Non-cognitive aspects of dementia

OBJECTIVE: To observe the frequency of various psychiatric disorders (depressive disorders, anxiety state and paraphrenic-paranoid disorders). PATIENTS AND METHODS: This study includes the 'cases' of dementia detected in an epidemiological field study done door-to-door, double phased and including non-institutionalized persons aged over 69 years in a rural area. All diagnoses were done by CAMDEX and on these criteria. RESULTS: Depressive disorder was diagnosed in 26.5% studied, paraphrenic or paranoid disorder in 14% and anxiety state in 6.5%. Depression and paraphrenic-paranoid disorder were not associated with the severity of the dementia, whilst anxiety state was more commonly seen in mild dementia. Paraphrenic-paranoid disorders were commoner in women than in men. CONCLUSION: The considerable prevalence of other psychiatric diagnoses in persons with dementia shows that non-cognitive symptoms are common in these patients.     

Management of the aggressive and dangerous patient

Violence is the ultimate maladaptive coping behavior manifested by a small but significant number of psychiatric patients. The management of the aggressive and dangerous patient depends on recognition of predisposing developmental experiences, cognitive and behavioral factors, and situational circumstances that potentiate a violent outburst. The author presents management guidelines, which stem from an understanding of the paranoid process, respect for the limited coping skills of the individual, and appropriate use of verbal, physical, and chemical interventions.     

Personal efficacy, external locus of control, and perceived contingency of parental reinforcement among depressed, paranoid, and normal subjects.

Hypothesized that different combinations of personal efficacy and outcome expectancies (i.e., locus of control) would characterize the thought structures of normal Ss and of psychiatric patients suffering from distinctly different disorders. 26 normal (mean age 30.1 yrs), 15 depressed, and 22 paranoid Ss (mean age of patients 34.5 yrs) completed scales that measured beliefs in personal efficacy, beliefs that outcomes are controlled either by chance or by powerful others, and perceived contingency of parental reinforcement. Findings show that normals judged themselves to be more efficacious than did psychiatric Ss, depressives expected outcomes to be controlled by chance, and paranoids expected outcomes to be under the control of powerful others. Among the normals, outcome expectancies were strongly associated with personal efficacy, but among the patients, these beliefs were unrelated. Depressives and paranoids equally reported more noncontingent parental reinforcement than did normals. Perceived contingency of parental reinforcement was predictive of outcome expectancies but not of personal efficacy. Data suggest that low personal efficacy may be a distinguishing characteristic of all psychiatric patients, whereas outcome expectancies may determine the specific nature of the psychiatric disorder. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alopecia areata and increased prevalence of psychiatric disorders

BACKGROUND: The relationship between psychiatric disorders and alopecia areata has not been well studied. Although previous reports have been unable to correlate psychiatric illness with hair loss, a recent study determined that 74% of patients with alopecia areata (AA) under evaluation had one or more lifetime psychiatric diagnoses. METHODS: Two hundred and ninety-four community-based patients with alopecia areata responded to a detailed questionnaire distributed by Help Alopecia International Research, Inc. The prevalence of psychiatric disorders was determined using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR). RESULTS: Major depression, generalized anxiety disorder, social phobia, and paranoid disorder were all present in patients with alopecia areata at rates significantly higher than in the general population. CONCLUSIONS: Alopecia areata patients are at a higher risk of developing psychiatric comorbidity during their clinical course.     

Ovarian aging and hormone replacement therapy. Hormonal levels, symptoms, and attitudes of African-American and white women

The purpose of the study was to identify psychiatric symptoms, neurological impairments, and situational factors associated with the emergence of violence and with its persistence. Psychiatric symptoms were assessed in newly admitted physically assaultive psychiatric patients and nonviolent controls. Patients were than evaluated for 4 weeks to determine the persistence or resolution of these physical assaults. Patients who showed marked resolution of assaults were classified as transiently violent (n = 41), and those who remained assaultive throughout were categorized as persistently violent (n = 34). At the end of 4 weeks, all patients received a comprehensive psychiatric and neurological assessment. Physical assaults were associated initially with prominent positive psychotic symptoms. Both transiently and persistently violent patients were more psychotic than the nonviolent controls; however transiently violent patients showed better resolution of these symptoms over the 4 weeks. They also evidenced less frontal lobe impairment on the neurological examination than the persistently violent patients. The two violent groups differed in their susceptibility to environmental influences: the surrounding ward agitation fostered physical assaults in transiently but not in persistently violent patients. This differentiation between transiently and persistently violent patients has major implications for the comprehensive treatment of violent behavior.     

