Psychiatric Illness In Patients Research Articles

English

Physical symptoms in depression are highly prevalent and associated with substantial functional impairment. The prevalence of physical illness in psychiatric patients is higher than that in the general population. Both in developed & developing countries, very little attention is paid to the physical illness of psychiatric patients, which leads to a poorer outcome. Hence we decided to conduct this study and find out the effect of antidepressant treatment on somatic symptoms in depressive disorders. The study was conducted at Sri Venkateshwaraa medical college hospital & research center, Puducherry. Our study sample consisted of 72 consecutive new patients who fulfilled inclusion criteria and had consented to participate in the study. All new patients in the age group 18 to 60 years, who fulfill ICD-10-DCR (Diagnostic criteria for Research) criteria for the Depressive episode (F 32), recurrent depressive disorder (F33), Dysthymia (F 34.1), bipolar affective disorder, current episode depression (F 31.3) were included in our study. MATERIALS AND METHODS: A semi-structured proforma was used to collect socio demographic and clinical data from all the subjects included in the study. Enrolment of cases was done over a period of 6 months. All the subjects were rated on the Hamilton Depression Rating Scale (HDRS-17) to quantify the baseline severity of the depressive symptoms. Screenings for physical symptoms were done for all patients using the Patient Health Questionnaire (PHQ-15). The patients were classified into 4 groups based on physical complaints & co-morbid medical/ surgical diagnosis. HDRS-17 rating was recorded at baseline, 1 month & 6 months for the entire study sample. PHQ-15 scores were recorded at baseline, 1 month & 6 months after initiation of antidepressant treatment for all patients enrolled in the study. RESULTS: The study revealed the prevalence of medically unexplained physical symptoms in depressive disorders in patients attending our psychiatry OPD. The Results depicts the prevalence of physical pain symptoms in patients with depressive disorders. The reduction in HDRS-17 and PHQ15 scores in 1month and 6 months shows the effect of antidepressant treatment in reducing both depressive symptoms and physical symptoms CONCLUSION: This study had been undertaken with intent to study the prevalence of unexplained physical symptoms and physical illnesses among patients with depressive disorders and to analyze the effect of antidepressant treatment on these unexplained physical symptoms.

Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa

<p><strong>Background</strong>. There is a lack of studies addressing the frequency and correlates of comorbidities among heroin users admitted for treatment in South Africa (SA). Objective. To assess the frequency and correlates of psychiatric comorbidity among patients with heroin use disorder admitted to the Opioid Detoxification Unit at Stikland Hospital in the Western Cape, SA.</p><p><strong>Method.</strong> Participants (<em>N</em>=141) were assessed for psychiatric illness (Mini International Neuropsychiatric Interview), comorbid substance use disorders (World Health Organization’s Alcohol Smoking Substance Involvement Screening Tool), and legal and social problems (Maudsley Addiction Profile). Demographic, personal, psychiatric and substance-use history, in addition to mental state examination on admission, were collected from the case notes.</p><p><strong>Results.</strong> The largest group of patients (<em>n</em>=56, 40%) had not been abstinent from heroin use since drug debut, and most had been arrested for drug-related activities (<em>n</em>=117, 83%) and had family conflicts related to use <em>(n</em>=135, 96%). Nicotine was the most common comorbid substance of dependence (<em>n</em>=137, 97%) and methamphetamine was the most common comorbid substance abused (<em>n</em>=73, 52%). The most common comorbid psychiatric illness was previous substance-induced psychosis (<em>n</em>=42, 30%) and current major depressive disorder (<em>n</em>=37, 26%). Current major depressive disorder was significantly associated with females (p=0.03), intravenous drug use (<em>p</em>=0.03), alcohol use (<em>p</em>=0.02), and a higher number of previous rehabilitation attempts (<em>p</em>=0.008).</p><p><strong>Conclusion.</strong> Patients with heroin use disorders present with high rates of psychiatric comorbidities, which underscores the need for substance treatment services with the capacity to diagnose and manage these comorbidities.</p>

Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa

Background . There is a lack of studies addressing the frequency and correlates of comorbidities among heroin users admitted for treatment in South Africa (SA). Objective. To assess the frequency and correlates of psychiatric comorbidity among patients with heroin use disorder admitted to the Opioid Detoxification Unit at Stikland Hospital in the Western Cape, SA. Method. Participants ( N =141) were assessed for psychiatric illness (Mini International Neuropsychiatric Interview), comorbid substance use disorders (World Health Organization’s Alcohol Smoking Substance Involvement Screening Tool), and legal and social problems (Maudsley Addiction Profile). Demographic, personal, psychiatric and substance-use history, in addition to mental state examination on admission, were collected from the case notes. Results. The largest group of patients ( n =56, 40%) had not been abstinent from heroin use since drug debut, and most had been arrested for drug-related activities ( n =117, 83%) and had family conflicts related to use (n =135, 96%). Nicotine was the most common comorbid substance of dependence ( n =137, 97%) and methamphetamine was the most common comorbid substance abused ( n =73, 52%). The most common comorbid psychiatric illness was previous substance-induced psychosis ( n =42, 30%) and current major depressive disorder ( n =37, 26%). Current major depressive disorder was significantly associated with females (p=0.03), intravenous drug use ( p =0.03), alcohol use ( p =0.02), and a higher number of previous rehabilitation attempts ( p =0.008). Conclusion. Patients with heroin use disorders present with high rates of psychiatric comorbidities, which underscores the need for substance treatment services with the capacity to diagnose and manage these comorbidities.

Psychosis in a Case of Kleine-Levin Syndrome: A Diagnostic Challenge

Kleine-Levin syndrome (KLS) is a rare disorder of sleep diagnosed mainly on clinical grounds. It presents a unique diagnostic dilemma for neurologists and psychiatrists; especially due to a high risk of being diagnosed as a psychiatric condition like a mood disorder. However, there is literature available documenting the cooccurrence of psychiatric illnesses in patients diagnosed with KLS. The following case highlights the above points.

Psychiatric Co-morbidity in HIV/AIDS: A Neglected Issue

HIV/AIDS epidemic remains among the most significant challenges to public healthcare systems worldwide . There are approximately 50,200 people living with HIV/AIDS (PLHA) in Nepal among the total 33 million PLHAs . Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDS) is a significant cause of death and disability, especially in developing countries. Studies have shown that there is a bidirectional link between Mental illness and HIV/AIDS. However, mental illnesses are under detected in HIV/AIDS care settings. In spite of a good financial support from international partners, PLHA in Nepal do not receive necessary psychiatric services. Psychiatric illness in patients with HIV/AIDS has been associated with negative health behaviors and poorer clinical outcomes. This article, therefore, aims to highlight this issue among the stakeholders by reviewing the research on the topic in Nepal and making them aware of the need to DOI: http://dx.doi.org/10.3126/jpan.v2i2.9718 J Psychiatrists’ Association of Nepal Vol.2, No.2, 2013 6-10

Psychiatric morbidity, quality of life and caregiver burden in patients undergoing hemodialysis

<b>Background:</b> Psychiatric illnesses such as, depression, adjustment disorders, delirium, and anxiety disorders are common in dialysis patients and are likely to reduce patient's quality of life (QOL). Presence of chronic medical and psychiatric illness in patients increases burden on caregivers. <b>Aims:</b> The aim was to assess sociodemographic profile and to estimate the prevalence and type of psychiatric morbidity, QOL in patients undergoing hemodialysis. Furthermore, the study aimed to assess perceived burden in caregivers of these patients. <b>Materials and Methods:</b> This was a cross-sectional observational study conducted at hemodialysis unit of an urban tertiary care hospital. Fifty consecutive patients undergoing hemodialysis were included. Sociodemographic profile was assessed through semi-structured proforma. Psychiatric morbidity was assessed using Diagnostic and Statistical Manual IV Text Revised Criteria and World Health Organization QOL Scale-BREF scale was used to measure patient's QOL. Perceived burden in caregiver was assessed using Zarit Burden Interview. Data obtained were tabulated and analyzed using the SPSS software version 17. <b>Results:</b> Majority of patients was males, in middle-age group, secondary educated, unemployed and married. Psychiatric diagnosis was observed in 64% of the patients. Most common psychiatric diagnoses were major depressive disorder, adjustment disorder with depressed mood. Overall QOL score in patients was significantly low in those with psychiatric morbidity. Caregiver's burden was significantly high in those caring for patients with co-morbid psychiatric illness. <b>Conclusions:</b> Psychiatric morbidity in hemodialysis patients is high and impairs their QOL. Perceived burden of care in their caregivers is high in the presence of psychiatric co-morbidity.

