Subgroups Of Psychiatric Patients Research Articles

Forensic-Psychiatric Consultations in General Psychiatry

A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.

Prevalence of Smoking among Male Psychiatric Outpatients

The prevalence rate of smoking among psychiatric patients has been shown to be higher than that among general population, especially those with schizophrenia and affective disorders. This may reflect self-medication of symptoms, medication side effects, and cognitive deficits associated with psychiatric disorders. The aim of the study is to examine the prevalence of smoking among male psychiatric outpatients. 384 male psychiatric patients were participating in for this study. Another 280 patients, of the same age groups, attending general outpatient department of the same hospital for medical elements other than psychiatric acted as normal control. Diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Both psychiatric patients and control group were assessed by using a smistructured interview questionnaire, which includes questions about each patient's sociodemgraphic variable, comprehensive smoking history. The sociodemgraphic of smokers among psychiatric patients were single72.3%, come from rural areas 74.9%, illiterate or had low education 82.2% and unemployed 83.2%. A prevalence of smokers among subgroup of psychiatric patients were, Schizophrenia 80.9%, Major Depression 60%, Mania 80%, Anxiety disorder 62.7%, Somatoform disorder 51.4%, Personality disorder 65% and substance abuse disorder 71.4%. Distribution of smokers among psychiatric patients and control group, 63.8 of the psychiatric patients were smokers against 32.1% of the control group were smokers. The prevalence of smoking in psychiatric male patients is high. It is consistent with other international studies.

SKINREMS-A New Method for Assessment of the Niacin Skin Flush Test Response in Schizophrenia.

Schizophrenia has been considered a disorder linked with faulty lipid homeostasis, and the proposed tool for assessment of these disruptions is the niacin skin flush test. The aims of the study were: 1. Create a new tool to analyze results of the niacin skin flush test more precisely and objectively. 2. Verify the utility of a self-created tool for differentiating between schizophrenia (SZ; n = 56), bipolar disorder (BD; n = 29) and healthy control (HC; n = 45) individuals. The proposed developed method, based on the Skin Reaction Measurement Computer System (SKINREMS), allows one to evaluate the response to the niacin skin flush test quickly and objectively. SKINREMS showed good accuracy in discriminating SZ from BD (with sensitivity 91% and specificity 72%), and SZ from HC (71% and 66%, respectively), and sufficient but not excellent accuracy in discriminating BD from HC (55% and 54%, respectively). The pathophysiological pathways and features shared by schizophrenia and bipolar disorder may be the reason for difficulties in fully discriminating between these two mental disorders using the niacin challenge test. The management of disruptions in the phospholipid metabolism and the inflammatory process could potentially become an individualized form of therapy in a subgroup of psychiatric patients.

A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders

The clinical significance of anti-neuronal antibodies for psychiatric disorders is controversial. We investigated if a positive anti-neuronal antibody status at admission to acute psychiatric inpatient care was associated with a more severe neuropsychiatric phenotype and more frequent abnormalities during clinical work-up three years later. Patients admitted to acute psychiatric inpatient care who tested positive for N-methyl-D-aspartate receptor (NMDAR), contactin-associated protein 2 (CASPR2) and/or glutamic acid decarboxylase 65 (GAD65) antibodies (n = 24) were age – and sex matched with antibody-negative patients (1:2) from the same cohort (n = 48). All patients were invited to follow-up including psychometric testing (e.g. Symptom Checklist-90-Revised), serum and cerebrospinal fluid (CSF) sampling, EEG and 3 T brain MRI. Twelve antibody-positive (ab+) and 26 antibody-negative (ab−) patients consented to follow-up. Ab+ patients had more severe symptoms of depression (p = 0.03), psychoticism (p = 0.04) and agitation (p = 0.001) compared to ab− patients. There were no differences in CSF analysis (n = 6 ab+/12 ab−), EEG (n = 7 ab+/19 ab−) or brain MRI (n = 7 ab+/17 ab−) between the groups. In conclusion, anti-neuronal ab+ status during index admission was associated with more severe symptoms of depression, psychoticism and agitation at three-year follow-up. This supports the hypothesis that anti-neuronal antibodies may be of clinical significance in a subgroup of psychiatric patients.

