Sex differences in psychiatric inpatients: Demographics, psychiatric diagnoses and medical comorbidities

ObjectivesThere are few published studies on the relationship between gender and psychiatric disorders. We assessed sex differences in a sample of first-admission psychiatric inpatients to identify possible risk factors and targets for sex-tailored treatment interventions.MethodsA retrospective study of admissions to the psychiatry department, Coimbra hospital Universitary Centre, Portugal, in 2015 was accomplished (n = 924). The two groups were compared for demographic features, psychiatric diagnoses and medical comorbidities.ResultsMale patients were significantly younger (age average = 47.7 vs. 53.3). Differences in employment, educational, and marital statuses were found between male and female psychiatric patients. Having a degree was a protective factor for males, whereas it was a risk factor for females. Being divorced and single were both risk factors for medical co-morbidity in females. A higher proportion of men among patients hospitalized for schizophrenia (14.9 vs. 5.5%) or substance use disorder (10.3 vs. 2.1%) and a higher proportion of women among those admitted for affective disorders (43.3 vs. 25.9%), including bipolar disorder (13.4 vs. 9.0%), were found. No significant differences in duration of hospitalization between the two groups (22.8 in male vs. 22.2 days in female)ConclusionsThe differences between the two groups of inpatients were very pronounced. A better understanding of these differences may help to establish more effective treatment strategies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Comparison of Risk Factors of Falling for Psychiatric Inpatients and General Ward Inpatients Who Had Fallen

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211033028 ◽

2021 ◽

pp. 107839032110330

Author(s):

Wen P. Chang ◽

Hsiu J. Jen

Keyword(s):

Risk Factors ◽

Multinomial Logistic Regression ◽

Psychiatric Patients ◽

Length Of Hospital Stay ◽

Psychiatric Inpatients ◽

General Ward ◽

Prevention Measures ◽

Risk Of Falling ◽

Multinomial Logistic Regression Analysis ◽

Risk Factors For Falling

BACKGROUND: For psychiatric patients, the issue of falling is complex. OBJECTIVE: The objective of this study was to compare the risk factors for falling in psychiatric inpatients and general ward inpatients who had fallen. METHODS: The researchers first derived official fall records for 122 psychiatric inpatients and then selected 122 psychiatric inpatients who had not fallen as well as 122 general ward patients who had fallen, matched for gender, age, and length of hospital stay at the time of the fall incident. RESULTS: After controlling other variables, multinomial logistic regression analysis revealed that psychiatric inpatients who had fallen and had dizziness (odds ratio [OR] = 7.11, p < .001), had an unsteady gait (OR = 1.97, p = .030), or were not using aids (OR = 0.42, p = .042) were at greater risk of falling than those who had not fallen. The researchers also found that general ward inpatients who had fallen and had higher Charlson Comorbidity Index scores (OR = 1.77, p < .001), were clear-headed (OR = 27.15, p = .001), had dizziness (OR = 11.55, p < .001), were unable to walk (OR = 64.28, p < .001), or were using aids (OR = 3.86, p = .001) were at greater risk of falling than those who had not fallen before. CONCLUSIONS: The causes of falling among psychiatric inpatients and general ward inpatients are different. Medical personnel should understand the medications and attributes of patients for an accurate assessment of their risk factors for falling and thus implement fall prevention measures and health education to reduce falls.

Download Full-text

Abstract 3000: Epidemiology of Cerebrovascular Diseases Among Chinese with Diabetes Mellitus in Toronto: A Retrospective Ten Years Case-mix Study

Stroke ◽

10.1161/str.43.suppl_1.a3000 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Susy Lam ◽

