Liaison psychiatry–characterization of inpatients with psychiatric pathology in the infectiology service

2017 ◽  
Vol 41 (S1) ◽  
pp. S489-S489
Author(s):  
T. Carvalhao
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Social Life ◽  
Direct Action ◽  
Demographic Data ◽  
University Hospital ◽  
Emotional Impact ◽  
Liaison Psychiatry ◽  
Competing Interest ◽  
The Individual

IntroductionThe interface of the Liaison Psychiatry with Infectiology is fundamental for the continuous and specialized support of these patients. Prevalent psychiatric records are known in the HIV infection, such as anxiety, depression and abuse and/or addiction to substances. There are also different neuropsychiatric situations associated with this infection owing, namely, to the HIV direct action on the central nervous system, to the adverse effect of the antiretroviral therapy and to the resurgence of existing prior pathology.ObjectiveThe author intends to characterize the population evaluated in the Liaison psychiatry in the Coimbra university hospital with respect to inpatients of the Infectiology Service in a central hospital in order to optimize resources and better adjust interventions made.Methods and resultsThe quantitative retrospective study was carried out between May 2015 and May 2016, with a duration of one year, in the infectiology service of the Coimbra university hospital.Observation and evaluation of the inpatient of the infectiology service having in view the sample characterization in relation to demographic data, nature of the request, antiretroviral therapy, psychiatric diagnosis, type of intervention and follow-up. The quantitative data were subject to statistical analysis.ConclusionThe prevalence of the psychiatric disorders associated with HIV infection is high and with great emotional impact and implications in the personal, sexual, occupational and social life of the individual. The diagnosis and treatment of the psychiatric comorbidity is determinant in the patients’ evolution, both in reducing suffering associated with experience of HIV infection and in its implications.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Low frequency of request for liaison psychiatry: A difficulty in the early detection of mental disorders by medical assistants?

2017 ◽  
Vol 41 (S1) ◽  
pp. S487-S487
Author(s):  
M. Aguiar Machado ◽  
J. Gonçalves Oliveira ◽  
E. Oliveira Cunha ◽  
E. Vieira de Melo ◽  
E. Oliva-Costa
Keyword(s):  
Depressive Symptoms ◽  
Mental Disorders ◽  
Early Detection ◽  
Clinical Medicine ◽  
Demographic Data ◽  
Low Frequency ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Liaison Psychiatry ◽  
Epidemiological Profile

IntroductionThe liaison psychiatry (LP) is a feature used by the psychiatrist in order to improve the management of patients with mental suffering and/or mental disorder admitted to general hospital.ObjectivesTo characterize the epidemiological profile of hospitalized patients at the university hospital of the federal university of Sergipe (HU-UFS) submitted to LP.Methodsretrospective and observational study, through analysis of medical records of patients admitted in the wards of clinical medicine and surgery from the HU-UFS, in the period from January to December 2015, submitted to LP. The information collected fed a specific questionnaire developed by the authors, intended for research of socio-demographic data and clinical profile.Resultsthe frequency of request for IP was of 3.5%, with the majority of applications was performed by clinical medicine (71.2%), while the surgical clinic was responsible for 28.8%. The main reason for the request of LP was the presence of depressive symptoms (49.1%). There was a predominance of females (52.5%) and the mean age was 45.9 ± 14.6 years.ConclusionsThe frequency of request for LP was very low, suggesting a difficulty in the early detection of mental disorders by physicians. This finding points to an underreporting of cases, since the prevalence of depressive symptoms in hospitalized patients is over 50% in this institution.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Impact of HIV-1 Infection and Antiretroviral Therapy on Bone Homeostasis and Mineral Density in Vertically Infected Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
D. Donà ◽  
E. Mozzo ◽  
D. Luise ◽  
R. Lundin ◽  
A. Padoan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Antiretroviral Therapy ◽  
Side Effects ◽  
Hiv Infection ◽  
Antiretroviral Drugs ◽  
University Hospital ◽  
Bone Homeostasis ◽  
Mineral Density ◽  
Anthropometric Data ◽  
Hiv 1

