Therapy For Psychiatric Patients Research Articles

Family-based therapy for internet addiction among adolescents and young adults: Ameta-analysis.

Internet addiction (IA) has been identified as a major public health problem that is more prominent in adolescents and young adults. Some researchers have indicated certain advantages of family-based therapy over other treatments in participants with IA, but no conclusive evaluation has been reported. The present meta-analysis aims to review the efficacy of family-based therapy on Internet addiction in adolescents and young adults. Relevant articles published from 1996 to February 15th, 2024, were searched from 14 databases, including three Chinese databases. A total of 19,590 articles were identified using a combination of three sets of search terms (Internet addiction, family therapy, and adolescents). Only RCTs and nonrandomized controlled trials were included. 18 studies, most of which were conducted in Asian countries, were included in the final data analysis. The overall severity of Internet addiction in the family-based therapy group was significantly lower than that in the control group. However, significant heterogeneity was detected. Subgroup analysis showed a beneficial effect of family-based therapy when compared with non-intervention and when added to another psychological or behavioural therapy in psychiatric patients with co-medication. Few studies have examined secondary outcomes or follow-up effects. Family-based therapy is most effective in reducing the severity of Internet addiction when combined with other therapies, especially medication treatments in psychiatric patients. It might also be helpful to relieve depression and enhance family functions, which needs further evidence. More studies following up on the post-intervention effects are recommended in the future.

AI to Train AI: Using ChatGPT to Improve the Accuracy of a Therapeutic Dialogue System

In this work, we present the use of one artificial intelligence (AI) application (ChatGPT) to train another AI-based application. As the latter one, we show a dialogue system named Terabot, which was used in the therapy of psychiatric patients. Our study was motivated by the fact that for such a domain-specific system, it was difficult to acquire large real-life data samples to increase the training database: this would require recruiting more patients, which is both time-consuming and costly. To address this gap, we have employed a neural large language model: ChatGPT version 3.5, to generate data solely for training our dialogue system. During initial experiments, we identified intents that were most often misrecognized. Next, we fed ChatGPT with a series of prompts, which triggered the language model to generate numerous additional training entries, e.g., alternatives to the phrases that had been collected during initial experiments with healthy users. This way, we have enlarged the training dataset by 112%. In our case study, for testing, we used 2802 speech recordings originating from 32 psychiatric patients. As an evaluation metric, we used the accuracy of intent recognition. The speech samples were converted into text using automatic speech recognition (ASR). The analysis showed that the patients’ speech challenged the ASR module significantly, resulting in deteriorated speech recognition and, consequently, low accuracy of intent recognition. However, thanks to the augmentation of the training data with ChatGPT-generated data, the intent recognition accuracy increased by 13% relatively, reaching 86% in total. We also emulated the case of an error-free ASR and showed the impact of ASR misrecognitions on the intent recognition accuracy. Our study showcased the potential of using generative language models to develop other AI-based tools, such as dialogue systems.

The Efficacy and Tolerability of Electroconvulsive Therapy in Psychiatric Patients with Arachnoid Cysts: A Retrospective Chart Study.

Electroconvulsive therapy (ECT) is an effective therapy for many psychiatric illnesses. However, intracranial occupying lesions are a relative contraindication to ECT. Arachnoid cysts are benign, congenital, and space-occupying lesions. Our study aimed to evaluate the efficacy and tolerability of ECT in psychiatric patients with arachnoid cysts. We retrospectively identified 62 psychiatric patients with arachnoid cysts; 43 of them underwent ECT and 19 did not. Their conditions were assessed by CGI-S and different scales depending on different diagnoses (PANSS for schizophrenia; HAMD for depression; YMRS for bipolar disorder). The side effect was assessed by TESS. Significant differences were shown in the reduced scores of the CGI-S between patients who underwent ECT and those who did not (p = 0.001), while, at the same time, there was no significant difference in their TESS score (p = 0.297). The current study found that ECT is an effective and tolerable therapy for psychiatric patients with arachnoid cysts.

History of the Hospital Real y General de Nuestra Señora de Gracia in Saragossa: Occupational Therapy Pioneer in Neurology and Psychiatry in Spain

In this article the authors describe the program of the Hospital Real y General de Nuestra Señora de Gracia in Saragossa (Spain) and its importance in the history of occupational therapy. It is believed to be the first hospital in the world to use occupations as therapy for psychiatric patients. Pinel knew about this new trend through a report by Iberti and wrote about it in his book Medico-Philosophical Treatise on Mental Alienation.