Prevalance of Depression among Patients with Chronic Kidney Disease

Objective: Depression is a common psychiatric illness in patients with chronic kidney disease (CKD). It has been shown to affect morbidity & mortality in these patients. This study was done to determine the prevalence of depression in CKD patients. Method: This cross sectional study was done in DMIMS university, Acharya Vinobha Bhave Rural Hospital located in central india is a tertiary hospital. A self administered Zung questionnaire was administered. This questionnaire has 20 questions with an individual scoring to each question. Individuals with a total score of 50 are considered depressed & score above 70 indicates severe depression. Results: Thirty (30) patients of CKD with or without dialysis & 14 controls were interviewed. There were 12 (85%) males & 2 (15%) females. All were age matched. The prevalence of depression among CKD patients was 96.66% while for control group was 5% (P<0.00). Further analysis revealed that CKD patients who were not on dialysis were more depressed than the patients who were on dialysis treatment. The mean Zung score in pre dialysis patients was 61.47 ± 3.95 versus ESRD patients on dialysis which was 56.30 ±3.79 (P<0.001). Conclusion: Depression is highly prevalent among our patients with CKD. We opine that along with other management of CKD symptoms of depression should be targeted & should be considered for treatment.

The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers

Objective To examine the mortality experience of psychiatric patients in Western Australia compared with the general population.Design Population based study.Setting Western Australia, 1985-2005.Participants Psychiatric patients (292 585) registered with mental...

“Fishing in the Trachea”

A 36-year-old white man presented with hemoptysis and hematemesis. The medical history was significant for a bipolar disorder and schizophrenia. He had swallowed 3 fishhooks and aspirated 1 into his lungs. A chest x-ray showed the fishhook in the right main stem bronchus. He underwent a flexible bronchoscopy for removal of the foreign object. The technique of the removal of the fishhook is described. Foreign object aspiration usually occurs in the pediatric or the geriatric population. Aspiration of foreign objects in adults is commonly associated with psychiatric illnesses in patients. After appropriate imaging, bronchoscopy or even cardiothoracic surgery is usually required for removal of the foreign object. Fishhooks may be more difficult to remove.

Detecting and Managing Depressed Patients: Palliative Care Nurses' Self-Efficacy and Perceived Barriers to Care

Depression is a highly prevalent yet under-recognized and under-treated psychiatric illness in patients receiving palliative care. Nurses are the front-line health care professionals in these settings and are well-positioned to detect depressive symptoms and initiate pathways to care. Previous research suggests, however, that nurses' confidence and skills in relation to this task are low, and there appear to be a number of barriers within these settings that may impede nurses' engagement in this process. To further investigate these factors, a quantitative study was carried out with 69 palliative care nurses from three palliative care services in Australia. A number of issues were identified, including the need for further training in the signs and symptoms of depression, issues around discussing depression with patients and their family members, and difficulty differentiating depressive symptoms from grief. These findings provide insight into specific areas in which palliative care nurses would benefit from further training to improve detection rates for depression in this vulnerable population.

