographic and clinical predictors showed lower levels of variance in each dimension of social support. Patients reported less perceived instrumental support at a longer duration since diagnosis. Women perceived less instrumental support than men (p < 0.01). Also, signifi cant group differences were observed for patients who were married compared with non part- nered. Patients with personal psychiatric antecedents compared with non psychiatric antecedent, perceived signifi cantly less Emotional/Informational (p < 0.01) and Affective support (p < 0.01), in addition to lower scores in overall index of social sup- port (p < 0.01). The fi ndings point out that assessing socio-demographic and illness-related characteristics of cancer patients can lead to a better understanding of the differences in perceived social support.

Visual Hallucinations in Psychiatry's Interconsultation: Charles Bonnet Syndrome

Sometimes psychiatrists don't take account in medical issues in psychiatric patients although it is a classical item we should deal with in everyday practice. One of more interesting issues in psychiatry are visual hallucinations. We report a case about a 49 years old man patient without psychiatric antecedents and visual hallucinations which had started suddenly, so that we reviewed literature about somatic illnesses with visual hallucinations. This patient had a visual disability caused by glaucoma, he didn't have any other psychotic symptomatology, had reality judgment preserved and criticized properly this hallucinations. Finally he was diagnosed of Charles Bonnet syndrome and his symptomatology remitted with Risperidone, but a few weeks later the patient presented some side effects, so that it was necessary to change to Aripiprazole with better response and sustained remission. Charles Bonnet syndrome is characterized by complex, recurrent or persistent visual hallucinations in visually impaired individuals without cognitive or psychiatric disorders. It mainly affects elderly patients affected by macular degeneration associated with age, glaucoma or cataracts but can be found also in some psychiatric and neurological disorders such as abuse of alcohol (delirium tremens) or abuse of other substances, dementia, narcolepsy or long-term sleep deprivation, epilepsy, Parkinson's disease, brain tumors, migraine or even infection by Epstein-Barr virus in mononucleosis. It is considered that this phenomenology represents cortical release phenomena due to deafferentation of visual association areas of the cerebral cortex.

Gambling disorder in older adults: A cross-cultural perspective

IntroductionGambling disorder (GD) in older adults is significantly increasing and became an important public health issue in different countries. However, little is known regarding GD in older adults. The prevalence and acceptance of gambling vary among different cultures and this raises the question of how and to what extent culture affects older gamblers. The majority of the important studies regarding GD in older adults have been conducted mainly in Anglo-Saxon cultures and little information is available regarding GD in other cultures. The objective of this paper is to perform the first standardized cross-cultural comparison regarding older adults presenting GD. MethodsThe total studied sample involved 170 subjects: 89 from the Brazilian (BR) sample and 81 from the American (US) sample. It consisted of 67 men and 103 women (average age=64.42, standard deviation=±3.86). They were evaluated for socio-demographics, gambling behavior variables and psychiatric antecedents. ResultsOverall, there were significant differences between BR and US older adult gamblers in marital status, onset of gambling activity, onset of GD and urge scores. DiscussionThis study showed that there are important differences in gambling course, gambling behavior and personal antecedents between two samples of older adults presenting GD from countries with different social-cultural background. It weakens the possibility of generalization of results found in Anglo-Saxon countries to other cultures and reinforces for the need for development of research on GD in older adults outside the Anglo-Saxon culture.

Familial Risk Across Three Generations and Psychosocial Correlates for Developing Psychopathology in a Changing World