The role of histamine in platelet aggregation by physiological and immunological stimuli

This paper reviews the current state of the debate on the relationship between mental disorder and violent behaviour. Starting from the discussion of methodological approaches to assessing a possible association, the most important studies carried out on the issue in recent years are discussed. Their results concur in supporting the assumption that there is a moderate but reliable association between mental disorder and violence. However, this does not imply that people with mental illness are generally more likely to commit violent acts than members of the general population. An elevated risk of violent behaviour is only evident for specific psychiatric diagnoses and for particular symptom constellations. For schizophrenia and other psychotic disorders, a significant increase in the likelihood to commit violent acts is reported. Substance use disorder and antisocial personality disorder, however, represent a markedly higher risk for violent behaviour. The article further discusses possible determinant of violent behaviour such as psychotic symptoms and comorbidity with substance abuse, and considers who is at particular risk of becoming a target of violent acts.     

Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.     

The treatment of mentally disordered offenders.

However narrowly defined, mentally disordered offenders (MDOs) are heterogeneous in demographics, diagnoses, offense characteristics, risk, and clinical needs. Treatment planning for MDOs should begin with an assessment of risk of future violent behavior in the community and risk of violence toward self or others inside an institution. Purposes of treatment among MDOs include treatments both to reduce risk of future violence and to alleviate the mental disorder. Relevant outcome measures include criminal and violent behavior, psychiatric symptomatology, admission to correctional or psychiatric facility, and quality of life. Clinical problems include aggression and problems of institutional management, criminal propensity, life skills deficits, substance abuse, active psychotic symptoms, social withdrawal, and depression. Because evidence relating them to risk of future violence is highest for the first 4 problems, it is argued that inpatient treatments should especially target them. Whenever risk levels and legal circumstances permit, community treatment is to be preferred. Sex offenders are discussed as a group for whom specialized services are indicated.… (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of chronic administration of alcohol on neural mechanisms of arterial blood pressure regulation]

Metaphor comprehension was studied in schizophrenics as compared to psychiatric and nonpsychiatric controls. Subjects were asked in a two-condition forced-choice response task to detect the metaphor similar or contrary to a proverb with an abstract meaning. Schizophrenic patients were impaired in both conditions. However, the paranoid patients' performances did not differ from psychiatric and nonpsychiatric controls. These results are consistent with the hypothesis that the ability of metaphorizing is preserved in some schizophrenic patients.     

Reaction time, distractibility, and overinclusive thinking in psychotics.

Fifteen paranoid schizophrenics, 15 nonparanoid schizophrenics, and 15 nonschizophrenic psychiatric inpatients were given 3 of Babcock's tests of psychomotor retardation, and a test of overinclusive thinking based on Benjamin's proverbs. In addition, they took part in a simple and multiple-choice auditory reactiontime experiment in which the presence and number of distracting stimuli were varied. As predicted, the reaction times of the overinclusive patients were initially significantly slower. Overinclusive patients were also significantly more affected by the distraction, presumably because they are less able to filter out these irrelevant stimuli. A similar performance characterized those diagnosed as paranoid schizophrenic, as contrasted to those with other diagnoses, probably because of the significant relationship between paranoia and overinclusive thinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violence and aggression in psychiatric units

OBJECTIVE: To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored. METHODS: Data on violent incidents were gathered prospectively in three adult acute psychiatric units in a general hospital and two units in a primary psychiatric hospital in Sydney, Australia. Staff recorded violent and aggressive incidents, which were ranked on an 8-level scale. They also completed weekly reports of staffing levels and patient mix. Poisson regression analysis was used to calculate relative rates, 95 percent confidence intervals, and p values. RESULTS: A total of 1,289 violent incidents were recorded over a seven-month period. Based on the scale, 58 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence. CONCLUSIONS: Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.     