Anxiety and depression in patients with allergic and non‐allergic cutaneous disorders

Numerous studies have shown that anxiety and depression are more prevalent among patients suffering from chronic skin disorders. The aims of this study were to assess the prevalences of depression and anxiety in patients suffering from chronic skin disorders, focusing particularly on allergic skin conditions. Additionally, we investigated resilience to disease progression using the Sense of Coherence Scale. A total of 112 consecutive patients without known psychiatric disease were interviewed and asked to complete questionnaires in order to assess psychiatric symptomatology. The following scales were completed: the Mini International Neuropsychiatric Interview; the Hamilton Anxiety Scale (HAS); the Hamilton Depression Rating Scale (HDRS); and the self-administered questionnaire for the Sense of Coherence Scale (SoCS). Rates of anxiety and depression in patients with allergic and non-allergic conditions were considerably higher than those in the general population. This difference was notable in patients with allergic skin diseases, reaching 58.3 and 48.3%, compared with 15.4 and 23.1% for participants with non-allergic conditions, as measured by the HAS and HDRS, respectively (P < 0.05). Statistically significant negative correlations between scores on the SoCS and scores on the HAS (r = -0.45, P < 0.01) and HDRS (r = -0.37, P < 0.01) were observed. Our findings support the hypothesis that rates of anxiety and depression are higher among patients suffering from allergic chronic skin disorders. High SoCS scores may protect against the development of psychiatric illness in patients suffering from allergic skin disease.

Comment on Treatment of Psychiatric Illness in Patients with Mitochondrial Disease

Comment on Treatment of Psychiatric Illness in Patients with Mitochondrial Disease

Undiagnosed Mental Illness in the Emergency Department

BackgroundMental illness affects 8% of the population. The early identification and treatment of mental illness can reduce the progression and complications of the illness. ObjectiveThe objective of this study was to identify unsuspected psychiatric illness in patients presenting to the emergency department (ED) with non-psychiatric-related complaints. A comparison of the test results and the emergency physician assessments were then compared. MethodsAll consenting and stable patients who presented to the ED with non-psychiatric complaints were given the Mini-International Neuropsychiatric Interview (MINI). It was administered to the patient by a trained research fellow before the patient was seen by the physician. Before the patient's departure from the ED, the research fellow notified the emergency physician of the results of the MINI interview. After the emergency physician was notified of the diagnosis of the MINI, any change in the treatment was reviewed. ResultsA total of 211 patients were enrolled in the study. The majority of patients (55%) tested negative for all undiagnosed mental illnesses. The top diagnoses were as follows: major depression (24%), general anxiety (9%), and drug abuse (8%). Of all those patients who tested positive for an undiagnosed mental illness, only 2% were diagnosed by the ED attending. ConclusionsThe idea that the ED is a good place to identify undiagnosed mental health illnesses was confirmed. The use of an independent test such as the MINI was also shown to be useful to aid the emergency physician in identifying undetected mental illnesses.

Prevalence of symptoms of depression among patients with chronic kidney disease

Depression is the most common psychiatric illness in patients with chronic kidney disease (CKD). Depression has been shown to affect mortality in end-stage renal disease patients. The objective of this study was to determine prevalence of depressive symptoms among CKD patients. A cross-sectional study of patients with CKD (Stages 3-5) attending the renal clinic of a tertiary hospital was conducted. Demographic and clinical data were documented. A self-administered Zung depression questionnaire was administered. The Zung depression questionnaire has 20 weighted questions. Individuals with a total score of 50 are considered to be depressed, while a score of 70 and above is indicative of severe depression. One hundred and eighteen patients and fifty controls were interviewed. There were 73 (61.9%) males and 45 (38.1%) female patients. The mean age did not differ: males 43.8 ± 15.4 years, females 43.2 ± 14.7 yrs, P = 0.83. The prevalence of depression among the CKD patients was 23.7%, while for the control group was 2%; χ2 = 10.14, P < 0.001. Further analysis showed that CKD patients on dialysis were more likely to be depressed than the pre-dialysis patients with frequency of depressive symptoms of 34.5% for dialysis patients versus 13.3% in pre-dialysis patients; χ2 = 6.17, P = 0.01. No difference was observed in the mean Zung score among males, and female patients mean Zung score was 40.1 in females and 40.7 in male patients; P > 0.05. Depression is highly prevalent among our patients with CKD and treatment modality was the major predictor of depression among our patients.