Background: Human development is a highly complex, environment-dependent process including mental health and psychopathology among its outcomes. Thus, it needs to be studied comprehensively in order to identify correlations and interactions among different biological, economical and psychosocial variables across time and generations. Objective: Is familial psychopathology risk across three generations significantly associated with ongoing psychosocial variables reported by probands? Methods: The study was designed as a household survey on a representative sample of the adult population aged 18 - 65 years in Mexico City. The family-history method was used to obtain information about psychiatric antecedents on their parents and a validated screening instrument was used to evaluate caseness in their offspring. Lifetime prevalence of psychiatric disorders on probands was evaluated using the Composite International Diagnostic Interview. Morbid risk in terms of the odds ratio and prevalence ratio were calculated using logistic regression with fixed effects as well as with generalized estimating equations (GEE) population-averaged models with an exchangeable structure. Aditionally, the population attributable risk percent was also calculated for selected variables associated with the outcome in the complete models. Results: The strenght of the association of familial psychiatric antecedents is moderate between generations on either direction: backwards in regards of proband’s parents or downwards in regards of their children. However, when interaction between the two previous generations was considered, the strenght of the association was higher, crude OR=7.8, and showing significant variations when controlling for the effect of the rest of the variables and especially for probands’ psychosocial correlates. The population attributable risk percent for these variables across generations is sometimes higher than the obtained for familial risk. Conclusions: Findings suggest that besides psychiatric familial risk, socioeconomial and psychodynamic risk factors have been interacting across time and generations contributing to the high prevalence of psychiatric disorders recently reported on youth Mexican population

Psychosis associated with methimazole-induced hypothyroidism: a case report

INTRODUCTION: Thyroid dysfunction has often been associated with several psychiatric manifestations. Previous case reports/series suggest the possible role played by acute alteration of thyroid status in the onset of psychotic symptoms. METHODS: Case report and literature review. RESULTS: A 45-year-old woman with no psychiatric antecedents was brought to the ER with a full-blown psychotic episode, marked by paranoid delusions, which developed gradually over two months. She had been treated elsewhere for hyperthyroidism for five years with methimazole 40 mg/d, with poor compliance. One month before the beginning of the psychotic symptoms, methimazole was raised to 60 mg/d and she started taking it correctly. Five months earlier she had TSH: 0.074 uUI/ml and free T4: 1.3 ng/dl. At admission we found a diffuse thyroid goiter, TSH: 70.9 uUI/ml and free T4: 0.03 ng/dl. Brain CT was normal. We hospitalized her with the diagnosis of a psychosis secondary to hypothyroidism, suspended methimazole, and gave her levothyroxine (up to 75 µg/d) and risperidone (2 mg/d). The patient had a quick remission and was discharged after 15 days. Within one month she had TSH: 0.7 uUI/ml and was completely recovered psychiatrically. She has been well since then, with risperidone in the first 8 months, and without it for 10 months now. CONCLUSION: This case report is a reminder of the necessity of checking thyroid status as part of clinical assessment of psychoses. It also supports the hypothesis that antithyroid drugs may have severe psychiatric consequences, especially when they lead to an acute change of thyroid status.

Psychic family violence and pathological jealousy with tragic consequences: Homicide

The presented case is not a singular one and it belongs to the pathology of the last period in Romania as a consequence of an unprecedented social phenomenon in the last 50 years, namely the massive migration of the young labor force especially in Western-European countries. One of the consequences is that many children are left in the care of only one parent or more often in the care of the grandparents. Another consequence is that the spouses separate for shorter or longer periods of time, they keep in touch only through telephone and after months, or even years, when they meet, they fight, especially regarding the possible infidelity. Authors have published several papers about children left to grow up without parents. This time it's about a young man who killed his wife in a very particular way, the wife having returned from working in Italy for one day. The psychological profile of the perpetrator and even more the lack of psychiatric antecedents wouldn't have suggested such an ending to the relationship between the two, but still the murder took place and the authors are trying to explain it.

Non-lethal Self-harm among Inmates

The prison environment represents a supplemental risk factor in the increased frequency of non-lethal self-harm among inmates, by comparison with the general population. The paper aims at defining the socio-demographic characteristics of 175 inmates who carried out the act by chemical means (drug intoxication or the consumption of other toxic substances) – classified as substance abuse, in contrast with the inmates who chose to act by physical means (plagues at various levels and/or ingestion of alien bodies). Differences were revealed between the two lots regarding temporal data, psychiatric antecedents, relapse frequency, acceptance of the treatment.