P-1106 - Agression and drug treatment choices concerning inpatients with serious mental disorder

Introduction Psyhiatrists who work in hospitals and treat patients who show aggression present particular challenges. The course and treatment of serious psychiatric disorders can be complicated because of the comorbidity with substance abuse. The objective of the present study is the drug treatment of aggression among in-patients with serious mental disorder. Method The participants (423 patients) were randomly screened among the in-patients of the 9 acute departments of PHA (Psyhiatric Hospital of Attica). For the statistical analysis, the program SPSS was used. Results The participants (423 patients): average age 45.9 years old (sd = 13.1), 60.8% men, 63.7% involuntary admitted, disorder onset: 28.4 years (sd = 12.1), diagnosis of Schizophrenia 72.1%, Bipolar disorder 16.8%, Depression 11.1% with substance abuse in 18.7%, and reason of admission: auto/hetero- agression 24.3%, relapse of the disease 46.1%, interruption of drug therapy 27%. 67,5% showed aggression at the admission, 25.6% were administered more than one antipsychotic drug at the admission, along with benzodiazepines in 53.7%. During their hospitalization, aggression was reduced to 22.9%, with verbal aggression first in line with 14.4%, and 41.9% of the patients were administered more than one antipsychotic drug. The SGAs dominated and were administered in combination with stabilizers, antidepressants and benzodiazepines. Conclusions There are few documented points to guide daily practice, and it seems that case reports, advices from other colleagues and/or personal experience may influence in an important way the therapy of psychiatric patients who show aggressive behavior.

Effect of remifentanil or esmolol on stress response during electric shock therapy in psychiatric patients

To observe the effects of remifentanil or esmolol on the stress responses during electric shock therapy in psychiatric patients. Upon the approval of institutional Ethics Committee, Eighty psychiatric patients requiring electric shock therapy were randomly divided into 2 groups:esmolol group (Group E) and remifentanil group (Group R) (n = 40 each). The patients in Groups E and R were injected with esmolol 1 mg/kg or remifentanil 2 µg/kg respectively before induction of anesthesia. Electric shock therapy was performed after a disappearance of fasciculation. MAP (mean arterial pressure) and HR (heart rate) were recorded at the following time points:prior to anesthesia (T0), prior to electric shock therapy (T1) and at 1 min (T2), 3 min (T3) & 5 min (T4) after electric shock therapy. Venous blood samples were collected at (T0) and (T4). The plasma levels of cortisol and norepinephrine were determined by enzyme-linked immunosorbent assay. The levels of MAP and HR at T2, T3 were significantly higher than those at T0 in Group E (P < 0.05). And the levels of cortisol and norepinephrine at T4 were significantly higher than those at T0 in 2 groups (P < 0.05). However, their levels were significantly higher in Group E than those in Group R (P > 0.05). In modified electric convulsive treatment, remifentanil is superior to esmolol in maintaining the stabilization of cardiovascular system and effectively inhibiting the stress responses.

The Recognition of Music Therapy of Psychiatric Patients

The Recognition of Music Therapy of Psychiatric Patients

Safety of Electroconvulsive Therapy in Psychiatric Patients Shortly After the Occurrence of Pulmonary Embolism

We encountered 2 patients with a psychiatric disorder (depression in one and catatonia in one) accompanied by motor inhibition that was complicated by pulmonary embolism (PE). In both cases, the psychiatric disorder was safely resolved with electroconvulsive therapy (ECT) during anticoagulant therapy. The 2 cases direct our attention to at least 3 important points regarding safe administration of ECT shortly after the occurrence of PE, that is, careful evaluation of cardiac function and residual deep vein thrombosis before the start of an ECT course, adjustment of anticoagulants, and prevention of recurrent deep vein thrombosis and PE by methods in addition to anticoagulant therapy (fluid infusion, use of support hose, and timely ECT).

Targeting the NMDA Receptor for Fear-Related Disorders

The gap between basic neuroscience and clinical psychiatry in the treatment of anxiety disorders has been steadily diminishing over recent years. Among the leading advances in this field of translation research is the application of knowledge on the neurobiology of fear memory to the treatment of anxiety disorders in humans. Animal studies have identified N-methyl-D-aspartate (NMDA) receptors as crucial in fear memory acquisition and consolidation, as well as in its extinction and reconsolidation. Based on this, the NMDA receptor partial agonist D-cycloserine, which facilitates fear extinction in rodents, has been shown to increase the effect of exposure therapy in psychiatric patients for conditions such as phobias, social anxiety and obsessive-compulsive disorder. In this article, we review current strategies for targeting the NMDA receptor in the treatment of fear-related disorders, analyzing experimental results, clinical data, and recent patents in the field, while also addressing potential new approaches to explore this field of drug discovery.