Psychiatric care of the patient with hepatitis C: a review of the literature.

Approximately 1.8% of the US population is chronically infected with the hepatitis C virus (HCV). The prevalence rates of psychiatric illness in patients with HCV infection are higher than those rates in the general US population, and the prevalence of HCV infection in patients with severe mental illness may be as high as 9 times that of the general US population. Primary care physicians and psychiatrists are on the forefront of identifying patients with psychiatric illness who are at risk for HCV infection and can screen for HCV infection. This review summarizes the psychiatric implications of HCV infection and strategies for the management of interferon alfa-induced neuropsychiatric adverse effects. English-language studies were identified by computerized searches using the term hepatitis C psychiatric between 1972 and 2009, and further references were obtained from bibliographies of the reviewed articles. Relevant references were reviewed by the authors and included the basis of significance and applicability to practicing psychiatrists and internists. Since primary care physicians and psychiatrists are sometimes the only medical link for patients with psychiatric illness, they are expected to provide posttest counseling for their patients with HCV and psychiatric illness. The task of conducting a psychiatric and psychosocial pretreatment risk-benefit assessment to determine whether or not to treat HCV infection is increasingly delegated to primary care providers as well as psychiatrists. The use of interferon alfa-based therapies to eradicate HCV has been associated with frequent neuropsychiatric adverse effects (eg, affective, anxiety, cognitive, and psychotic symptoms) that compromise the management of HCV patients with and without a preexisting history of psychiatric illness. Primary care physicians and psychiatrists are frequently asked to assist in the management of these neuropsychiatric adverse effects and evaluate the risks and benefits of using prophylactic psychotropics. Despite the clinical challenge that interferon alfa treatment for patients with comorbid HCV and psychiatric illness presents, recent research indicates that interferon alfa can be safely administered to HCV-infected patients with psychiatric disorders provided there is a comprehensive pretreatment assessment, a risk-benefit analysis, and intensive ongoing medical and psychiatric follow-up.

Prospective study about depression in oncology and assessment of the medical decision-making strategy.

e19684 Background: Depression in one the most common psychiatric illness in patients with cancer and it is known to reduce quality of life. The study of depression has been a challenge because symptoms occur on a broad spectrum that ranges from sadness to major affective disorder because mood change is often difficult to evaluate in palliative situation. Many depressed patients in oncology are not treated due to the difficulty in assessment. Difficulties in assessment may be due to nondisclosure by patients who may feel they are wasting the doctor's time. There is also the mistaken belief among some professionals that the cancer invariably causes depression. Our hypothesis is that depressive symptoms are overlooked whereas others symptoms like anxiety are easily detect. Aim: To assess oncologists decision making strategy for depression's management and to assess how they manage depression. Methods: It was a multicenter prospective study. We used a qualitative-quantitative design with all the oncologist of three cancer center. Results: Thirty-four physicians were included in our study. The mean age of our sample was 44 years. The mean duration of interviews was 17 min 45 (from 11 min to 27 min ). The first results are that the oncologists' evaluation of depressive symptoms is heterogeneous, with a low rate of physicians using a screening tool. They are in the majority favorable to a systematic screening procedure despite the lack of time they underline. They don't use any algorithm for the management of their patients' depression. The discourse analysis is still in progress and will be presented at the congress. Conclusions: We hope that this research will help us to understand the underdiagnosis off depression in oncology. An other expected result is the sensibilization of the carrers to the management of depression. Last, we hope that these data will help up us to propose new strategies. No significant financial relationships to disclose.