Assessing the Outcome of Compulsory Treatment Orders on Management of Psychiatric Patients at 2 McGill University- Associated Hospitals

Some literature suggests that compulsory community treatment orders (CTOs) are effective in reducing hospitalizations in a subgroup of psychiatric patients with histories of repeated hospitalization, allowing them to be treated in the community under less restrictive measures. However, studies have yielded contradictory findings, in part because of methodological differences. Our study examines the effectiveness of CTOs in reducing hospitalizations and increasing community tenure of such patients. The sample included all psychiatric patients who had been given a CTO during a 9-year period at 2 of McGill University's hospitals. This is a naturalistic, observational, retrospective, before-and-after study where patients acted as their own control subjects. We examined variables, including the number, duration, and time to psychiatric admissions, comparing 4 time periods: early, pre-index, index (when the first CTO was in force), and post-index periods. The total study duration per subject encompasses the longest period of observation within existing studies in Canada. Psychiatric patients with histories of frequent readmissions demonstrated a significant reduction in their number of hospitalizations as well as an increase in the median time to re-hospitalization, during the period when they were treated under a CTO. This effect of CTO was sustained even after the CTO had expired. Our study suggests that CTOs are effective in assisting psychiatric patients with histories of repeated hospitalizations to live and be treated in the community, diminishing the occurrence of frequent hospitalization.

Spectrum of Autoantibodies in Tunisian Psychiatric Inpatients

One hundred and three psychiatric inpatients (74 men) were assessed for a wide spectrum of autoantibodies including antinuclear, antismooth muscle, antimitochondrial, antiDNA, anti-phospholipid, anti-cardiolipin IgG and IgM, antikeratin, rheumatoid factor, antithyroperoxydase, antigliadin IgA and IgG, antitransgutaminase, and antiendomysium antibodies. Four groups of patients were considered separately, including 47 with schizophrenia, 23 with schizoaffective disorder, 16 with bipolar disorder and 17 patients with other different psychiatric diagnosis. Forty one healthy, age- and sex-matched blood donors were used as a control group. There were no significant difference in the prevalence of the different autoantibodies between patients (N = 103) and controls except for antigliadin IgG (30.1 vs 9.8 respectively, p = 0.01). Presence of autoantibodies was influenced by age but not by sex or treatment. As for diagnosis categories, patients with bipolar disorder presented significantly more autoantibodies than the three other categories and controls. These results point out a possible autoimmune activation in at least a subgroup of psychiatric patients especially amongst those suffering from bipolar disorder.

Anti‐Borna disease virus antibody responses in psychiatric patients: Long‐term follow up

Data suggesting a pathogenetic role for Borna disease virus (BDV) in neuropsychiatric diseases are still inconclusive and it is unknown whether humans become persistently infected or clear the virus infection. The aim of the present study was therefore to investigate long-term BDV-specific antibody responses in psychiatric patients in order to gain new insights into human BDV infection and its pathogenicity. BDV-specific antibody titers and associations with clinical conditions were studied retrospectively in 94 seropositive patients with schizophrenia (n = 46), affective disorders (n = 19) and other psychiatric disorders (n = 29) who had been repeatedly tested for the presence of BDV-specific antibodies on indirect immunofluorescence assay between 1985 and 2006. Long-term titer dynamics were studied in 46 patients followed up for a period of >36 months. A total of 25 of these 46 patients (54.3%) had persistent seropositivity, whereas seroreversion from positive to negative was observed in 21 (45.7%). Patients in the early course of schizophrenia had lower antibody titers compared to patients in the advanced course (P = 0.017), while a higher proportion of patients in the early course had titer increases (P < 0.05). There were no significant differences in antibody titers between patient subgroups with clinically stable and acute psychiatric disorders. Persistent seropositivity in a subgroup of psychiatric patients in the long-term analysis suggests chronic BDV infection in humans.

P03-76 - Mild encephalitis inflammation subgroups in affective and schizophrenic disorders

ObjectivesLow level inflammatory Mild Encephalitis (ME) mechanisms were suspected in a subgroup of treatment resistant hospitalised affective and schizophrenic spectrum disorder patients.MethodsWe analysed albumin, IgG, IgA, IgM, oligoclonal IgG and specific antibodies in paired cerebrospinal fluid (CSF) and serum samples from patients with affective (n=24) or schizophrenic spectrum disorders (n=39). Numerical and graphical interpretation of CSF protein data was performed by Reibergrams with reference to a large control group (n= 4100).ResultsIn 41% of the psychiatric patients (n=63) we observed CSF pathologies: 14% displayed intrathecal humoral immune responses, 10% slightly increased CSF cell counts (5-8/μL) and 29% had moderate blood-CSF barrier dysfunctions, in 24% as the only pathological sign with normal IgG, IgA and IgM concentrations in CSF (p= 0.9 testing the null hypothesis for intrathecal synthesis with reference to Qmean of the reference group). In the affective (n= 24) spectrum 20% displayed a systemic immune reaction as detected by oligoclonal IgG. In probable 6% of virusspecific, bacterial or autoimmune associated disorder with CNS involvement. Elevated CSF neopterin concentration in 34% of the patients was interpreted as an increased release from astrocytes or from other glia cells.ConclusionThe low level immune response and barrier dysfunctions are discussed on the base of a ME pathomechanism in subgroups of psychiatric patients. CSF analysis is shown to be a useful diagnostic tool for differential diagnosis in psychiatric diseases.