Efficacy of Add-On Topiramate Therapy in Psychiatric Patients with Weight Gain

Weight gain is a common adverse effect of many psychotropic medications including antipsychotics, antidepressants, and mood stabilizers. There is a growing body of evidence that topiramate may be useful as an add-on therapy to induce weight loss in patients who have experienced psychotropic-induced weight gain. To determine the efficacy and tolerability of topiramate for treatment of weight gain in a naturalistic mental health clinic setting. A retrospective chart review was conducted at a community mental health clinic. Subjects were non-elderly adults who received topiramate therapy beginning in 2002-2005 for documented weight gain during treatment with psychotropic drugs. Primary outcome measures included response rate (based on weight loss of any magnitude) and mean changes in weight and body mass index (BMI). Forty-one patients were included in the study. There was a 58.5% (n = 24) response rate. Mean reductions in weight and BMI were approximately 2.2 kg and 0.5 points, respectively. Responders lost an average of 7.2 kg, whereas nonresponders gained an average of 5.0 kg. Patients with a baseline weight of at least 91 kg and those receiving a greater number of psychotropic medications were more likely to experience success with topiramate therapy. Of the 24 patients who responded to therapy, 22 experienced onset of weight reduction by the next clinic visit (1-4 mo) following either initiation of therapy or titration to the eventual therapeutic dose, and the usual rate of weight loss was 0.45-1.4 kg per month. Therapy was typically initiated at 50 mg/day. The mean maximum dose was 93.9 mg/day and the median maximum dose was 100 mg/day. Seven (17.1%) patients had documented adverse effects to topiramate therapy. Topiramate therapy resulted in overall modest (ie, <2%) decreases in weight and BMI, but many patients experienced more impressive weight loss. Therapy was generally well tolerated.

Parrots as therapy for psychiatric patients

I would agree with Pease & Brown ( Psychiatric Bulletin , December 2006, 30 , 463) that parrots are probably not suitable for health centres, not because of confidentiality problems but because they can be noisy and it is unfair to keep them constantly caged. When parrots breach confidentiality it

Management of Psychiatric Disorders in a Resident-Run Multi-Disciplinary Clinic Improves Adherence to Interferon Alpha Therapy in Patients with Chronic Hepatitis C

Purpose: Treatment of chronic hepatitis C (HCV) in patients with psychiatric illness is controversial secondary to depression and other neuropsychiatric side effects. The purpose of this study is to evaluate adherence to therapy with interferon-alpha in patients with chronic hepatitis C and established psychiatric diagnoses in a resident-run multidisciplinary HCV clinic. Methods: Medicine residents in the HCV clinic are precepted by an attending gastroenterologist and psychiatrist and are supported by a registered nurse coordinator. Treatment for HCV with peg-interferon alpha 2a and ribavirin is guided by evidence-based protocols within the confines of managed care formularies. Baseline psychiatric diagnoses and course of psychiatric illness is followed. Results: 16 patients had baseline psychiatric diagnoses. 7 had Major Depressive Disorder, 3 had Bipolar Disorder, 1 had Generalized Anxiety Disorder, 2 had Schizophrenia and 3 had Schizoaffective Disorder. 10 had co-morbid substance abuse disorders. 1 patient had a substance abuse disorder as the only diagnosis. Throughout treatment with interferon-alpha, all patients were maintained on their psychiatric medications, with rare adjustments. 2 patients needed increases in antidepressant dosage, 1 patient needed an antidepressant added to their regimen, and 13 had no changes in their antidepressant dose. No patient had a significant change in their mood stabilizing/antipsychotic doses. 3 patients had an increase while 13 had no change in dose of their anti-anxiety medication. 1 patient had a psychiatric hospitalization due to bizarre behavior after taking narcotics and benzodiazepines, but interferon treatment was not discontinued. No patients experienced suicidal ideation. None of the 16 patients had interferon therapy discontinued. Conclusions: During treatment of under-insured and uninsured patients with HCV via a resident-initiated, multidisciplinary clinic, there were no significant changes in psychiatric symptoms of the 16 patients with prior psychiatric diagnosis who underwent treatment with interferon-alpha. Strict follow-up, with availability of a gastroenterologist, psychiatrist, residents and a nurse, led to 100% adherence to HCV therapy in psychiatric patients in our HCV clinic. This suggests that an integrative clinic can safely manage psychiatric co-morbidities and interferon-alpha treatment to expand access to care.