Treating Psychiatric Illness in Patients With Mitochondrial Disorders

Treating Psychiatric Illness in Patients With Mitochondrial Disorders

Inappropriate Psychiatric Admission of Elderly Patients with Unrecognized Delirium

To explore factors that might contribute to misattribution of mental status changes to psychiatric illness when an elderly patient actually has a delirium (mental status changes due to a medical condition). Records of 900 elderly patients referred to a Veterans Affairs psychiatric inpatient unit and 413 to an inpatient psychiatric team at a public hospital from 2001 to 2007 were reviewed. Cases referred because of symptoms secondary to an unrecognized delirium underwent further analysis of preadmission assessments. Comparisons were made to elderly patients with delirium appropriately admitted to medical units. Thirty (2.3%) of the patients referred to psychiatric units were found to have a physical disorder requiring medical intervention within twelve hours. Compared to 30 delirious patients admitted to medical units, those inappropriately referred to psychiatric units had significantly lower rates of adequate medical histories, physical examinations, cognitive assessments, and laboratory/radiological studies. Among patients with delirium referred to psychiatric units, 66.7% had a history of mental illness, versus 26.7% of comparable admissions to medical units (chi (7) = 60.00, P < 0.001). Our findings suggest that elderly patients with delirium admitted to psychiatric units are less likely to undergo complete diagnostic assessments than delirious elderly patients admitted to medical units. Symptoms of delirium appear more likely to be incorrectly attributed to psychiatric illness in patients with a history of mental illness than in patients without such a history. Possible explanations for these findings and suggestions for addressing these issues are offered.

A pilot study of the prevalence of psychiatric disorders in PLS and ALS

The prevalence of psychiatric disorders in primary lateral sclerosis (PLS) is currently unknown. In the present study, we compared the prevalence of psychiatric illness in patients with PLS and amyotrophic lateral sclerosis (ALS). We hypothesized that if the psychosocial stress of motor neuron disease predisposes patients to depressive disorders, patients with ALS (with a poorer prognosis and more disability than patients with PLS) should have a higher prevalence of depressive disorders than patients with PLS. We administered the gold standard of psychiatric assessment, the SCID, to 19 PLS and 13 ALS patients. We found a prevalence of current depressive disorders in PLS patients that was, by a non-significant trend, lower than that of ALS patients. The prevalence of current depressive disorders in the ALS patients was higher than previously reported and similar to that observed in non-neurological medical disorders. Other psychiatric disorders were rare. In conclusion, depressive disorders were the most commonly observed psychiatric disorders in both PLS and ALS. By a non-significant trend, the PLS patients had a lower current prevalence of depressive disorders than the ALS patients. These data are consistent with the hypothesis that the psychosocial stress of MND is a risk factor for depression.

Relationships between auditory event‐related potentials and mood state, medication, and comorbid psychiatric illness in patients with bipolar disorder

Patients with bipolar disorder (BD) exhibit aberrations in auditory event-related potentials (ERPs), although the relationships between these measures and mood state at testing, comorbid psychiatric illness, presence of psychotic features, and medication usage are unclear. The purpose of this study was to investigate the relationships between these factors and auditory ERP measures in BD patients. An auditory 'oddball' discrimination task was used to elicit ERPs from 69 patients with type I BD and 52 healthy controls. Patients were placed into subgroups based upon their mood state at testing (euthymic or symptomatic), and ANOVA was used to compare amplitude and peak latency measures from the N100, P200, N200, and P300 ERP components across subgroups. Multiple regression was used to investigate relationships between ERP measures and comorbid psychiatric diagnosis, history of psychotic features, and medication status. Relative to healthy control participants, euthymic and symptomatic BD patients exhibited reduced P300 and P200 amplitude, but ERP measures did not differ among BD patients on the basis of mood status. A history of a comorbid anxiety disorder was associated with reduced N200 peak latency, but prolonged P300 peak latency among BD patients. No other relationships between clinical variables and ERP measures were significant. The results suggest that disrupted auditory attention may be observed in BD patients regardless of their mood state at testing, medication status, or history of psychosis. These results extend previous findings, and provide further evidence for aberrations in the P300 ERP as an endophenotype for BD.