Diabetes: Psychiatric and somatic comorbidity

2016 ◽  
Vol 33 (S1) ◽  
pp. S396-S397
Author(s):  
J.Á. Monforte Porto ◽  
A. San Román Uría ◽  
C. Llanes Álvarez ◽  
P. Herguedas Vela ◽  
I.E. Escuer Núñez ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Rural Areas ◽  
Diabetic Patients ◽  
Liaison Psychiatry ◽  
Somatic Comorbidity ◽  
History Of ◽  
Principles Of Justice ◽  
Competing Interest ◽  
Somatic Diseases ◽  
Symptomatic Control

IntroductionDiabetes mellitus (DM) has been associated with major depressive disorder, schizophrenia, Alzheimer's, Parkinson's and mild cognitive impairment. To determine the psychiatric and somatic comorbidity in diabetic patients treated by our Liaison Psychiatry Unit.MethodsSociodemographic variables (age, sex, marital status, place of residence) and clinical (somatic disease that motivates the admission, comorbid somatic pathology, number of concomitant somatic diseases, drug consumption and its type, psychiatric history, previous psychiatric diagnosis, number of concomitant psychiatric disorders).Study DesignEpidemiological study of 172 diabetic patients, from the total of 906 consulted from 1 January 2012 until 31 December 2014.Bioethical considerationsThe study complies with the principles of justice, non-maleficence, autonomy and beneficence.ResultsThe average age is 72 years, 50% are women, 49.4% are married, and 54.1% live in rural areas. Somatic diseases that most frequently motivate admission at the hospital are the endocrine-metabolic (14%), gastrointestinal (12%) and cardiovascular (12.2%). A total of 32.5% of the sample have six comorbid somatic diseases and 55.2% five. A percentage of 14.5 of patients recognize consumption of toxic (cigarettes–12.2%–7.6% Alcohol). One hundred and eight patients have a history of psychiatric disorders (62.8%), especially anxiety disorders (28.4%), depression (14.5%) and organic mental disorders (11.1%).ConclusionsThere is a high psychiatric and somatic comorbidity in diabetic patients, therefore it would be desirable early diagnosis and treatment to provide symptomatic control of both types of pathologies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Consultation liaison psychiatry in Talavera's hospital during the year 2014

2016 ◽  
Vol 33 (S1) ◽  
pp. S394-S394
Author(s):  
M. Palomo Monge ◽  
D.C. Sandra ◽  
A.L. Maria Fernanda ◽  
G.M. David ◽  
T.G. Maria Fernanda ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Psychiatric Disorders ◽  
Descriptive Study ◽  
Liaison Psychiatry ◽  
Consultation Service ◽  
Cross Sectional ◽  
Consultation Liaison Psychiatry ◽  
Competing Interest

IntroductionAnalyze the number of interdepartmental consultations carried out at Department of Psychiatry, Hospital Nuestra Señora del Prado from other areas of hospitalization during 2014.ObjectivesThe goal is to evaluate the prevalence of psychiatric disorders in patients who are hospitalized for other reasons, and which services are needed the most.MethodsRetrospective cross-sectional descriptive study. A record of consultations carried out by the psychiatry service in 2014 was collected. The data were analyzed according to the origin of the consultation service, the month when it was performed and the sex of the patient. The monthly percentage of interconsultations and the percentage represented by each interconsultation service were calculated. They classified according to sex.ResultsIn 2014, 211 interconsultations were carried out, 104 men and 86 women. Surgery 16, 11%, pneumology 13, 74%, internal medicine 12, 32%, traumatology 8, 06%, digestive 7, 11%), I.C.U. 6, 64%, cardiology 6, 16%, hematology 5, 69%, oncology 5, 21%, pediatrics 4, 27%, gynecology 2, 84%, emergency 1, 90%, palliative1, 90%, endocrinology 1, 42%, urology 1, 42, nephrology 0, 95%, E.N.T. 0, 95%, obstetrics 0, 47%, dermatology 0%, ophthalmology 0%, rheumatology 0%. January 12, 8%, February 13%, March 9, 5%, April 6, 2%, May 5, 7%, June 8, 1%, July 6, 2%, August 4, 3%, September 8, 1%, October 12%, November 7, 6%, December 6, 2%.ConclusionsMost of the interconsultations were carried out in January, February and October. However, August was the least busy month. The busiest service was the Surgery service, followed by the Pneumology and Internal Medicine one. There were no interconsultations of the Ophthalmology, Rheumatology and Dermatology services. The consults were in demand mainly by men rather than women.Disclosure of interestThe authors have not supplied their declaration of competing interest.