Family psychiatric morbidity of acute and transient psychotic disorders and their relationship to schizophrenia and bipolar disorder

Although transient psychotic disorders are currently classified as a category separate from schizophrenia (SZ) and affective disorders, their distinctive features remain uncertain. This study examines the family psychiatric morbidity of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs), pointing out differences from SZ and bipolar disorder (BD). From a cohort of 2.5 million persons, we identified all patients enrolled in the Danish Psychiatric Register who were ever admitted with ATPDs (n=2537), SZ (n = 10639) and BD disorder (n=5292) between 1996 and 2008. The relative risk (RR) of ATPDs, SZ and BD associated with psychiatric morbidity in first-degree relatives (FDRs) was calculated as the incidence rate ratio using Poisson regression. The RR of ATPDs [1.93, 95% confidence interval (CI) 1.76-2.11] was higher if patients with ATPDs had at least one FDR admitted with any mental disorder than patients without family psychiatric antecedents. An additional risk arose if they had FDRs admitted not only with ATPDs (RR 1.60, 95% CI 1.33-1.92) but also with SZ (RR 2.06, 95% CI 1.70-2.50) and/or BD (RR 1.55, 95% CI 1.23-1.96). Despite some overlap, the risk of SZ (RR 2.80, 95% CI 2.58-3.04) and BD (RR 3.68, 95% CI 3.29-4.12) was markedly higher if patients with SZ and BD had FDRs admitted with the same condition. These findings suggest that family psychiatric predisposition has a relatively modest impact on ATPDs and argue against a sharp differentiation of ATPDs from SZ and BD.

Efficacy of Plasma Exchange in Pharmaco-Resistant Acute Mania in Systemic Lupus Erythematosus