Daily assumption of antiretroviral drugs and HIV-related immune activation lead to important side effects, which are particularly evident in vertically infected patients. Bone homeostasis impairment and reduction of bone mineral density (BMD) is one of the most important side effects. Primary aim of this study is to assess the prevalence of bone homeostasis alterations in a group of vertically infected patients; secondary aim is to analyze the relationship between bone homeostasis alterations and anthropometric data, severity of HIV infection, and antiretroviral therapy. We studied 67 patients with vertically transmitted HIV-1 (aged 6-31 years), followed by the Pediatric Infectious Disease Unit of the University Hospital of Padua, Italy. We analyzed bone turnover markers (P1NP and CTx) and we performed lumbar spine and femoral dual energy X-ray absorption densitometry (DXA). Personal and anthropometric data and information on HIV-infection severity and antiretroviral therapy were collected for all patients. We found that BMD values recorded by DXA showed a significant correlation with age, race, BMI, physical activity, and antiretroviral therapy duration. P1NP was increased in 43% of patients, while CTX in 61% of them. P1NP alteration was related to age, race, BMI, physical activity, therapy duration, and ever use of protease inhibitors and nucleotide reverse transcriptase inhibitors. CTX alteration was found to be correlated only with age. In conclusion, our study confirms that a wide percentage of HIV vertically infected patients show reduced BMD and impaired bone homeostasis. Strict monitoring is needed in order to early identify and treat these conditions.

The Late-onset Bipolar Disorder: A Comparative Study

2017 ◽  
Vol 41 (S1) ◽  
pp. S113-S114
Author(s):  
C. Derbel ◽  
R. Feki ◽  
S. Ben Nasr ◽  
S. Bouhlel ◽  
B. Ben Hadj Ali
Keyword(s):  
Comparative Study ◽  
Late Onset ◽  
Demographic Data ◽  
Bipolar Disorders ◽  
The Elderly ◽  
University Hospital ◽  
Professional Activity ◽  
Competing Interest ◽  
Secondary Mania ◽  
Depressive Episodes

IntroductionBipolar disorders (BP) with late onset are underestimated by their frequency, their misleading presentations and therapeutic difficulties due to the high prevalence of somatic comorbidities.AimTo identify sociodemographic, clinical and therapeutic characteristics in subjects with a late-onset BP.Patients and methodsRetrospective and comparative study of 101 patients followed for a BP (12 patients with BP started after 50 years and 89 patients with BP started earlier) from 2009 to 2015, in the department of psychiatry of the University Hospital Farhat Hached, Sousse, Tunisia.ResultsThe mean age of subjects with late-onset TBP was 46.11 ± 12.85 years. Women were in the majority (65.3%). Ten patients had a novo mania, four patients had a late-onset mania and one patient had a secondary mania. Regarding the socio-demographic data, only the regular professional activity was more reported in the elderly (P = 0.017). Regarding clinical data, BP type 1 and secondary mania were more reported in elderly with (P = 0.050 and P = 0.000 respectively). Elderly had significantly fewer depressive episodes (P = 0.026), fewer hypomanic episodes (P = 0.000). The durations of the latest episodes and the last intervals were shorter in elderly (P = 0.045 and P = 0.000). Concerning therapeutic data, elderly had fewer hospitalizations (P = 0.045), required lower mean doses of lithium (P = 0.04) and greater mean doses of tricyclic antidepressants (P = 0.047).ConclusionIt is always necessary to look for an organic cause in manic syndrome in late-onset BP. Doses of lithium should be lower. However, doses of TAD should be higher.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuropsychiatric manifestations in patients with HIV treated with antiretroviral drugs versus untreated

2017 ◽  
Vol 41 (S1) ◽  
pp. s493-s493
Author(s):  
V. Gonçalves ◽  
A. Ribeirinho ◽  
L. Ferreira ◽  
P. Cintra
Keyword(s):  
Antiretroviral Therapy ◽  
English Language ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Dropout Rate ◽  
Antiretroviral Drugs ◽  
Liaison Psychiatry ◽  
Personality Changes ◽  
Neuropsychiatric Manifestations ◽  
Competing Interest