Joseph Y Chu

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Treatment Strategies ◽

Specific Treatment ◽

Stroke Patients ◽

Stroke Incidence ◽

Small Vessels ◽

Guideline Values ◽

Co Morbidity ◽

Stroke Type

BACKGROUND: An article published in Neurology Asia(2006;11:13-18) by Chu etal provided essential data to investigate whether specific genetic or environmental differences exist within the diabetic-Chinese stroke community. Insight into distinctive epidemiologic and cerebrovascular patterns will bring forth effectively focused treatment and prevention. From that basis, we hypothesized: Chinese who had stroke-history within 15 years are more commonly diabetic than Europeans, and Chinese more frequently have small vessels disease (SVD) than Europeans. METHODS: Patients seen during 2001-2011 at the Toronto Queensway Professional Center Neurology clinic and at William Osler Health System, Brampton Site, were investigated. Chinese diabetic stroke patients were selected by last name and birth country; similarly diagnosed European patients were age-sex matched correspondingly. Risk factors were acknowledged if patients were given explicit medical treatments. Otherwise, guideline values were obtained from the WHO criteria. Data was collected through screening patient charts for the following: diabetic prevalence through screening stroke patients (122 Chinese, 880 European) excluding TIAs, subarachnoid and subdural haemorrhages; etiology and stroke type comparison in patients with DM (48 Chinese, 127 European); risk factors differences between Chinese and Europeans with DM. Odds ratios and unpaired two-sample t-testing were used to confirm significance. RESULTS: Significance confirmed (P<0.05): Chinese had higher DM and stroke incidence than Europeans (28.7% vs. 23.2%). Diabetic Chinese more frequently had SVD (51.1% vs. 44.1%), specifically lacunar stroke (47.9% vs. 36.4%). The co-morbidity of SVD risk factors of hypertension, hyperlipidemia and overweight were more frequent in Chinese (Table 1.0). Furthermore, SVD frequency dominated over large vessels disease (LVD) in the Chinese (Table 1.1). Table 1.0 - RISK FACTOR INCIDENCE Overweight HBP HPL Chinese, SVD 26.9% 53.8% 36.5% European, SVD 16.5% 33.1% 23.6% OR Chinese/Euro.1.86 2.36 1.86 Table 1.1 - STROKE TYPE AND RISK Overweight, SVD Overweight, LVD Hyperlipidemia, SVD Hyperlipidemia, LVD Hypertension, SVD Hypertension, LVD : Chinese 26.9% 7.7% 36.5% 15.0% 53.8% 25.0% OR SVD/LVD 4.42 3.26 3.50 European 16.5% 7.9% 23.6% 15.0% 33.1% 26.0% OR SVD/LVD 2.32 1.76 1.41 CONCLUSIONS: Chinese with stroke are more frequently diabetic than Europeans. Diabetic Chinese are especially susceptible to small vessels disease and certain stroke risk factors are more frequent compared to the Europeans. Risk factor prevalence and stroke types differ considerably between Chinese and Europeans within Toronto, which may imply that specific treatment strategies are required to target towards each population.

Download Full-text

Prevalence and predictors of metabolic syndrome in a sample of Italian psychiatric inpatients

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.542 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S472-S472

Author(s):

L. Fusar-Poli ◽

N. Brondino ◽

M. Rocchetti ◽

M. Ballerio ◽

M. Vercesi ◽

...

Keyword(s):

Metabolic Syndrome ◽

Medical Records ◽

Psychiatric Patients ◽

Psychiatric Inpatients ◽

Roc Curves ◽

Psychiatric Ward ◽

Psychotropic Agents ◽

Unhealthy Diet ◽

Common Risk Factors ◽

Competing Interest

IntroductionPsychiatric population is characterized by a higher prevalence of cardiovascular events compared to general population. This difference might be due, in part, to the metabolic adverse effects of psychotropic agents, and, in part, to common risk factors such as smoking, sedentary lifestyle and unhealthy diet. Another potential risk factor is represented by the presence of metabolic syndrome (MetS).ObjectivesWe aimed to evaluate the prevalence of MetS and to identify the baseline predictors for the longitudinal development of MetS in a sample of Italian psychiatric inpatients.MethodsMedical records of 343 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.ResultsPrevalence of MetS was 21.5%. MetS appeared directly associated with age and number of medication assumed. ROC curves showed HDL as the best predictor of metabolic syndrome in our sample.ConclusionsOur results confirm previous data on the association between metabolic syndrome and exposure to complex polytherapy. Additionally, our findings support the notion of psychiatric patients as an at-risk group for metabolic abnormalities, which should be carefully monitored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Evaluation of suicide risk in psychiatric patients after discharge. A follow-up study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.756 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s282-s282

Author(s):

G. Giordano ◽

R. Federica ◽

E. Denise ◽

M. Monica ◽

I. Marco ◽

...

Keyword(s):

