Psychopharmacotherapy in a Multy-type Hospital

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P. Pyrkov
Keyword(s):  
Mental Disorders ◽  
General Hospital ◽  
Psychotic Disorders ◽  
Psychiatric Service ◽  
List Type ◽  
Psychiatric Facility ◽  
Amnesic Syndrome ◽  
Number Of Patients ◽  
Short Time ◽  
Mental And Behavioral Disorders

Introduction:The increasing number of patients with comorbide mental disorders, who were staying in multy-type hospitals, necessitates the organization of psychiatric service, which includes psychopharmacotherapy.Results:Observations were performed during 25 years in a multy-type emergency hospital.Indications for psychopharmacotherapy were:1.Organic (somatogenic) mental disorders (F06) - 61%, among them are: organic delirium ((F05, 8) - 25%, organic hallucinosis (F06.0) - 10%, organic amnesic syndrome (F04) - 27%, organic anxiety phobic disorder with agitation (F06.4) - 9%.2.Mental and behavioral disorders due to psychoactive substance use (F10 - 19%, F10.03 -12%, F10.31 - 6%, F11.21 - 1%.3.Neurotic depression with suicidal behaviour (accomplished parasuicide) (F43, 24) - 1%.4.Anorexia nervosa (F50.0) - 3%.5.Dementia (F00-F02) - 16%.The examination showed that short-time (up to 10-15 days) psychotic disorders could be reduced with parenteral introduction of the Diazepam 2ml 2-3 times/day.The use of Nootropics (Pyracetam 20% 10-20ml, Cerebryl 250ml iv) and B vitamins stimulated reduction of psychosis.Any of patients wasn't moved to the residential psychiatric facility.We didn't use neuroleptics cause their iatrogenic activity by organic psychosis and incompatibility with some somatotropic medicaments, employing by multiplex somatic disorder.Conclusion:Optimization of the psychopharmacotherapy in general hospital requires a regular psychiatrist on its staff. The treatment of the patient in the general hospital seems to be economic and moral effective.

Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches

2008 ◽  
Vol 13 (6) ◽  
pp. 1-7
Author(s):  
Norma Leclair ◽  
Steve Leclair ◽  
Robert Barth
Keyword(s):  
Mental Disorders ◽  
Behavioral Disorders ◽  
Psychotic Disorders ◽  
Behavioral Disorder ◽  
Behavioral Impairment ◽  
Central Nervous System Damage ◽  
Brain Functioning ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
Mental And Behavioral Disorders

Abstract Chapter 14, Mental and Behavioral Disorders, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines a process for assessing permanent impairment, including providing numeric ratings, for persons with specific mental and behavioral disorders. These mental disorders are limited to mood disorders, anxiety disorders, and psychotic disorders, and this chapter focuses on the evaluation of brain functioning and its effects on behavior in the absence of evident traumatic or disease-related objective central nervous system damage. This article poses and answers questions about the sixth edition. For example, this is the first since the second edition (1984) that provides a numeric impairment rating, and this edition establishes a standard, uniform template to translate human trauma or disease into a percentage of whole person impairment. Persons who conduct independent mental and behavioral evaluation using this chapter should be trained in psychiatry or psychology; other users should be experienced in psychiatric or psychological evaluations and should have expertise in the diagnosis and treatment of mental and behavioral disorders. The critical first step in determining a mental or behavioral impairment rating is to document the existence of a definitive diagnosis based on the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The article also enumerates the psychiatric disorders that are considered ratable in the sixth edition, addresses use of the sixth edition during independent medical evaluations, and answers additional questions.

Emergency pshychiatric treatment in a multy-type hospital

2011 ◽  
Vol 26 (S2) ◽  
pp. 749-749
Author(s):  
P.P. Pyrkov
Keyword(s):  
Myocardial Infarction ◽  
Mental Disorders ◽  
General Hospital ◽  
Psychotic Disorder ◽  
Mental Hospital ◽  
Psychotic Disorders ◽  
Drug Induced ◽  
Psychiatric Examination

ObjectivesWe have studied the treatment modes and therapies of patients with acute psychotic disorders, in a general hospital for 1600 bedsMethodsClinicopshycopathologic, clinicotherapeutic, and statistical.Results1982 patients, 18–92 years of age, 64% of them males, have been examined.All the patients have been primary admitted with acute somatic disorders:insult - 18%,skull injury - 21%,myocardial infarction - 23%,exogenic poisoning - 31%,parasuicides -4%,operations on the thoracic organs - 3%.The mental disorders diagnosed were following:amnesic syndrome, organic - F04 - 29%,depression - F43.20 - 5%,organic hallucinosis - F06.0 - 12%,organic delirium - F05 - 33%,psychotic disorder - or drug induced - F1 - 21%.ConclusionAfter psychiatric examination by an attending psychiatrist, the patients have been moved to the resuscitation department where they have been treated up to their recovery. No one patient has been moved to the mental hospital.

scholarly journals The relationships between obstructive sleep apnea and psychiatric disorders: a narrative review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kaja Hanna Karakuła ◽  
Aleksander Ryczkowski ◽  
Elżbieta Sitarz ◽  
Jacek Januszewski ◽  
Dariusz Juchnowicz
Keyword(s):  
Obstructive Sleep Apnea ◽  
Cognitive Impairment ◽  
Sleep Apnea ◽  
Mental Disorders ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
List Type ◽  
Study Protocols ◽  
Obstructive Sleep ◽  
Increased Risk