Has amobarbital expired?

Juhn Wada1 and W. James Gardner2 were among the first investigators to anesthetize the cerebral cortex, although their agents and aims differed. Gardner directly injected procaine hydrochloride (Novocain) through holes drilled into the brain, for the purpose of localizing speech in two left-handed patients scheduled for resection of brain tumors. Dr. Wada first used intracarotid amobarbital injections to treat a patient in status epilepticus, and later to direct placement of electrodes for electroconvulsive therapy in psychiatric patients. Subsequently, Dr. Wada and colleagues at the Montreal Neurologic Institute extended his technique to assessment of language and memory in epilepsy surgery patients. The intracarotid amobarbital procedure has emerged in epilepsy surgery centers around the world as the standard method to lateralize speech and memory functions and to prevent or predict the magnitude of related declines following epilepsy surgery. The continuation of this practice has recently been challenged on two fronts, however. First, some have proposed that new methodologies and technologies can replace the Wada. Second, a recent interruption in the supply of amobarbital has caused some centers to seek out novel anesthetic agents. In 2003–2004, there was a shortage of amobarbital on a worldwide basis for at least several months when the manufacturing …

Abnormal QT prolongation and psychotropic drug therapy in psychiatric patients: Significance of bradycardia-dependent QT prolongation

Because many psychotropic drugs have electrophysiological properties similar to antiarrhythmic drugs, they might lengthen QT interval and cause torsades de pointes. Electrocardiograms were obtained in 688 psychiatric patients receiving psychotropic drugs. A QTc interval >460 ms was observed in 96 (14%) patients. To elucidate the heart rate dependence of QT prolongation, we measured QT intervals and the preceding R-R intervals at various heart rates by 24-hour Holter electrocardiogram in 97 patients. We estimated the QT intervals at the heart rates of 80 beats/min and 50 beats/min by the regression curve. A QT interval at the heart rate of 80 beats/min exceeded 400 ms in 14 (15%) patients and that at the heart rate of 50 beats/min exceeded 480 ms in additional 12 (12%) patients. Therefore, additional attention is needed for bradycardia-dependent QT prolongation even when the QT interval was not prolonged at usual heart rates.

Antipsychotic drugs influence transport of the β-adrenergic antagonist [3H]-dihydroalprenolol into neuronal and blood cells

SummaryThe amine hypothesis suggests that the cause of schizophrenic or depressive psychosis is dysfunction of noradrenergic or serotonergic neurotransmission. We investigated pharmacological properties of [3H]-dihydroalprenolol (DHA) transport into C6, IMR32, native lymphocytes, B-lymphoblastoids and MOLT-3 cells. DHA transport was inhibited by a heterogeneous group of structurally related compounds exhibiting an amine group and various aromatic ring structures. It was verified on cells of neuronal/glial and blood cell origin but in detail on B-lymphoblastoids. The latter once showed strongest inhibition of DHA transport using tricyclic antidepressants (amitriptyline: IC50=2.86 μM, imipramine: IC50=3.33 μM) and haloperidol (IC50=3.98 μM) as a neuroleptic. Antipsychotics like clozapine (IC50=11 μM), olanzapine (IC50=15 μM), spiperone (IC50=66 μM) and EMD 49980 (IC50 ≫ 100 μM) were less effective. In contrast to cells of blood origin, a stimulation of DHA transport by antipsychotics was not detectable using neuronal cells.As antipsychotics showed a distinct inhibition and, concerning cells of blood origin, a stimulation of transport after pre-incubation, further investigations seem to be of interest in respect to its involvement in the cellular uptake of drugs and therefore its impact on the quality of therapy of psychiatric patients.

