The role of high- and low-dose corticotropin tests in the diagnosis of secondary adrenal insufficiency

Mini Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS) and subscales of the BPRS were performed on 73 elderly inpatients (mean age: 67.9 years; standard deviation: 7.2; range: 60-89) diagnosed with DSM-III-R chronic schizophrenia. Forty of the subjects were men and 33 were women. A significant negative correlation was observed between MMSE and the age, factor negative, factor depressive, and total score of BPRS. We believe, however, that it is relatively sufficient to screen for demented illness of schizophrenics using MMSE when considering the age and the psychiatric symptoms (especially negative or depressive symptoms ). Forty-eight (66%) of the 73 patients were categorized as 'demented' by MMSE. These results suggest that the aged inpatients with schizophrenia in a hospital showed certain kinds of cognitive deficits (including senile dementia) more frequently than the general population.     

Use of the Brief Psychiatric Rating Scale to measure success in a psychosocial day program

This study contrasted six subscales of the Brief Psychiatric Rating Scale (BPRS) to determine their sensitivity to psychosocial treatment outcome. An expanded version of the BPRS was administered to 216 clients on admission to a day program. The subscale measuring hostility and suspiciousness discriminated at intake clients who were therapeutically discharged from clients who did not complete the program and predicted discharge status after the investigators controlled for the effects of demographic variables. Significant reductions in scores were obtained on five subscales for a subset of clients to whom the BPRS was readministered before discharge. The results support the use of the expanded BPRS as an evaluative tool in psychosocial rehabilitation programs.     

A multinational study of psychiatric nursing staffs' beliefs and concerns about work safety and patient assault

In an effort to understand beliefs and concerns about work safety and patient assault, the author describes the results of a multinational survey of 999 nursing staff members working in psychiatric facilities across the United States, Canada, United Kindgom, and South Africa. Although the majority of the sample (75%) reported being physically assaulted at least once during their careers, 62% responded that they felt safe in their work environment most of the time. Significant differences were found among the nurses with regard to beliefs about adequacy of staffing, safety of the physical environment, admission of assaultive patients, expectations about being victims of assault, overall level of safety, and taking legal action against a patient. A significant difference in attitudes was also found among nursing staff members, who reported previous assaults. They believed that assaults are expected events in their work with psychiatric patients.     

A multiregional study of nurses' beliefs and attitudes about work safety and patient assault

OBJECTIVE: The study attempted to increase understanding of nursing staff members' beliefs and concerns about work safety and patient assault. METHODS: A study conducted at a university-affiliated psychiatric facility in California in the late 1980s was replicated in five other psychiatric settings. Data were collected using the Attitudes Toward Patient Physical Assault Questionnaire, containing 31 statements designed to elicit nurses' beliefs about safety concerns, staff performance, and legal issues related to assaults. RESULTS: A total of 557 nursing staff members at the six sites responded to the questionnaire; 84 percent were female. The majority (76 percent) had been physically assaulted at least once, but 71 percent reported feeling safe in their work environment most of the time. Compared with female staff members, males tended to believe that assaults were to be expected, that assaulted staff have personality traits that make them vulnerable to assault, and that legal action against assaultive patients might jeopardize their jobs. Recently hired staff were more confident that their facilities did not admit unmanageable patients and that the environment was adequate to prevent assaults. Staff who had been assaulted more frequently tended to believe that assaults were to be expected. CONCLUSIONS: The study highlights a nationwide concern among nursing staff about safety. Ensuring a safe working environment requires better training, more adequate staffing, and a security plan to protect staff, patients, and others.     

Physical assault in New Zealand: the experience of 21 year old men and women in a community sample

AIM: To obtain epidemiological information on physical assault in a high risk group of New Zealanders. METHOD: Rates of physical assault in the preceding twelve months were ascertained by interview in a cohort of 21 year old, Dunedin-born men (n = 482) and women (n = 462). RESULTS: Forty-five percent of the men and one quarter of the women reported at least one physical assault, either completed, attempted or threatened. A small proportion of these received medical treatment. Most serious assaults were by a perpetrator who was thought to have been drinking alcohol. Most assaults on men were by strangers but partners carried out more assaults against women, especially those receiving medical treatment. One quarter of all assaults on women were by other women, compared to 15% of the assaults on men. Differences between patterns of assaults on women and on men are discussed. CONCLUSION: It is important for doctors to be aware of the widespread occurrence of interpersonal violence in New Zealand and its underreporting.     