When seizures are non-epileptic

2017 ◽  
Vol 41 (S1) ◽  
pp. s499-s499
Author(s):  
J. Nogueira ◽  
R. Taylor
Keyword(s):  
Age Of Onset ◽  
Behavioral Therapy ◽  
Health Anxiety ◽  
Onset Time ◽  
Epileptic Seizures ◽  
Liaison Psychiatry ◽  
Generalized Seizures ◽  
Royal London Hospital ◽  
History Of ◽  
Competing Interest

IntroductionNon-epileptic seizures (NES) are a diverse group of disorders, whose paroxysmal events can be mistaken for epilepsy, although they are caused by a mental or psychogenic process rather than a neurological cause.Objectives/methodsWe present a case of a 45-year-old female patient with history of generalized seizures prior to Meningioma resection in August 2015, referred to the Liaison Psychiatry outpatient follow up clinic at the Royal London Hospital after has gone several times to emergency department complaining about flush and hot sensation that proceeded to corners of mouth turning down, teeth chattering, shaking of left arm and torso at first and then legs. During the episodes, she was awake with no consciousness loss. Her mood was low, with clinical evidence of depression and she had very high levels of health anxiety.DiscussionA diagnosis of non-epileptic attacks was made in the sequence of those episodes. A holistic and multidisciplinary approach was made, including pharmacotherapy, cognitive-behavioral therapy and domiciliary support. The clinical response was good regarding both mood, anxiety levels and NES.ConclusionsApproximately 25% of patients who have a previous diagnosis of epilepsy and are not responding to drug therapy are found to be misdiagnosed and it is common that epileptic patients have both epileptic and non-epileptic seizures. Although distinguishing epileptic and non-epileptic seizures is not easy, there are some clinical clues that the physicians should look for, like age of onset, time of the day that episodes occur and presence or absence of postictal confusion.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Prospective study on the knowledge and practice of foot care among diabetic patients

2020 ◽  
Vol 9 (6) ◽  
pp. 924
Author(s):  
Meghana Manjunath ◽  
Nandini T.
Keyword(s):  
Diabetic Foot ◽  
Rural Areas ◽  
Foot Ulcer ◽  
Knowledge Score ◽  
Care Practice ◽  
Diabetic Patients ◽  
Foot Care ◽  
History Of ◽  
Knowledge And Practice ◽  
Urban And Rural Areas

Background: The magnitude of diabetic foot ulcers (DFUs) and the amputation rates due to DFUs are high in India. Proper diabetic foot care can minimize these rates. Although numerous such studies have been done, reinforcement of awareness to practice diabetic foot care is necessary to reduce the incidents of DFUs.Methods: 134 voluntary participants from SSMC, Tumkur and Karnataka Institute of Endocrinology and Research, Bangalore were included following ethical clearance. The patients were requested to fill the validated knowledge and practice questionnaire which were presented to them in their own language. Demographic details of the participants were also collected. The responses were recorded and statistically analyzed. A score of >70% was gauged as good, 50 to 70% as satisfactory and <50% as poor.Results: Of the 134 participants, 73.13% had good knowledge on foot care, 22.8% had good foot care practice and 73.13% had a satisfactory practice score. Patients with history of foot ulcer had a mean score (±SD) of 12.75 (±1.91) knowledge score and 47.75 (±6.05) practice score which is lower compared to those without history of ulcers, 13.86 (±2.37) and 55.40 (±6.88) respectively. Patients from urban and rural areas had about the same mean scores, 13.51 (±2.50), 54.98 (±6.83) and 13.30 (±2.60), 54.73 (±7.49) (knowledge, practice score) respectively.Conclusions: Foot care among diabetics is only satisfactory and has to be improved. Knowledge is the key to better practice so early diagnosis, repeated counselling, regular follow ups and good sugar control is necessary to reduce incidents of DFUs.