Treating mother and baby in conjoint hospitalization in a psychiatric hospital

Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatric hospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), affective disorder (4), schizo-affective schizophrenia (1) and borderline personality disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended.     

Craniofacial morphology in adult patients with unoperated complete bilateral cleft lip and palate

With recent advances in DNA technology, questions have arisen as to how this technology should be appropriately used. In this article, results obtained from a survey designed to elicit attitudes of college students to prenatal testing and gene therapy for human attributes and psychiatric conditions are reported. The eleven hypothetical disease phenotypes included schizophrenia, alcoholism, tendency toward violent behavior, attention deficit/hyperactivity disorder, depression requiring medical treatment, obesity, involvement in "dangerous" sports activities, homosexuality, borderline normal IQ (80-100), proportional short stature, and inability to detect perfect pitch. Most students supported prenatal genetic testing for psychiatric disorders and behavior that might result in harm to others (i.e., tendency towards violent behavior) and found prenatal genetic testing for human attributes less desirable. However, the lack of unilateral agreement or disagreement toward any one condition or attribute suggests the potential difficulties ahead in the quest for guidelines for the application of new technologies available to manipulate the human genome.     

Hostile attributional biases in severely aggressive adolescents.

128 adolescent boys (aged 14 yrs 2 mo to 19 yrs) from a maximum security prison for juvenile offenders were administered a task to assess hostile attributional biases. As hypothesized, these biases were positively correlated with undersocialized aggressive conduct disorder (as indicated by high scores on standardized scales and by psychiatric diagnoses), with reactive-aggressive behavior, and with the number of interpersonally violent crimes committed. Hostile attributional biases were found not to relate to nonviolent crimes or to socialized aggressive behavior disorder. These findings held even when race and estimates of intelligence and socioeconomic status (SES) were controlled. These findings suggest that within a population of juvenile offenders, attributional biases are implicated specifically in interpersonal reactive aggression that involves anger and not in socialized delinquency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Magical ideation and schizophrenia.

The Eckblad and Chapman (1983) Magical Ideation Scale was administered to groups of paranoid and nonparanoid schizophrenics and control subjects. Schizophrenics were found to score significantly higher than nonschizophrenic psychiatric patients (mainly cases of affective disorder) and normal control subjects. The potential theoretical and prognostic utility of this finding is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitative analysis of polychlorinated biphenyls, organochlorine insecticides, polycyclic aromatic hydrocarbons, polychlorinated hydrocarbons and polynitrohydrocarbons in spiked samples of soil, water and plasma by selected-ion monitoring gas chromatography-mass spectrometry

The current study assesses the relationship between presenting symptomatology of the self-labeled Hispanic popular diagnosis of ataques de nervios and the specific co-morbid psychiatric diagnoses. Hispanic subjects seeking treatment at an anxiety disorders clinic (n = 156) were assessed with a specially designed self-report instrument for both traditional ataque de nervios and panic symptoms, and with structured or semistructured psychiatric interviews for Axis-I disorders. This report focuses on 102 subjects with ataque de nervios who also met criteria for panic disorder, other anxiety disorders, or an affective disorder. Distinct ataque symptom patterns correlated with co-existing panic disorder, affective disorders, or other anxiety disorders. Individuals with both ataque and panic disorder reported the most asphyxia, fear of dying, and increased fear during their ataques. People with ataques who also met criteria for affective disorder reported the most anger, screaming, becoming aggressive, and breaking things during ataques. Ataque positive subjects with other anxiety disorders were less salient for both panic-like and emotional-anger symptoms. The findings suggest that (a) ataque de nervios is a popular label referring to several distinct patterns of loss of emotional control, (b) the type of loss of emotional control is influenced by the associated psychiatric disorder, and (c) ataque symptom patterns may be a useful clinical marker for detecting psychiatric disorders. Further study is needed to examine the relationship between ataque de nervios and psychiatric disorders, as well as the relationship to cultural, demographic, environmental, and personality factors.     