Videoscopic resection of a thrombosed aneurysm of a patent ductus arteriosus in a neonate

OBJECTIVE: In the wake of the U.S. Supreme Court's 1990 decision in Zinermon v. Burch, renewed attention has been given to capacities patients must have to be considered competent to consent to voluntary hospitalization. An American Psychiatric Association (APA) task force suggested that strong policy interests support the establishment of a low threshold for competence in this situation. The study examined whether, as previous research suggested, patients would have difficulty meeting even this lenient standard. METHODS: One hundred voluntarily hospitalized psychiatric patients were read two brief paragraphs, one explaining the purposes of psychiatric hospitalization and and the other explaining policies for discharge. The paragraphs' readability measured about eighth-grade level. After each paragraph, participants were read two sets of questions, one testing recall of the presented information and the other testing recognition of the information in a true-false format. The scores of patients grouped by selected demographic and clinical variables were compared. RESULTS AND CONCLUSIONS: The vast majority of patients were able to comprehend the information that the APA task force suggested was relevant to their decision. However, a subgroup of patients who were initially admitted involuntarily had significantly poorer performance and may constitute a group who need special educational efforts focused on the consequences of voluntary admission.     

Therapeutic implications of microglia activation by lipopolysaccharide and reactive oxygen species generation in septic shock and central nervous system pathologies: a review

OBJECTIVE: Olanzapine, a potent 5-HT2a/2c, dopamine D1D2D4 antagonist with anticholinergic activity, has a profile of known receptor affinity similar to that of clozapine. This pilot study examined the efficacy of olanzapine for treatment-refractory childhood-onset schizophrenia in eight patients who had received 8-week open-label trials. For comparison, data are included from 15 patients who had received 6-week open-label clozapine trials using identical rating instruments (largely by the same raters) in the same treatment setting. METHOD: Twenty-three children and adolescents with an onset of DSM-III-R schizophrenia by age 12 for whom at least two different typical neuroleptics had been ineffective participated in the two separate studies. Some of the patients were intolerant of clozapine, although it had been effective (n = 4). Patients receiving olanzapine were evaluated over 8 weeks with the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Clinical Global Impressions Scale for Improvement. RESULTS: For the eight patients who received olanzapine trials, at week 8 there was a 17% improvement in the BPRS total score, a 27% improvement in the Scale for the Assessment of Negative Symptoms, and a 1% improvement in the Scale for the Assessment of Positive Symptoms, relative to "ideal" admission status on typical neuroleptics. In contrast, the magnitude of the effect sizes for each of the clinical ratings was larger at week 6 of the previous clozapine trial than for an 8-week olanzapine trial, relative to admission status on typical neuroleptics. For the four children who had received both clozapine and olanzapine, BPRS total scores were significantly lower at week 6 of clozapine treatment compared with week 6 of olanzapine treatment (p = .03). CONCLUSION: These data provide preliminary evidence for the efficacy of olanzapine for some children and adolescents with treatment-refractory schizophrenia, but they also suggest the need for a more rigorous double-blind comparison of these two atypical antipsychotics.     

Urbanisation and psychiatric admission rates in The Netherlands

This article discusses the possible links between urbanisation, demographic variables and psychiatric admission rates. Inpatient psychiatric admission rates were determined for the 647 Dutch municipalities. Then urbanisation was determined using 'area address density', a unit of measurement developed by the Dutch Central Statistical Office. Five degrees of urbanisation are distinguished. Twenty-nine demographic variables which might have a theoretical link with admission rates were collated for all municipalities. The results show that standardised total admission rates increase with urbanisation. The mean admission rate for the least urbanised municipalities is 2.02 per 1000 resident population, the rate for the most urbanised municipalities is 3.72 per 1000. It was then found that the prevalence of demographic risk factors increased with urbanicity. At the same time, it was found that almost all demographic variables correlated with admission rates. A multiple regression mode--which accounts for 22% of variance--shows that income distribution, address density and mortality all contribute significantly to the variance in admission rates for the 647 Dutch municipalities.     

Direct observational coding of staff who are the victims of assault.

Staff members in psychiatric hospitals are frequently assaulted by patients. When asked what events triggered specific assaults on staff, staff and patients disagree. Staff members usually say that symptoms of psychosis led to the assault, whereas patients usually say aversive interactions with staff triggered the incident. For years, experts have called for direct observational research to address this issue and possibly resolve the discrepancy found in the verbal-report data. Over 26,000 hr of direct observational coding of staff activities, including staff–patient interactions, was collected across 10 years by independent, noninteractive raters on Social Learning Program units. Eight of nine kinds of aversive staff–patient interactions occurred more frequently among staff members who had been assaulted. One possible interpretation of these data is that aversive interactions lead to assaults on staff, but other possibilities must be considered. Practical recommendations for reducing likelihood of assault are detailed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mood improvement in elderly women after in-hospital physical rehabilitation