Risk of Suicidal Behaviours in Elderly

2017 ◽  
Vol 41 (S1) ◽  
pp. S652-S652 ◽  
Author(s):  
S. Goretti ◽  
M.D.C. Sanchéz Sanchéz ◽  
B. Góngora Oliver ◽  
M.D. Sanz Fernández
Keyword(s):  
Risk Factors ◽  
Suicidal Behaviour ◽  
The Elderly ◽  
Progressive Increase ◽  
Age Group ◽  
Somatic Illness ◽  
History Of ◽  
Competing Interest ◽  
Chronic Somatic Diseases ◽  
Somatic Diseases

IntroductionOlder adults constitute the age group in which suicide more often reaches its most categorical expression: consummation.ObjectiveIdentify risk factors for suicide in older people.MethodSystematic review of the literature on the subject. The databases consulted were Dialnet and Pubmed. The descriptors used have been: “suicide”, “risk factors” and “elderly”, accepting the works found in English and Spanish, with a total of 501 references found after the search, from which 75 have been selected.ResultsAs shown in the reviewed studies, there is a progressive increase in suicide rate with age in males. The purpose of dying in the old man is usually characterized by his firm conviction, not infrequently reflexive and premeditated. In the multifactorial etiology of suicidal behaviour in this age group, the main elements to be considered would be psychosocial factors, psychiatric diseases and chronic somatic diseases, resulting in a potentiation among them due to their frequent interaction. The feeling of abandonment, the feeling of emptiness, the despair of the organic collapse and the self-perception of being a useless person, without projects, generates deterioration in the quality of life.ConclusionsIn the multifactorial etiology of the suicidal behaviour of the elderly, they usually play coprotagonic roles, loneliness, isolation, somatic illness and depression. The most likely profile of the suicidal elder would be represented by a man with a history of depressive episode after age 40, who lives alone, with a family history of depression or alcoholism and a recent loss.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychotic symptoms in a patient diagnosed with temporal lobe epilepsy and schizoaffective disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S150-S150
Author(s):  
G. Martinez-Ales ◽  
V. Baena ◽  
I. Rubio ◽  
B. Rodriguez-Vega ◽  
V. Bonan ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Schizoaffective Disorder ◽  
Neuropsychiatric Symptoms ◽  
Clinical History ◽  
Psychotic Symptoms ◽  
Antiepileptic Medication ◽  
Complex Motor ◽  
History Of ◽  
Competing Interest ◽  
Symptomatic Remission

IntroductionEpilepsy is considered a complex neurological disorder, and its clinical picture can resemble many different cerebral dysfunctions, including those associated to major psychiatric disorders.Case reportWe report the case of a 52-year-old gentleman, with a 30-year history of schizoaffective disorder and of complex partial epilepsy with secondary generalization. He was admitted to an emergency room due to a voluntary overdose with 8 mg of clonazepam. The patient explained how he had recently experienced visual hallucinations and insomnia, symptoms that originally led to the psychotic diagnosis. He had previously presented these symptoms, along with stupor, delusions and lability, as a prodrome of complex motor epileptic decompensations. Thus, he took the overdose not to suffer seizures. After carefully reconstructing the clinical history, psychiatric admissions had shown seizures, and periods of clinical stability had been achieved by regulating antiepileptic medication. Eslicarbazepine and lamotrigine reintroduction, and quetiapine withdrawal, led to symptomatic remission.DiscussionEpilepsy and major psychiatric disorders show a high comorbidity. There has been an effort to even include epilepsy and psychosis in a unique diagnosis (alternant psychosis). Furthermore, polimorphism and restitutio ad integrum may resemble classic cycloid psychosis. In this case, chronological study showed all symptoms could be explained by one disorder.ConclusionEpilepsy includes a variety of neuropsychiatric symptoms. It can be difficult to withdraw psychiatric diagnoses from patients after years of follow-up. However, a carefully taken medical history clarifies temporal criteria.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Prevalence of Tuberculosis in Diabetic Patients Living in Rural Areas of Northern Iran in 2016

2021 ◽  
Vol 29 (4) ◽  
pp. 114-121
Author(s):  
Arash Naghipour ◽  
◽  
Zahra Khatirnamani2 ◽  
Ehsan Allah Kalteh ◽  
Sonbol Taramian ◽  
...  
Keyword(s):  
Skin Test ◽  
Rural Areas ◽  
Sputum Smear ◽  
Diabetic Patients ◽  
Northern Iran ◽  
Abnormal Chest ◽  
Night Sweats ◽  
History Of ◽  
Chest X Ray ◽  
And Control