Suicidal Ideation ◽

Suicide Risk ◽

Attempted Suicide ◽

Psychiatric Patients ◽

Psychiatric Inpatients ◽

Type I ◽

Follow Up Study ◽

Significant Difference ◽

Competing Interest

RésuméIntroductionSeveral studies show that the first period after discharge has an higher suicide risk.ObjectivesFollowing up psychiatric inpatients after discharge may be important in order to better understand the risk and the protective factors of suicide.AimThe aim of our follow-up study is to evaluate the predictive factors of suicide in a sample of psychiatric inpatients after discharge.MethodsWe analyzed the temperament and the levels of hopelessness, depression, suicide risk in a sample of 87 (54% males) inpatients at time T0 (during the hospitalization), T1 (12 months after discharge) and T2 (8 months after T1). We administered the following scales: BHS, MINI, TEMPS, GMDS, CGI.ResultsA statistically significant difference on the risk of suicide with substance abuse was found among patients who were followed up and who refused to participate, respectively at T1 (χ24 = 2.61; P < 0.05) and T2 (χ24 = 1.57; P = 0.05). At T1, 4 patients attempted suicide and 18 showed suicidal ideation. In the second follow-up, 1 patient successful committed suicide, 1 subject attempted suicide and 10 patients showed suicidal ideation. Patients with suicidal ideation at T1 showed higher levels of hopelessness and a diagnosis of bipolar disorder type I (χ24 = 10.28; P = 0.05). Sixty-seven percent of subjects with suicidal ideation showed higher scores in the BHS at T1. Significant differences were found on the anxious temperament at T2 between two groups.ConclusionsThe follow-up could represent a significant strategy to prevent suicide in psychiatric patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Metabolic syndrome and its association with psychotropic medications in psychiatric patients from CAISM–IGSS (Center for Comprehensive Care Mental Health/Guatemalan Institute of Social Security)

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2016 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S545-S546

Author(s):

J. Lopez

Keyword(s):

Metabolic Syndrome ◽

Valproic Acid ◽

Risk Factor ◽

Social Security ◽

Protective Factor ◽

Psychiatric Patients ◽

International Diabetes Federation ◽

Mood Stabilizers ◽

Competing Interest ◽

Glucose And Lipid Homeostasis

IntroductionThe use of antipsychotics represents an integral part of the psychiatric practice, unfortunately the use seems to be associated with an elevated frequency of metabolic alterations causing an important weight disorder and glucose and lipid homeostasis, diminishing life expectations for these patients, likely to develop metabolic syndrome without proper control.ObjectivesThis study intended to find the association between metabolic syndrome in patients with psychotropic treatments used in the Guatemalan Institute of Social Security (IGSS).MethodologyCohort Study (n = 43 patients) who were treated combined with antipsychotics and mood stabilizers or antidepressants, conducting checkups at the beginning, then two to four months after, evaluating diagnosis of metabolic syndrome according to the criteria stated by the International Diabetes Federation (IDF).ResultsRisk factor with the use of clozapine and valproic acid was revealed after four months of exposure (RR = 2.32). With the use of clozapine and mood stabilizers a risk factor was prevalent with exposure after four months (RR = 2.67), and with the use of antidepressants a protective factor for the development of metabolic syndrome was revealed at four months of exposure (RR = 0.3741).Conclusionsthe use of antipsychotics in combination with mood stabilizers represents a risk factor for developing metabolic syndrome, especially the association with valproic acid.Disclosure of interestThe author has not supplied his declaration of competing interest.

Download Full-text

In-Patient and Post-Discharge Suicides in Tyrol 2004–2011

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.161 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S292-S292

Author(s):

E.A. Deisenhammer ◽

E.M. Behrndt ◽

G. Kemmler ◽

C. Haring ◽

C. Miller

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Suicide Attempts ◽

Psychiatric Patients ◽

High Risk Population ◽

Post Discharge ◽

Patient Status ◽

History Of ◽

Competing Interest ◽

Commit Suicide

IntroductionPsychiatric patients constitute a high-risk population for suicide. In-patient status and the period after discharge are of particular interest concerning risk assessment.ObjectiveTo assess risk factors for in-patient and post-discharge suicides.MethodsThe Tyrol suicide register was linked with the registers of three psychiatric departments/hospitals of the region. Suicides were categorized according to whether the suicide was committed during a hospital stay or within 12 weeks after discharge or whether the suicide subject had not recently been hospitalized. Groups were compared with regard to demographic and clinical variables. Further, case-control comparisons were performed for the in-patient and post-discharge groups.ResultsDuring the study period (2004–2011) 30 in-patients, 89 post-discharge and 592 not recently hospitalized suicides were identified. Groups differed in terms of gender distribution, history of suicide attempts, warning signals and suicide methods. Compared with controls matched for a number of variables, in-patient suicides were significantly more suicidal and depressed at admission, reported more often a recent life event and showed less often aggressive behavior and plans for the future. Post-discharge suicides had more often a history of attempted suicide, depressive and thought disorder symptomatology, a ward change and an unplanned discharge and less often a scheduled appointment with a non-psychiatric physician.ConclusionsSuicide victims differ with regard to whether they die during, shortly after or not associated with a hospitalization. Compared to controls there are specific risk factors for those who commit suicide during a hospital stay and within 12 weeks after discharge.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Predictors of dropout from inpatient treatment for eating disorders

European Psychiatry ◽

10.1016/s0924-9338(11)72421-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 716-716 ◽

Cited By ~ 1

Author(s):

S. Catellani ◽

F. Arnone ◽

E. De Bernardis ◽

S. Ferrari ◽

L. Pingani ◽

...