OBJECTIVE: To evaluate the relationship between change in depressive symptoms and in-hospital physical rehabilitation in elderly women. DESIGN: Longitudinal study. SETTING: Hospital facility (geriatric evaluation and rehabilitation unit). PATIENTS: One hundred twenty-three elderly inpatient women (mean age: 78.4+/-6.9 years, range 60 to 93) with good cognitive status (Mini Mental State Examination: 23.1+/-5.1) consecutively admitted over a 7-month period. INTERVENTION: Physical therapy tailored to individual needs (five sessions a week of 30 to 45 minutes each). MAIN OUTCOMES MEASURES: On admission: cognition (MMSE), depressive symptoms (Geriatric Depression Scale [GDS]), functional status (basic and instrumental activities of daily living [BADL, IADL], Tinetti scale), and somatic health. On discharge: depressive symptoms and gait and balance performances (Tinetti scale). RESULTS: Seventy-five patients (61%) did not show changes on Tinetti scale over the hospitalization period and 48(39%) had a change of 3 or more points. Nonresponders had no change of GDS over the hospitalization period for all levels of physical disability on admission, whereas responders had relevant improvement of depressive symptoms when markedly disabled on admission, and progressively smaller improvements of depressive symptoms with increasing function on admission. CONCLUSIONS: The study provides evidence that mood status changes synchronically with disability.     

Sensitivity to change of the Brief Psychiatric Rating Scale-Extended (BPRS-E): An item and subscale analysis.

The Brief Psychiatric Rating Scale (BPRS) is the most commonly used outcome measure for the severely and persistently mentally ill (SPMI) population, possessing good interrater reliability, concurrent validity, and a strong factor structure. However, psychometric study of the extended version of the BPRS (the BPRS-E) is limited when compared with earlier versions (BPRS and BPRS-A). This study examined the item, factor, and diagnosis-specific sensitivity to change of the BPRS-E, the most recent version of this popular scale. Assessments were conducted at 90-day intervals with 201 adult psychiatric inpatients at the Utah State Hospital, yielding 786 symptom ratings. Of note was that ratings were conducted by independent assessors who were unaware of patients' treatment status. All but 2 of the 24 BPRS-E items, all 4 factors, and the total score were found to be sensitive to change when comparing patients' admission and discharge scores. Patient diagnosis was not associated with item, factor, or total score sensitivity to change. These findings extend the psychometric support for the BPRS-E and have implications for assessing outcome with the SPMI population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Islet amyloid polypeptide in patients with pancreatic cancer and diabetes

Population-based psychiatric admission rates vary across geographic areas, but reasons for this variation are unknown. Insofar as Community Mental Health Centers (CMHCs) provide outpatient services that may deter the need for hospitalization, the presence and structural characteristics of CMHCs may have an impact on a population's psychiatric admission rates. This study uses small area analysis to examine how general hospital psychiatric admission rates are associated with CMHC characteristics. Based on a survey of all CMHCs in Iowa and corresponding small area variation data, it was found that population admission rates were higher in areas closer to the CMHC and lower in outlying catchment areas, adjusting for age, sex, and urban/rural differences in populations. There was little evidence that differences in staffing and service variables influenced admission rates, although greater CMHC staff coverage by social workers and psychiatric residents was associated with lower admission rates. The results suggest that CMHCs do not lower an area's hospitalization rate, and in fact, the presence of CMHCs may promote a "supplier-induced demand" phenomenon of higher admissions.     

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.     

Relationship of cocaine and other substance dependence to well-being of high-risk psychiatric patients

OBJECTIVE: The co-occurrence of substance dependence disorders was determined in a sample of 160 frequently hospitalized adults with severe mental illness, and the relationship between substance dependence and psychosocial functioning and well-being was examined. METHODS: A structured interview was used to assess subjects for co-occurring current DSM-III-R substance dependence disorders during an acute psychiatric hospitalization. They were administered a structed interview that included the subscales of the Addiction Severity Index, the Center for Epidemiological Studies-Depression Scale, Lehman's Quality of Life Interview, Rosenberg's Self-Esteem Scale, the Mastery Scale, and questions about service needs. RESULTS: Seventy-eight of the subjects (48.8 percent) were diagnosed as having at least one current substance dependence disorder. Most subjects with comorbid substance dependence were polysubstance dependent (55.1 percent), and almost half (44.9 percent) met criteria for cocaine dependence. Subjects who were substance dependent were significantly overrepresented among those diagnosed with bipolar disorder, psychotic disorder not otherwise specified, and major depression. When the analysis controlled for demographic characteristics and primary diagnosis, comorbidity was related to depressive symptoms, adverse life conditions, and diminished life satisfaction in several domains. Substance-dependent subjects were significantly more likely to have been arrested and jailed than nondependent subjects. Cocaine-dependent subjects were significantly less satisfied than all other subjects with their living situation and personal safety and more likely to request assistance for their drug and alcohol use problems. CONCLUSIONS: The findings corroborate high rates of co-occurring substance dependence disorders among frequently hospitalized patients with severe mental illness. They also reveal a high prevalence of cocaine dependence and a dramatic pattern of negative correlates of cocaine dependence. The findings suggest that successful interventions for substance dependence may improve these patients' life circumstances and that psychiatric patients may be particularly receptive to such interventions during hospitalization.     