The hidden illness of endoscopy patients: mental health disorders, Part I

Because nearly half of all adults experience some mental health disorders in their lifetime, many endoscopy patients must have psychiatric problems along with their gastrointestinal (GI) illnesses. In addition, all patients undergoing an endoscopic procedure experiences some degree of apprehension and worry; anxiety itself is a major factor in most mental illnesses. Endoscopy nurses are very good at establishing rapport quickly with patients and learning about the patient's health history from all the available sources of information. These nurses spend much of their time teaching, listening, reassuring, and caring for people undergoing GI procedure, and these same skills are an important part of the care in mental health disorders. A series of case studies of GI patients in a busy endoscopy department document and summarize the mental health disorder each experienced and the pertinent care given by the GI nurse during an endoscopy or gastric laboratory procedure. Although it is inappropriate for endoscopy nurses to attempt to diagnose major psychiatric disease or provide psychiatric interventions for these patients, their nursing care and reassurance enable the patients to successfully complete their GI procedures.     

Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit

OBJECTIVE: To compare psychiatric diagnoses of hospitalized adolescents who (a) have made previous but no recent suicide attempts, (b) have recently made their first suicide attempt, (c) have recently made a second or subsequent attempt, or (d) have never made an attempt. METHOD: Semistructured psychiatric diagnostic interviews were used to determine psychiatric diagnoses and history of recent and previous suicidal behavior of 269 consecutively admitted adolescents to an inpatient psychiatric facility. Forty-nine previously suicidal youths, 28 first-time attempters, and 33 repeat attempters were compared with 159 nonsuicidal youths in prevalence of Axis I psychiatric disorders and psychiatric comorbidity with affective disorder. RESULTS: Previous attempters and repeat attempters both reported more affective disorders, whereas first-time attempters reported more adjustment disorders than nonsuicidal youths. Previous attempters and nonsuicidal youths reported the most externalizing disorders. CONCLUSIONS: Previous attempters on an inpatient unit have multiple psychiatric problems. Like repeat attempters, they often are depressed, but like nonsuicidal youths, they also exhibit significant externalizing behaviors. Interventions with these adolescents should focus not only on immediate presenting problems, but also on ameliorating their long-term risk of posthospitalization suicidal behavior.     

Self-reported long-standing psychiatric illness as a predictor of premature all-cause mortality and violent death: a 14-year follow-up study of native Swedes and foreign-born migrants

The present study focuses on the associations between self-rated long-standing psychiatric illness, ethnicity, all-cause mortality and violent death (accidents and suicide), in a sample of 39,155 Swedish-born and foreign-born individuals. The study was designed as a longitudinal follow-up study, covering the period between 1 January 1979 and 31 December 1996. The data were analysed by a proportional hazard model and the results are given as hazard ratios (HR) with 95% confidence intervals (CI). Self-reported long-standing psychiatric illness was a strong risk factor for total mortality: women had an HR of 2.13 (CI = 1.78-2.54) and men an HR of 1.84 (CI = 1.53-2.21), when adjusted for background factors such as country of birth, civil status and socio-economic factors. Finnish men had an increased risk of all-cause mortality compared to Swedes in the final model, when adjusted for socio-economic factors. Long-standing psychiatric illness was also a strong risk factor for violent death, with an HR of 3.51 (CI = 2.32-5.32). The risk of violent death was 2.4 times higher for men than for women. The conclusions of the present study are that self-reported long-standing psychiatric illness is a strong predictor of an increased all-cause mortality and increased mortality from violent death. The increased age-adjusted mortality risk for foreign-born men could be explained by disadvantaged social and economic conditions. Only Finnish men demonstrated an independent increased all-cause mortality risk.