IntroductionUntreated patients for H.I.V can present various types of neuropsychiatric syndromes (NPS): subclinical cognitive symptoms, behavioral changes, agitation, personality changes, dementia complex associated with H.I.V and delirium, depressive disorder, bipolar affective disorder or manic episode. However, it is controversial whether antiretroviral induce NPS, or on the contrary, when there are patients will evolve into an AIDS stage for therapeutic resistance or noncompliance.AimsDescribe qualitatively and quantify the epidemiological point of the main subclinical and NPS symptoms in patients untreated and treated with antiretroviral drugs and their frequencies. Propose pharmacological treatments for each of the specified conditions.MethodsSearch in PubMed with the words “Neuropsychiatric and antiretroviral therapy” by applying the limits: full and free texts, past 10 years, Human, English language and adults; research liaison psychiatry textbooks.ResultsResults yielded 381 articles with the criteria selecting 102, the most relevant for the purposes of work. They chose four most relevant chapters in the literature.ConclusionsThe most effective treatment of NPS in unmedicated patients is to start antiretroviral therapy; only if it does not improve them should be introduced psychiatric drugs as if they were functional. 50% of treated with efavirenz patients will develop NPS in the early days with gradual decrease. The dropout rate associated with these adverse events varies from 2.6–16%. Treatment of these NPS a challenge by the existence of numerous drug interactions, it is essential to know to deal with these entities to improve the quality of life of people with this chronic disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals IMMUNE STATUS IN HIV-INFECTED PATIENTS COINFECTED WITH HEPАTITIS C VIRUS (HCV)

2019 ◽  
Vol 10 (4) ◽  
pp. 25-36
Author(s):  
K. V. Shmagel ◽  
V. A. Chereshnev
Keyword(s):  
Hepatitis C ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Immune Status ◽  
Direct Action ◽  
Hcv Infection ◽  
Viral Hepatitis C ◽  
Negative Effect ◽  
Negative Role

The most common co-infection associated with HIV infection is viral hepatitis C. More than half of HIV-infected patients is coinfected with HCV in Russia. Both infections can have a reciprocal negative effect, what is reflected in an increase in the morbidity and mortality of co-infected patients compared with mono-infected patients. The negative role of HIV infection in the development of hepatitis C is manifested by the acceleration of the process of fibrosis and the formation of cirrhosis of the liver, as well as the frequent occurrence of hepatocellular carcinoma. The effects of HCV infection on the course of HIV infection have been less studied. It is known that hepatitis can slow down the immune reconstitution while receiving antiretroviral therapy. In addition, a violation of the hepatic barrier for products supplying from the intestine, apparently, can lead to additional activation of the immune system, aggravatted immunodeficiency, increased systemic inflammation and the development of AIDS-non-associated diseases, primarily cardiovascular diseases. Most researchers see the solution of the problem in the early start of antiretroviral therapy, as well as in the transition from interferon therapy to the appointment of drugs of direct action in the treatment of HCV infection.

scholarly journals Cryptococcus neoformans infection in Human Immunodeficiency Virus (HIV)-infected and HIV-uninfected patients at an inner-city tertiary care hospital in the Bronx

2019 ◽  
Vol 58 (4) ◽  
pp. 434-443 ◽  
Author(s):  
Hyun Ah Yoon ◽  
Uriel Felsen ◽  
Tao Wang ◽  
Liise-anne Pirofski
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Inner City ◽  
Cryptococcus Neoformans ◽  
Demographic Data ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Care Hospital ◽  
Immunodeficiency Virus

AbstractCryptococcus neoformans causes life-threatening meningoencephalitis. Human immunodeficiency virus (HIV) infection is the most significant predisposing condition, but persons with other immunodeficiency states as well as phenotypically normal persons develop cryptococcosis. We retrospectively reviewed medical records of all patients with a diagnosis of cryptococcosis between 2005 and 2017 at our inner-city medical center in the Bronx, an epicenter of AIDS in New York City, and analyzed demographic data, clinical manifestations, laboratory findings, treatment, and mortality for these patients. In sum, 63% of the cases over this 12-year period occurred in HIV-infected patients. And 61% of the HIV-infected patients were non-adherent with antiretroviral therapy, 10% were newly diagnosed with AIDS, and 4% had unmasking cryptococcus-associated immune reconstitution inflammatory syndrome. The majority were Hispanic or black in ethnicity/race. HIV-uninfected patients (47/126) were older (P < .0001), and the majority had an immunocompromising condition. They were less likely to have a headache (P = .0004) or fever (P = .03), had prolonged time to diagnosis (P = .04), higher cerebrospinal fluid (CSF) glucose levels (P = .001), less CSF culture positivity (P = .03), and a higher 30-day mortality (P = .03). Cases in HIV-uninfected patients were often unsuspected during their initial evaluation, leading to a delay in infectious diseases consultation, which was associated with mortality (P = .03). Our study indicates that HIV infection remains the most important predisposing factor for cryptococcosis despite availability of antiretroviral therapy and highlights potential missed opportunities for earlier diagnosis and differences in clinical and prognostic factors between HIV-infected and HIV-uninfected patients.