Back to table of contents Previous article Next article This article has been corrected | View Correction LettersFull AccessEfficacy of Plasma Exchange in Pharmaco-Resistant Acute Mania in Systemic Lupus ErythematosusR. Schwan, M.D., Ph.D., M. Tadri, M.D., S. Zuily, M.D., Ph.D., J. Lerond, M.D., Ph.D., and V. Laprevote, M.D., Ph.D.R. SchwanSearch for more papers by this author, M.D., Ph.D., M. TadriSearch for more papers by this author, M.D., S. ZuilySearch for more papers by this author, M.D., Ph.D., J. LerondSearch for more papers by this author, M.D., Ph.D., and V. LaprevoteSearch for more papers by this author, M.D., Ph.D.Published Online:1 Jan 2013https://doi.org/10.1176/appi.neuropsych.11120373AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect any part of the body, including the central nervous system. Psychiatric manifestations during SLE are not unusual; their characteristic features are early occurrence and clinical polymorphism.1,2 This clinical case shows a picture of SLE in which the first manifestations were psychiatric, with, in particular, an episode of mania3 with delirium that was resistant to drug treatment but responded well to plasmapheresis.A 28-year-old, socially well-integrated woman without psychiatric antecedents, was admitted in restraint to our psychiatric ward, after presenting herself at a police station clad only in an overcoat and unable to give her identity. She presented with spatiotemporal disorientation, muddled thinking, mental automaticity, vivid delirium of polymorphic content, and hetero-aggressivity. Somatic and neurological examination results were unexceptional, and the biological analysis results showed leuconeutropenia and a high sedimentation time. Serological tests for syphilis, HIV, HVB, and HVC were negative, and a brain scan and EEG showed no anomalies. A nonspecified psychotic state was diagnosed, and an antipsychotic treatment combining risperidone and loxapine was given.After 3 weeks in the hospital, with a favorable progression and near-complete regression of the delirium, the patient suddenly relapsed, presenting a manic state with psychotic symptoms and megalomaniac delirium.Treatment with olanzapine was started, and loxapine was maintained at a higher dose of 600 mg/day. A thymoregulator (valproic acid) was added 2 weeks later, as the symptoms did not improve.The symptoms of acute mania were accompanied by an episode of fever, a malar erythema, multiple joint pain of the upper limbs, ulceration of buccal and vulvar mucosae, and Raynaud’s syndrome. Biological analysis showed a slight normocytic anemia and leucopenia with neutropenia and lymphopenia. Strongly positive antinuclear antibodies were found (titer above 1/1,280, speckled type). Native anti-DNA antibodies also tested positive, together with anti-RNP/Sm and anti-SSA/RO antibodies. The total complement was lowered, with a collapse of fraction C4.The diagnosis of a severe flare-up of SLE was therefore made. In association with the psychotropic treatment, a course of cyclophosphamide was given every 3 weeks at 0.6 mg/m3. Progression in 1 month was marked by normalizing of biological analysis, but mania symptoms worsened, with more severe behavioral disorders requiring near-continual isolation of the patient. Brain MRI still showed no sign of vascularity.3Therefore the psychotropic treatments were discontinued, and, for maniac symptoms, indication was given for a series of six plasma exchanges.We noted an improvement in the psychiatric symptoms immediately after the first plasmapheresis. After the third plasma exchange session, a regression of the mania symptoms was observed. There still remained brief and fluctuating auditory hallucinations, which totally disappeared 2 weeks after the last plasmapheresis session, marking the total regression of all psychiatric symptoms.No psychiatric treatment was resumed, and no psychiatric relapse has been reported after 1 year of follow-up.To our knowledge, this clinical case is the first description of indication and utilization of plasma exchange for a manic state secondary to an SLE flare-up.University Hospital of Psychiatrie and Psychothérapie, Laxou, France (RS, JL)Faculty of Medicine, Lorraine-University, Vandoeuvre-lès-Nancy, France (RS, SZ)Inserm 9501, University Hospital of Nancy, Nancy, France (RS, MT, SZ, JL, VL)CSAPA (Health Care Centre of Accompaniment and Prevention in Addictology), University Hospital of Nancy, Nancy, France (RS, VL)CHU de Nancy, service de médecine vasculaire, Vandoeuvre-les-Nancy, F-54500, France (SZ)Correspondence: Professor Raymund Schwan, CHU de Nancy; e-mail: r.[email protected]frReferences1 Waterloo K, Omdal R, Husby G, et al.: Neuropsychological function in systemic lupus erythematosus: a five-year longitudinal study. Rheumatology (Oxford) 2002; 41:411–415Crossref, Medline, Google Scholar2 Fernández Ga de Las Heras V, Gorriti MA, García-Vicuña R, et al.: Psychosis leading to the diagnosis of unrecognized systemic lupus erythematosus: a case report. Rheumatol Int 2007; 27:883–885Crossref, Medline, Google Scholar3 Brey RL: Neuropsychiatric lupus: clinical and imaging aspects. Bull NYU Hosp Jt Dis 2007; 65:194–199Medline, Google Scholar4 Alao AO, Chlebowski S, Chung C. Neuropsychiatric systemic lupus erythematosus presenting as bipolar I disorder with catatonic features. Psychosomatics 2009; 50:543–547Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByOlanzapine6 March 2021 | Reactions Weekly, Vol. 1845, No. 1 Volume 25Issue 1 Winter 2013Pages E02-E03 Metrics PDF download History Published online 1 January 2013 Published in print 1 January 2013

Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis.