Background: Tuberculosis (TB) is a chronic bacterial infection. Simultaneous onset of diabetes and TB can interfere with the treatment and control of TB. Objective: This study aims to investigate the prevalence of TB in diabetic patients living in rural areas of northern Iran. Materials and Methods: Participants were 925 diabetic patients living in rural areas of Kordkuy County, Golestan, Iran. Data were collected using a checklist surveying demographic characteristics and medical records of patients. To diagnose TB, they underwent a TB skin test, sputum smear test, chest radiography, and referring to an infectious diseases specialist, if needed. Results: Seven hundred sixteen of participants were female. The mean age of participants and their mean duration of diabetes were 58.4±11.1 and 8.39±5.47 years, respectively. Results of test showed that 62 patients had abnormal chest x-ray; 14 had coughing more than two weeks; 1 had fever; 2 had night sweats; 11 had sputum; 152 had positive TB skin test result; 10 had a history of previous TB; and 1 had active TB. Conclusion: The prevalence and incidence of TB in diabetic patients is 60 and 6 times higher than in general population, respectively.

scholarly journals Predictors of Awareness and Management Practices of Diabetes among Rural Dwellers of Sindh

2016 ◽  
Vol 9 (5) ◽  
pp. 55
Author(s):  
Abdul Haseeb ◽  
Muhammad Bilal ◽  
Waqas Ahmed Farooqui ◽  
Hala Soomro ◽  
Muhammad Ahad Sher Khan ◽  
...  
Keyword(s):  
Rural Areas ◽  
Management Practices ◽  
Pathological Condition ◽  
Diabetic Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
High Blood Glucose ◽  
History Of ◽  
Sugar Levels ◽  
Rural Dwellers

<p><strong>INTRODUCTION: </strong>The most substantial method of control for the spread of DM, is the spreading of knowledge and information regarding DM and its complications. Therefore, the objective of this study was to investigate and evaluate the level of knowledge, awareness and management practices among people suffering from DM in the rural areas of Sindh.</p><p><strong>METHODOLOGY: </strong>A descriptive cross sectional survey was performed on 400 Diabetes Mellitus (DM) Type 2 patients from March 2015 to June 2015, dwelling in rural areas of Sindh province, South Pakistan. A paper based questionnaire was used to determine sociodemographic features, knowledge and awareness with regards to DM and its complications and last part evaluated management practices to manage diabetes.</p><p><strong>RESULTS:</strong> Only 50% participants knew that DM is a condition of high blood glucose and only 39% considered it as a preventable disease. With regards to management practices, only 65.0% had a home glucometer and 48% regularly checked their blood sugar levels. Family history of DM, BMI, education level, monthly household income, marital status and age were important predictors of knowledge among rural dwellers.</p><p><strong>CONCLUSION: </strong>Our study has revealed lack of knowledge and inadequate management practices among diabetic patients of rural areas of Sindh, especially in patients attending primary healthcare setups. Management techniques and knowhow of this silent and deadly pathological condition should be spread to rural populace through seminars and media, which would eventually mold their life in a better condition.</p>

scholarly journals Mortality and Conversion Rate to Below Knee or Above Knee Amputation Following Transmetatarsal Amputation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0011
Author(s):  
D. Anthony Barcel ◽  
Susan M. Odum ◽  
Taylor Rowe ◽  
Jefferson B. Sabatini ◽  
Samuel E. Ford ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conversion Rate ◽  
Significant Risk ◽  
High Rate ◽  
Administrative Database ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Knee Amputation ◽  
History Of ◽  
Transmetatarsal Amputation