scholarly journals End of Life Intervention Program During COVID-19 in Vall d'Hebron University Hospital

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna Beneria ◽  
Eudald Castell-Panisello ◽  
Marta Sorribes-Puertas ◽  
Mireia Forner-Puntonet ◽  
Laia Serrat ◽  
...  
Keyword(s):  
End Of Life ◽  
Intervention Program ◽  
Total Sample ◽  
University Hospital ◽  
Mitigation Measures ◽  
Emotional Impact ◽  
Unexpected Death ◽  
To Come ◽  
Medical Teams ◽  
The Individual

Introduction: The coronavirus disease 19 (COVID-19) and its consequences have placed our societies and healthcare systems under pressure. Also, a major impact on the individual and societal experience of death, dying, and bereavement has been observed. Factors such as social distancing, unexpected death or not being able to say goodbye, which might predict Prolonged Grief Disorder (PGD), are taking place. Moreover, hospitals have become a habitual place for End of Life (EOL) situations but not in the usual conditions because, for example, mitigation measures prevent families from being together with hospitalized relatives. Therefore, we implemented an EOL program with a multidisciplinary team involving health social workers (HSW) and clinical psychologists (CP) in coordination with the medical teams and nursing staff.Objectives: We aim to describe an EOL intervention program implemented during COVID-19 in the Vall d'Hebron University Hospital (HUVH). We present its structure, circuit, and functions. Descriptive analyses of the sample and the interventions that required psychological and social attention are reported.Material and methods: The total sample consists of 359 relatives of 219 EOL patients. Inclusion criteria were families cared for during the COVID-19 pandemic with family patients admitted to the HUVH in an EOL situation regardless of whether or not the patient was diagnosed with COVID-19.Results: Our program is based on family EOL care perceptions and the COVID-19 context features that hinder EOL situations. The program attended 219 families, of which 55.3% were COVID-19 patients and 44.7% had other pathologies. The EOL intervention program was activated in most of the EOL situations, specifically, in 85% of cases, and 78% of relatives were able to come and say goodbye to their loved ones. An emotional impact on the EOL team was reported. It is necessary to dignify the EOL situation in the COVID-19 pandemic, and appropriate psychosocial attention is needed to try to minimize future complications in grief processes and mitigate PGD.

Victorian Pain

2017 ◽  
Author(s):  
Rachel Ablow
Keyword(s):  
Nineteenth Century ◽  
Victorian Literature ◽  
Social Life ◽  
Charles Darwin ◽  
Harriet Martineau ◽  
The Status ◽  
History Of ◽  
The Individual ◽  
Natural Philosophers ◽  
First Time

The nineteenth century introduced developments in science and medicine that made the eradication of pain conceivable for the first time. This new understanding of pain brought with it a complex set of moral and philosophical dilemmas. If pain serves no obvious purpose, how do we reconcile its existence with a well-ordered universe? Examining how writers of the day engaged with such questions, this book offers a compelling new literary and philosophical history of modern pain. The book provides close readings of novelists Charlotte Brontë and Thomas Hardy and political and natural philosophers John Stuart Mill, Harriet Martineau, and Charles Darwin, as well as a variety of medical, scientific, and popular writers of the Victorian age. The book explores how discussions of pain served as investigations into the status of persons and the nature and parameters of social life. No longer conceivable as divine trial or punishment, pain in the nineteenth century came to seem instead like a historical accident suggesting little or nothing about the individual who suffers. A landmark study of Victorian literature and the history of pain, the book shows how these writers came to see pain as a social as well as a personal problem. Rather than simply self-evident to the sufferer and unknowable to anyone else, pain was also understood to be produced between persons—and even, perhaps, by the fictions they read.

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