Keyword(s):

Risk Factors ◽

Eating Disorders ◽

Inpatient Treatment ◽

Protective Factor ◽

Treatment Strategies ◽

Drop Out ◽

Self Report ◽

Psychometric Tests ◽

Improve Treatment ◽

Catholic Religion

IntroductionDrop-out from treatment for Eating Disorders is increasing (Campbell; 2007), and it is a risk factor for relapse and more chronic and severe course of the illness (Fassino et al.; 2009). Drop-out can be caused by interaction of concurrent, individual, familiar ad environmental factors (Sly; 2009).Aim of the studyTo examine possible risk factors of drop-out from inpatient treatment for eating disorders.Materials and methodsThe sample included 41 patients who voluntarily left the treatment before completion (’droppers’) and 88 patients who completed it (’completers’), in the period between 1st January 2006 and 31st December 2009 at Villa Maria Luigia Hospital (Monticelli Terme, PR, Italy). Patients were administered 2 self-report questionnaires and 3 psychometric tests: Eating Disorders Questionnaire, Predisposing, bringing on and maintaining risk factors for eating disorders, EDI-II, BUT, SCL-90.ResultsDroppers appear to be more aggressive (p = 0.022), get worse scholastic results (p = 0.016) and have less friendships and less social interaction (p = 0.021). Parental break-up (p = 0.015), moving house (p = 0.006), father's death (p = 0.005), abortition (p = 0.040), father's alcohol abuse (p = 0.011) and a mother who suffers of eating disorder (p = 0.008) are more frequent in droppers than completers. Catholic religion seems to be a protective factor from drop-out (p = 0.005).ConclusionDrop-out is a multifactor phenomenon; identification of risk factors can improve treatment strategies and outcome.

Download Full-text

P189 Diabetes may confer protection from giant cell arteritis: results from a large inception cohort

Rheumatology ◽

10.1093/rheumatology/keaa111.184 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Luke Spray ◽

Gary Reynolds ◽

Jonathon Heaney ◽

Karolyn Houghton ◽

Ben Hargreaves ◽

...

Keyword(s):

Diabetes Mellitus ◽

At Risk ◽

Side Effects ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Protective Factor ◽

Meta Analysis ◽

Treatment Strategies ◽

High Dose ◽

Co Morbidity

Abstract Background Giant cell arteritis (GCA) is the commonest large-vessel vasculitis. Until recently high dose corticosteroids had been the mainstay of treatment. Significant concern about steroid related co-morbidities have driven interest in developing new treatment strategies, and the potential to reduce costs associated with managing these complications was pivotal in securing funding for tocilizumab. Despite this little is known about the at-risk population, comprising both those diagnosed with GCA and those suspected of GCA, as both groups undergo the same steroid exposure. We therefore sought to determine if patients referred to our GCA fast track pathway (GCA-FTP) were more or less at risk than the general age matched population of developing corticosteroid related side effects. Methods Data from 356 consecutively referred patients to our GCA-FTP between January 1st 2017 and December 31st 2018 were reviewed. Co-morbidity data is routinely collected as part of our GCA-FTP rolling audit. We determined the frequency of pre-existing co-morbidities most often associated with steroid related side effects and compared these with published background prevalence estimates for a similar age group in the UK. Results In general rates of co-morbidities were lower than published estimates in over-70s, as we did not actively pursue their identification beyond what was readily available at referral (Table 1). Interestingly, however, whilst the prevalence of diabetes mellitus in our cohort (n = 356) was comparable to that in the general population (23.6%), it was significantly lower in those diagnosed with GCA (n = 83) at 11% (p = 0.0017). Despite this difference, background rates of cardiovascular and peripheral vascular disease were similar in each group. Conclusion In our cohort, diabetes mellitus seems to be a protective factor against the development of GCA. Similar results were reported in 2015 from a meta-analysis of inception cohorts involving 903 patients with GCA and 1064 controls. The interaction between diabetes and the onset of GCA merits further investigation. Disclosures L. Spray None. G. Reynolds None. J. Heaney None. K. Houghton None. B. Hargreaves None. B. Thompson None. A. Lorenzi None.