Category: Midfoot/Forefoot; Diabetes; Other Introduction/Purpose: Non-traumatic lower extremity amputations (LEA), especially those performed in dysvascular and diabetic patients, are known to have poor long-term prognosis. Perioperative mortality has been reported at between 4 and 10%, and the 1 and 5 year mortality rates range between 22-33% and 39-69%, respectively. While poor outcomes in these patients have been described, there is no consensus as to the predictors of mortality. The purpose of the study is to determine the percentage of patients who had a complication following transmetatarsal amputation (TMA) and identify associated risk factors for complications and mortality. Methods: We queried our institution’s administrative database to identify 247 TMA procedures performed in 229 patients between January, 2002 and December, 2016. Electronic health records were reviewed to document complications defined as reoperation, amputation and mortality. Mortality was also verified using the National Death Index. Additionally, we recorded risk factors including diabetes, A1c level, end stage renal disease (ESRD), cardiovascular disease (CVD), peripheral vascular disease (PVD), history of revascularization, contralateral amputation, and neuropathy. The majority of the study patients were males (157, 69%) and the average age was 57 years (range 24-91). The median BMI was 28 (range 16-58) and 29% of the study patients were obese with a BMI ≥ 30. Fishers Exact tests were used to compare categorical variables. Kruskal-Wallis and Independent T-tests were used to compare numeric data. All data were analyzed using SAS/STAT software version 9.4 (Carey, NC) and a 0.05 level of significance was defined apriori. Results: The conversion rate to below (BKA) or above knee amputation (AKA) was 26% (64 of 247). Males (p=.0274), diabetics (p=.0139), patients in ESRD (p=.019), and patients with a history of CVD (p=.0247) or perioperative revascularization (p=.022) were more likely to undergo further amputation following an index TMA. BMI was significantly higher in patients requiring BKA/AKA (p=.0305). There were no significant differences in age (p=.2723) or A1c levels (p=.4219). The overall mortality rate was 35% (84 of 229). Diabetes (p=.0272), ESRD (p=.0031), history of CVD (p<.0001) or PVD (p=.0179) were all significantly associated with mortality. Patients who died were significantly older (p=.0006) and had significantly higher A1c levels (p=.0373). BMI was not significantly associated with mortality. Twenty-two patients who had 23 further amputations subsequently died. Conclusion: In our series of patients undergoing TMA, 26% underwent further amputation and 35% of patients died. Conversion rate to BKA or AKA occurred at a high rate regardless of preoperative revascularization or the use of tendo-achilles or gastrocnemius lengthening procedures. Male sex, diabetes, ESRD, history of CVD or revascularization are significant risk factors for further amputation. ESRD, diabetes, history of CVD or PVD, older age and higher A1c levels are significant risk factors for mortality. These data provide useful insight into risk factors to be emphasized when counseling patients and their families to establish realistic postoperative expectations.

scholarly journals 651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S383-S384
Author(s):  
Fatma Hammami ◽  
Makram Koubaa ◽  
Amal Chakroun ◽  
Fatma Smaoui ◽  
Khaoula Rekik ◽  
...  
Keyword(s):  
Otitis Externa ◽  
Clinical Presentation ◽  
The Elderly ◽  
Causative Organism ◽  
Diabetic Patients ◽  
Duration Of Treatment ◽  
Evolutionary Features ◽  
Significant Difference ◽  
Malignant Otitis Externa ◽  
History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p&lt; 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p&lt; 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

Objectivization of vacuum-compression therapy effects on micro- and macrovascular perfusion in type 2 diabetic patients

2020 ◽  
Vol 65 (4) ◽  
pp. 469-476
Author(s):  
Jaroslav Prucha ◽  
Vladimir Socha ◽  
Lenka Hanakova ◽  
Andrej Lalis ◽  
Karel Hana
Keyword(s):  
Lower Limb ◽  
Compression Therapy ◽  
Neurological Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Therapeutic Procedures ◽  
History Of ◽  
Injury Recovery ◽  
Type 2 Diabetic

AbstractThe present study aimed to evaluate the characteristic influence of physical therapeutic procedures of vacuum-compression therapy (VCT) on microvascular perfusion (MiP) and macrovascular perfusion (MaP) of the lower limb in diabetic patients. A sample of nine patients with a medical history of type 2 diabetes was used for the purpose of this study. Most of the subjects’ medical conditions included venous and neurological complications of the lower limb, whereas the rest of the subjects entered the treatment due to injury recovery or their phlebological disease. The PeriFlux System 5000 (Perimed, Sweden) diagnostic device was used to measure MiP. The MaP was evaluated based on the perfusion index (PI) using the Extremiter monitoring device (Embitron, Czech Republic) designed to perform VCT procedures. The study found that MiP and MaP increase as an effect of VCT procedures and at the same time PI clearly reflects the effect of the applied vacuum and compression phases, verifying the method’s vital influence on peripheral perfusion disorders.

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