Critical Issues in the Use of Psychotropic Medication and Prolonged QTc

Free AccessCritical Issues in the Use of Psychotropic Medication and Prolonged QTcDorothy E. Stubbe and Lawrence ScahillDorothy E. Stubbe1. Child and adolescent psychiatry residency training, Yale University School of Medicine Child Study Center.Search for more papers by this author and Lawrence Scahill2. Yale University School of Nursing and Yale Child Study Center.Search for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.7.5.6.22724PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsDubin , D. (2000). Rapid Interpretation of EKG's (6th Edition), Cover Publishing Company, Tampa FL. Google ScholarGlassman , A. H., & Bigger, J. T. (2001). Antipsychotic drugs: Prolonged interval, torsade de pointes, and sudden death. American Journal of Psychiatry, 158, 1774–1782. Crossref, Google ScholarGralinski , M. R. (2000). The assessment of potential for QT interval prolongation with new pharmaceuticals: Impact on drug development. Journal of Pharmacological and Toxicological Methods, 43, 91–99. Crossref, Google ScholarGutgesell , H., Atkins, D., Barst, R., Muck, M., Franklin, W., Humes, R., Ringel, R., Shaddy, R., & Taubert, K. (1999). AHA scientific statement: Cardiovascular monitoring of children and adolescents receiving psychotropic drugs. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1047–1050. Crossref, Google ScholarKeating , M. T., & Sanguinetti, M. D. (1996). Molecular genetic insights into cardiovascular disease. Science, 272, 681–685. Review. Crossref, Google ScholarOesterheld , J. R., & Shader, R. I. (1998). Cytochromes: A primer for child and adolescent psychiatrists. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 447–450. Crossref, Google ScholarPopper , C. W, & Zimnitzky, B. (1995). Sudden death putatively related to desipramine treatment in youth: A fifth case and a review of speculative mechanisms. Journal of Child and Adolescent Psychopharmacology, 5, 283–300. Crossref, Google ScholarReilly , J. G., Ayis, S. A., Ferrier, I. N., & Jones, S. J., & Thomas, S. H. L. (2000). QT-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet, 355, 1048–1052. Crossref, Google ScholarUnited States Food and Drug Administration. Available at: http://www.verity.fda.gov/search97cgi/s97cgi.exe. Accessed September 4th, 2001. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 7Issue 5Oct 2002 Information© Guilford Publications Inc.PDF download

Abnormal QT prolongation and psychotropic drug therapy in psychiatric patients: significance of bradycardia-dependent QT prolongation

Abnormal QT prolongation and psychotropic drug therapy in psychiatric patients: significance of bradycardia-dependent QT prolongation

QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients

Sudden unexplained death in psychiatric patients may be due to drug-induced arrhythmia, of which lengthening of the rate-corrected QT interval (QTc) on the electrocardiogram is a predictive marker. We estimated the point prevalence of QTc lengthening in psychiatric patients and the effects of various psychotropic drugs. Electrocardiograms were obtained from 101 healthy reference individuals and 495 psychiatric patients in various inpatient and community settings and were analysed with a previously validated digitiser technique. Patients with and without QTc lengthening, QTc dispersion, and T-wave abnormality were compared by logistic regression to calculate odds ratios for predictive variables. Abnormal QTc was defined from the healthy reference group as more than 456 ms and was present in 8% (40 of 495) of patients. Age over 65 years (odds ratio 3.0 [95% CI 1.1-8.3]), use of tricyclic antidepressants (4.4 [1.6-12.1]), thioridazine (5.4 [2.0-13.7]), and droperidol (6.7 [1.8-24.8]) were robust predictors of QTc lengthening, as was antipsychotic dose (high dose 5.3 [1.2-24.4]; very high dose 8.2 [1.5-43.6]). Abnormal QT dispersion or T-wave abnormalities were not significantly associated with antipsychotic treatment, but were associated with lithium therapy. Antipsychotic drugs cause QTc lengthening in a dose-related manner. Risks are substantially higher for thioridazine and droperidol. These drugs may therefore confer an increased risk of drug-induced arrhythmia.

Hyponatraemia and the Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Drug Therapy in Psychiatric Patients

Hyponatraemia, the most common electrolyte disorder of all hospitalised patients, is particularly common in psychiatric patients. Hyponatraemia is generally defined as a serum sodium level of less than 135 mmol/L. Certain psychotropic medications may predispose to hyponatraemia, yet a causative role for most has not been firmly established and their effect is most likely to be idiosyncratic. Certain factors such as age, schizophrenia and a history of hyponatraemia or polydipsia should alert the clinician to the need for closer follow-up.

Monitoring of laboratory parameters during carbamazepine therapy in psychiatric patients.

In recent years, carbamazepine has increasingly also been used in psychiatric indications. However, the manifold action of this drug also manifests itself in a number of adverse effects. In a prospective study including 46 patients, who were given carbamazepine for psychiatric indications and most of whom were also treated with one or several other psychotropic drugs, the following laboratory parameters were determined at two-weekly intervals: red and white blood count, platelets, SGOT, SGPT, gamma GT, alkaline phosphatase, serum calcium, serum sodium, IgA, IgG, IgM. Statistically significant changes were found in erythrocytes, leucocytes, platelets (decrease), Gamma GT (increase), serum calcium (decrease), IgA, IgM (decrease). The clinical relevance of these changes is discussed.