Prognostic patterns in self-report, relative report, and professional evaluation measures for hospitalized and day-care patients.

Investigated differences between patients who relapse and those who do not in both hospital and day-care settings. Ss were 142 adult psychiatric patients. Hospital and day-care groups were matched on a variety of demographic, social, and clinical variables. Three groups of measures were used: one based on professional evaluation (e.g., Inpatient Multidimensional Psychiatric Scale), one based on self-report (e.g., Katz Adjustment Scales), and one based on relative report (e.g., MMPI). No differences were found between hospital and day-care centers in proportion of patients relapsed. Of the 3 groups of measures, those based on professional evaluation were least able to distinguish relapsed from nonrelapsed patients. On self-report and relative report measures, the scores of patients who relapsed following day-care treatment resembled those of patients who succeeded following hospital treatment and vice-versa. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial sequelae of violent victimization in a national youth sample.

In a national telephone sample of youths aged 10–16 years, over one third reported having been the victims of an assault. Victimized respondents displayed significantly more psychological and behavioral symptomatology than did non victimized respondents (more symptomatology related to post traumatic stress disorder, more sadness, and more school difficulties), even after controlling for some other possible sources of distress. Sexual assault was associated with particularly high levels of symptomatology. However, victims of other forms of assault—nonfamily assaults involving weapons or physical injury (aggravated assaults), assaults by parents, violence to genitals, and attempted kidnappings—also evidenced levels of distress that were not statistically lower than those suffered by victims of sexual assault. The findings suggest that substantial mental health morbidity in the general child and adolescent population is associated with victimization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expected responses to assault: The effects of circumstance and locus of control.

94 female and 48 male undergraduates were asked to imagine themselves in a hypothetical assault situation and to describe their expectations about their behavior during the assault as well as their postassault adjustment. These expectations were examined as a function of the S's score on the Nowicki-Strickland Internal–External Control Scale for Adults and 2 situational variables: whether the assault motive was rape or theft and whether the assailant was described as armed or unarmed. Results indicate that the situational variables influenced Ss' expectations about their level of resistance during an assault. Specifically, females who imagined themselves coping with the threat of rape expected to be more active in resisting their assailants than the females and males in the theft condition. All Ss expected to resist an unarmed more than an armed assailant. Expectations for postassault adjustment were influenced by the nature of the assault and by Ss' locus of control. Females in the rape condition expected to make a worse postassault adjustment than those in the theft condition and externally controlled Ss expected to have a more difficult time adjusting following the assault than those who were internally controlled. (French abstract) (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative symptoms in stroke patients and length of hospital stay

The purpose of this study was to assess whether the presence and severity of psychiatric symptoms in stroke patients correlate with their length of stay (LOS) in a rehabilitation unit, with special emphasis on the role of negative symptoms (NS). Twenty-three stroke patients, consecutively recruited from the inpatient rehabilitation unit, were evaluated on admission with the Mini-Mental State Examination (MMSE), the Positive and Negative Symptom Scale (PANSS), the Hamilton Depression Rating Scale (HDRS), the Scale for Assessment of Negative Symptoms (SANS), and the Functional Independent Measure (FIM). NS scores significantly correlated with LOS, with SANS total score being the most informative, and the attentional impairment subscale the least. The group of patients with pronounced NS stayed in the hospital twice as long as patients with the score on the NS subscale of PANSS below 16. These two groups did not differ in their cognitive performance or in the positive symptom subscale of PANSS scores. Total FIM score on admission was lower and HDRS scores higher in patients with pronounced NS. However, these differences, unlike those of LOS, have not reached statistical significance. The presence and severity of NS in stroke patients are associated with a longer hospital stay. Identification and treatment of NS might lead to a faster discharge from rehabilitation unit.     

The flavonoids of Allium ursinum

Recent research has linked sexual assaults with disordered eating behaviors. Whether the relationship of the perpetrator, intrafamilial or extrafamilial affects the development of disturbed eating is not known. Using data from 190 university women, we found that women with histories of intrafamilial assaults were more likely to suffer a serious eating problem (17 of 36 subjects, 47%) than women who had no history of sexual assault (30 of 142 subjects, 21%) and women who only reported extrafamilial assaults (76 of 212 subjects, 36%,).