Download Full-text

Syphilis sero-positivity in recently admitted and long-term psychiatric inpatients: Screening, prevalence and diagnostic profile

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v18i4.358 ◽

2012 ◽

Vol 18 (4) ◽

pp. 5 ◽

Cited By ~ 1

Author(s):

Maria P Henning ◽

Christa Kruger ◽

Lizelle Fletcher

Keyword(s):

High Risk ◽

Sexual Behaviour ◽

Psychiatric Patients ◽

Psychiatric Inpatients ◽

Enzyme Linked Immunosorbent Assay ◽

Co Morbidity ◽

High Risk Sexual Behaviour ◽

Syphilis Screening ◽

Risk Sexual Behaviour

Background. Syphilis research has neglected the prevalence of the disease among psychiatric patients, and traditional syphilis screening has been reported as inadequate.Objectives. (i) To assess the syphilis prevalence among psychiatric patients; (ii) to compare psychiatric diagnoses of syphilis-infected and -uninfected patients; (iii) to assess self-reported high-risk sexual behaviour; (iv) to establish syphilis/HIV co-morbidity; and (v) to investigate the performance of the rapid plasma reagin (RPR) test in syphilis screening, compared with the Treponema pallidum haemagglutination (TPHA) test.Methods. Psychiatric inpatients at Weskoppies Hospital, Pretoria, who consented to participate in the study (N=195) were categorised according to gender and length of admission (long-term or recent). Non-treponemal RPR, confirmatory TPHA, HIV-rapid and HIV enzyme-linked immunosorbent assay (ELISA) tests were performed. A reactive TPHA test was used to diagnose syphilis. Results. The estimated prevalence of syphilis was 11.7%. There was no significant association between TPHA sero-positivity and primary psychiatric diagnosis or self-reported high-risk sexual behaviour. Significant co-morbidity existed between syphilis and HIV (p=0.012). Compared with the TPHA test, the RPR test performed poorly, identifying only 2/23 patients who had a sero-positive TPHA test (8.7% sensitivity and 100% specificity).Conclusions. The prevalence of syphilis was higher than anticipated, supporting the need for routine testing. The significant co-morbidity and alarming prevalence of HIV and syphilis warrant testing for both conditions in all psychiatric admissions. Current syphilis screening with a single RPR test is inadequate; both RPR and TPHA tests should be performed.

Download Full-text

Risk factors for Clostridium difficile infection and colonization among patients admitted to intensive care units in Shanghai, China

10.21203/rs.2.13271/v1 ◽

2019 ◽

Author(s):

Yingchao Cui ◽

Lihua Zhang ◽

Danfeng Dong ◽

Daosheng Wang ◽

Cen Jiang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Clostridium Difficile ◽

Intensive Care Units ◽

Clostridium Difficile Infection ◽

Protective Factor ◽

Treatment Strategies ◽

Hospital Stays ◽

A Prospective Study ◽

Epidemiological Characteristics

Abstract Background : Clostridium difficile is considered to be the main pathogen responsible for hospital-acquired infections in western countries, but few studies on C. difficile have been carried out in China. This study performed a prospective study to describe the prevalence, molecular epidemiological characteristics and risk factors of Clostridium difficile infection (CDI) and Clostridium difficile colonization (CDC) among patients in intensive care units (ICUs), with the aim of providing strategies for efficient CD prevention and control.Methods: Stool samples were collected from adult patients on admission to an 18-bed ICU department, and were anaerobically cultured for C. difficile . The identified isolates were tested for toxin genes, followed by multilocus sequence typing to analyze the genotypes. Patients were divided into CDI, CDC and control groups according to clinical features. The medical records of these groups were collected and further analyzed using logistic regression to investigate the risk factors.Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) patients were identified with CDI and CDC, respectively. An association was found between CDI patients and having a fever (OR=13.993) or metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or a combination of antibiotics (OR=2.856). CDC patients were characterized by longer hospital stays (OR=1.137), an increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043) and treatment with vancomycin (OR=18.168). However, treatment with metronidazole was simultaneously found to be a protective factor in the two groups (OR=0.042; OR=0.013). Eighteen sequence types (STs) were identified. Among the CDI group, the isolates were predominantly toxin A- and toxin B-positive (A+B+) strains and genotype ST-2 was the epidemic clone. In the CDC group, the dominant strains were A+B+ and ST-81 was the epidemic clone.Conclusions: The prevalence of C. difficile colonization and infection in our ICU patients was relatively high, suggesting the importance of routine screening to detect the acquisition of this pathogen. Future prevention and treatment strategies for C. difficile -related disease should take into consideration the duration of hospital stays, enteral nutrition, underlying comorbidities, as well as the use of combined antibiotics. Moreover, metronidazole could be a protective factor for both CDI and CDC.

Download Full-text