Cerebrospinal fluid analysis in affective and schizophrenic spectrum disorders: Identification of subgroups with immune responses and blood–CSF barrier dysfunction

Immune and inflammatory mechanisms are detected in a subgroup of treatment resistant hospitalized affective and schizophrenic spectrum disorder patients. We analysed albumin, IgG, IgA, IgM, oligoclonal IgG and specific antibodies in paired cerebrospinal fluid (CSF) and serum samples. Numerical and graphical interpretation of CSF protein data was performed by Reibergrams with a new CSF statistics tool for nonlinear group analysis with reference to a large control group ( n = 4100). In 41% of the psychiatric patients ( n = 63) we observed CSF pathologies: 14% displayed intrathecal humoral immune responses, 10% slightly increased CSF cell counts (5–8/μL) and 29% had moderate blood–CSF barrier dysfunctions, in 24% as the only pathological sign with normal IgG, IgA and IgM concentrations in CSF ( p = 0.9 testing the null hypothesis for intrathecal synthesis with reference to Qmean of the reference group). In the group of affective ( n = 24) spectrum disorders 20% displayed a systemic immune reaction as detected by oligoclonal IgG. CSF analysis and interdisciplinary clinical approach revealed 6% of psychiatric patients likely to represent a virusspecific, bacterial or autoimmune associated disorder with CNS involvement. Elevated CSF neopterin concentration in 34% of the patients was interpreted as an increased release from astrocytes or from other glia cells. The low level immune response and barrier dysfunctions are discussed on the base of a mild encephalitis pathomechanism in subgroups of psychiatric patients. CSF analysis is shown to be a useful diagnostic tool for differential diagnosis in psychiatric diseases.

Prevalence of Hepatitis B, Hepatitis C, and HIV Infections Among Patients in a Psychiatric Hospital in Greece

Prevalence of Hepatitis B, Hepatitis C, and HIV Infections Among Patients in a Psychiatric Hospital in Greece

Clinical validation of the Chinese Personality Assessment Inventory.

The clinical validity of the Chinese Personality Assessment Inventory (CPAI; F. M. Cheung, K. Leung, et al., 1996) was examined in 2 studies involving a group of 167 male prisoners in Hong Kong and a group of 339 psychiatric patients in China. Elevated scores on the clinical scales were obtained for the clinical samples. Logistic regression analyses confirmed that the CPAI scales were useful in differentiating between male prisoner and the Hong Kong male normative sample and between psychiatric patients and a random sample of normal adults in China. Multivariate analyses of variance results showed significant differences on the CPAI clinical scales and personality scales among subgroups of psychiatric patients with diagnoses of bipolar, schizophrenic, and neurotic disorders. The usefulness of an indigenous personality inventory is discussed.

Digitized analysis of hand movements in psychiatry. Methods, clinical findings and perspectives

Numerous morbo- and pharmacogenic motor disorders are signs of psychiatric disease. In past, their exact and quantitative registration has not been possible or only possible using quite extensive procedures. Now we can use newer methods like the computer-aided analysis of hand movements, an elegant procedure allowing the detailed representation of discrete motor dysfunction. While these procedures are used with increasing tendency in neurology, their use aiming the investigation of psychiatric hypotheses is still at the beginning. Relevant application fields of the computer-aided analysis of hand movement are the differentiated and quantitative registration of movement disorders that could only be detected by use of rating scales so far; the registration of subclinical motor abnormalities leading to the detection of the participation of the motor system in certain subgroups of psychiatric patients; the differentiation of morbo- and pharmacogenic motor disorders (e.g. hypokinesia induced by neuroleptics versus schizophrenic negative symptomatology); the registration of neurological soft signs (e.g. in schizophrenic patients); the individual dose adjustment accounting for the threshold of extrapyramidal motor side effects (EPMS) under neuroleptic treatment and the detection and documentation of clinical and subclinical tremor. For some of these application fields there already exist promising findings. Some newer results will be presented. Schizophrenic patients were found to manifest impairments of velocity and degree of automatization and a reduced regularity of repetitive hand movements (fine motor dysdiadochokinesia)--a possible indicator for a disturbance of cerebral development. Patients with Alzheimer's disease showed loss of automatization and well preserved peak velocity. This finding could be relevant for the early detection of Alzheimer's dementia. Distal EPMS induced by neuroleptics can be exactly documented and their course can be represented using this method. The quick and economical utilization of digitized analysis of hand movements makes this procedure suitable for a broader application in the ambulatory setting.