This study was designed to determine whether pseudoexacerbations and confirmed MS exacerbations are preceded by or concurrent with increased anxiety or depressive symptoms. This was a secondary analysis of 121 patients with MS who were observed for 48 weeks during a randomized controlled trial. Participants completed monthly self-reports on depressive and anxiety symptoms. Patient-reported exacerbations were assessed through a telephone-administered symptom checklist and neurologic examination. Both pseudoexacerbations and confirmed exacerbations were associated with concurrent somatic depressive (β = .16 and β = .33, respectively; p values < .05), affective depressive (β = .17 [p = .02] and β = .12 [p = .06]), and anxiety symptoms (β = .24 and β = .20, p values < .01), controlling for baseline symptoms. Preexisting somatic and affective depressive symptoms predicted amplified relationships between concurrent confirmed exacerbations and these symptoms (β = .19 and β = .20, respectively; p values < .01). A standard deviation increase in anxiety symptoms relative to baseline predicted subsequent onset of pseudoexacerbations (odds ratio = 1.54, p = .02), whereas increased somatic depressive symptoms predicted confirmed exacerbations (odds ratio = 1.59, p = .01). Patients with MS experiencing pseudoexacerbations or confirmed exacerbations should be assessed and monitored for depressive and anxiety symptoms, and confirmed exacerbations are particularly concerning in patients with a history of depression. The psychological or psychiatric antecedents of MS exacerbations generate new hypotheses on etiologies of confirmed exacerbations and pseudoexacerbations. clinicaltrials.gov Identifier: NCT00147446.

First Anxiety, Afterwards Depression: Psychological Distress in Cancer Patients at Diagnosis and after Medical Treatment

The purpose of this study was to assess psychosocial changes at two particular moments: at cancer diagnosis and 2-4 weeks after having finished treatment. A total of 67 cancer outpatients were assessed in this study. The inclusion/exclusion criteria were as follows: ambulatory cancer patients aged 18 years or older and receiving medical treatment. Patients with a performance status <50 or with cognitive impairment (≥3 errors in the Pfeiffer Questionnaire) were excluded. The inclusion period ranged from 1 April 2005 to 30 April 2007. The scales used were the 14-item Hospital Anxiety and Depression Scale (HADS), which has two subscales for anxiety (seven items) and for depression (seven items), the Quality of Life Short Form 36 Questionnaire, the Mental Adjustment Scale and the Medical Outcomes Study Questionnaire for measuring social support. All data were compared with sociodemographic and medical characteristics. Patients had higher levels of pre-treatment versus post-treatment anxiety (HADS-Anxiety mean, 7.41 versus 6.69), whereas depression scores were higher post-treatment versus pre-treatment (HADS-Depression mean, 3.14 versus 3.89). After medical treatment, patients were more fatigued, with lower performance status (Karnofsky Index), less social support and less quality of life, but no differences in coping styles were found. Women had higher levels of anxiety than men. Patients with psychiatric antecedents had higher levels of distress, but these differences were only observed after diagnosis and not after the treatment. In general, head and neck cancer patients had higher levels of distress, worse coping and worse social functioning. Cancer patients require special consideration before and after treatment. Anxiety is the symptom that characterizes diagnosis, whereas depression is more common after medical treatment. The head and neck cancer patients were the group with the highest complexity.

Trichophagia and Trichobezoar: Case Report

Objective:Trichobezoar consists of a compact mass of hair occupying the gastric cavity to a various extent. When the trichobezoar extends past the duodenum it is better referred to as Rapunzel Syndrome. Although trichobezoars are well described in terms of surgical diagnostic and procedure, there are only but very scarce reports on psychiatric literature, usually associated with trichotillomania. The authors present a clinical case of trichobezoar and discuss the most relevant aspects concerning this entity.Methods:Presentation of psychiatric and surgical data concerning the case report. Previously reported cases are also mentioned.Results:Report of a 27-year-old female patient with a trichobezoar submitted to surgical removal, with a prior intervention 4 years before also due to trichobezoar, and with unknown psychiatric antecedents or follow-up.Conclusions:A trichobezoar represents a serious surgical condition. It is important to consider such diagnosis in face of suggestive symptoms, even if signs of trichotillomania are not present. The discrepancies between the prevalence of trichotillomania and trichobezoars due to trichophagia may be due to issues related to self-selection of patients and symptom severity. Such issues may also be important in the study of impulsive-compulsive spectrum models and to their relevance to impulse control disorders.