Psychosensory Symptomatology in Anticonvulsant-Responsive Psychiatric Illness

AbstractAn increasing body of literature indicates that anticonvulsants are effective psychotropic agents for a selected subgroup of psychiatric patients. Selection criteria for the identification of these patients are sparse, and this lack of specificity has contributed to the controversy regarding the psychotropic efficacy of this class of agents. Up to this point there have been no clear indicators on mental status examination that have been shown to correlate with anticonvulsant responsiveness in psychiatric patients. The present study evaluated psychosensory symptomatology in two groups of chronically stable affectively ill patients, one group on standard psychotropic medications and the other requiring anticonvulsants for stability after failing on standard psychotropic medication regimens. Abnormalities regarding the sensory pathways and suddenness of affective change showed significant differences between the two groups. Evaluation of these areas on mental status examination appears to be clinical...

After Discharge: The Importance of Life Events and Life Hassles for Psychiatric Patients

The relationship between life events and symptoms during a six month period following discharge was examined for four diagnostic subgroups of psychiatric patients (N = 505). The significant correlation between total life changes and symptoms disappeared when health related items were deleted. These events should be kept analytically distinct to avoid operational confounding. There was a correlation between undesirable life events and symptoms specific to the diagnostic subgroups characterized by depression. Although the correlations between life event scores and symptoms were weak or non-existent, there are strong correlations between social adjustment scores and symptoms. One explanation is that the most potent stressors are the ongoing difficulties rather than major changes which occur. It is suggested that the ongoing difficulties are, in part, a reflection of inadequate coping skills and a lack of social support: factors which may have a direct negative effect on symptoms and increase vulnerability to minor stressors.

Sexual histories and premenstrual affective syndrome in psychiatric inpatients.

Of 45 female inpatients with schizophrenia, depression, borderline personality, or depression and borderline personality, 28 met criteria for probable or definite premenstrual affective syndrome. Of these 28, 16 had abnormal sexual histories, compared with only 1 of the 17 women who did not have premenstrual affective syndrome. Of the 12 patients with both depression and borderline personality disorder, 9 had both premenstrual affective syndrome and abnormal sexual histories. The 6 patients who had been raped all met the criteria for premenstrual affective syndrome. The authors suggest that premenstrual affective syndrome may signify unresolved sexual conflicts in subgroups of psychiatric patients.

Wirkung von Psychopharmaka und zugrundeliegende theoretische Vorstellungen: Allgemeine methodologische Probleme der klinischen Prüfung von Psychopharmaka

The difference between the methodological approach of the basic neuro-sciences and the descriptive clinical methods consists in the possibility of isolating the object studied in the former, and in the complexity of relevant clinical terms in the latter which can only be quantified secondarily. Psychopathological symptoms, even operationalized and quantified as items in rating scales, remain complex, whereas the values taken from the substratum, i.e. physiological or biochemical can clearly be evaluated. The complexity of measuring psychopathological symptoms is illustrated in a study in which the scores of different scales of depressive patients are correlated before and after treatment, and the step from the physiological to the psychological level is discussed by means of the results of a psychophysiological study with normal subjects who were given a sedative. These results suggest a heterogeneity of samples of psychiatric patients selected for therapeutic studies according only to clinical criteria. This heterogeneity is discussed on five levels of psychopathological states in depressive, schizophrenic and nonpsychotic anxiety syndromes. Particular interest is put on to the psychophysiological level. From this heterogeneity of samples of psychopharmacological studies, two conclusions can be drawn: 1) Double blind studies are of limited value, since so far only the general effects of whole categories of psychotropic drugs could be determined, whereas it was not possible to determine specific indications for an individual drug. 2) The object of research must be to embody psychopathological states in psychophysiological and clinical-biochemical data, in order to find more homogeneous subgroups of psychiatric patients and to optimize therapeutic procedures; in other words, to find out which patients respond best to a given drug. This strategy, however, limits the generalisation of therapeutic use of a given drug, but it permits to find more specific indications. This is, of course, a general principle in the development of psychiatric therapy.