Abstract Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Its prevalence tends to increase worldwide. Untreated sleep apnea is associated with a higher risk of metabolic diseases, cardiovascular diseases, stroke, road accidents, and death, but also it is suggested that it increases the risk of mental disorders. Method: The literature review was based on a search of articles on Medline, Pubmed, and Google Scholar from 2003 to 2021 using the keywords: obstructive sleep apnea; mental disorders; cognitive functions; affective disorders; depression; bipolar disorder; schizophrenia; psychotic disorders. The analysis included original studies, meta-analysis, and review articles. Discussion: The result obtained from researches published so far does not allow for drawing unequivocal conclusions. There is a lot of bias present in study protocols and inclusion/exclusion criteria. Nonetheless, it seems that some disorders have a better proven correlation with OSA. Cognitive impairment, depression, and anxiety disorders are linked to OSA not only in terms of the overlapping of symptoms but also of a causal relationship. Psychotic disorders and bipolar disorders connections with OSA are confirmed, but they are not yet well understood. All correlations are found to be possibly bidirectional. Conclusion: 1. Multiple lines of evidence increasingly point towards a bidirectional connection between OSA and mental disorders, and the cause and effect relationship between these two groups of disorders requires further research. 2. Due to reports of an increased risk of OSA with antipsychotic drugs, caution should be exercised when initiating therapy with this type of drug in patients with known risk factors for it. 3. Screening for OSA in psychiatric patients should be introduced as OSA can increase cognitive impairment, affective, and psychotic symptoms.

Age differences in the dynamics of primary incidence of mental disorders in the Russian Federation in 1991–2018

2020 ◽  
pp. 33-40
Author(s):  
A. Yazdovskaya ◽  
N. Demcheva
Keyword(s):  
Health Care ◽  
Mental Disorders ◽  
Health Care Reform ◽  
Age Differences ◽  
Russian Federation ◽  
Psychotic Disorders ◽  
Psychiatric Care ◽  
Psychiatric Service ◽  
Working Age ◽  
The Russian Federation

The purpose of the study was to determine age characteristics in the dynamics of primary incidence of mental disorders in the Russian Federation in 1991–2018. 2 periods of distinct dynamics of indicators related to the primary incidence of mental disorders were distinguished on the basis of analysis of statistical reports: from 1991 to 2004, when the indicators grew rapidly, and from 2005 to 2018, when the indicators decreased. Change in the direction of the indicator dynamics coincided with the beginning of restructuring of the psychiatric service of the Russian Federation in 2005 as part of the health care reform. Age differences in the dynamics of indicators in 2004–2018 with a significant decrease in the primary incidence of the main forms of mental disorders among working-age people (20–59 years) and an increase in the rates of psychotic disorders among children 0–17 years old were noted. The authors of the article came to the conclusion that one of the main reasons for these changes was a decrease in the number of referrals due to problems of stigmatization and insufficient availability of psychiatric care.

Changing Pattern of Clinical Profile of First Contact Patients Attending Outpatient Services At the General Hospital Psychiatric Units In India Over the Last 50 Years

2016 ◽  
Vol 33 (S1) ◽  
pp. S487-S487
Author(s):  
M. Sood ◽  
R. Ranjan ◽  
R.K. Chadda ◽  
S. Khandelwal
Keyword(s):  
General Hospital ◽  
Psychotic Disorders ◽  
Somatoform Disorders ◽  
Indian Society ◽  
Outpatient Services ◽  
Number Of Patients ◽  
Psychiatric Units ◽  
Organic Brain ◽  
Competing Interest ◽  
First Contact

IntroductionOver the last eight decades, general hospital psychiatric units (GHPUs) have become important mental health service set-ups in India. This period has seen a large number of radical changes in the Indian society. In this background, it is important to know if it had any effects on the patients attending the GHPUs.MethodologyA total of five hundred subjects, attending a GHPU were recruited prospectively for the study. The subjects were assessed using a semi-structured proforma. A comparison was made with similar studies conducted in GHPU settings over the last 5 decades.ResultsNeurotic, stress related and somatoform disorders was the commonest diagnostic group (33%) followed by psychotic disorders (17%) and mood disorders (15%). The finding is broadly similar to the studies done at different times in the last 5 decades. However, there were lesser number of patients with mental retardation, organic brain syndrome and seizure disorder.ConclusionThe study highlights the strengths of GHPU set-ups like inter-speciality referrals, fewer stigmas, patients travelling from far off places to seek treatment and involvement of family in the care of mentally ill.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Impediments to Screening for Hazardous Alcohol Use and Dependence in General Hospital Psychiatric Inpatients

2001 ◽  
Vol 35 (5) ◽  
pp. 606-612 ◽  
Author(s):  
Gary K. Hulse
Keyword(s):  
Alcohol Use ◽  
General Hospital ◽  
Psychotic Disorders ◽  
Psychiatric Patients ◽  
Psychiatric Facility ◽  
Intervention Programme ◽  
Hazardous Alcohol Use ◽  
Significant Difference ◽  
Hazardous Alcohol ◽  
Hospital Stays

Objective: The Alcohol Use Disorders Identification Test (AUDIT) has been developed to screen for hazardous and harmful alcohol consumption. It has been used among a variety of primary care, general population and general hospital populations. However, with the exception of one study undertaken by the author and colleagues, the use of the AUDIT in general hospital psychiatric patients has not been reported. This paper reports on a substudy of this larger study whose aim was to determine the frequency of hazardous alcohol use and dependence among patients admitted to the psychiatric units of general hospitals in Perth, Western Australia, and discusses major reasons for non-AUDIT screening among this group. Method: In a 12-month period 990 patients aged 18–64 years and residing in the Perth metropolitan area were admitted to the psychiatric unit of the two hospitals. Using the AUDIT alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders, was assessed. Results: Of the 834 admissions targeted for AUDIT screening 263 were not screened. This non-screening represented 27–42% of patients in each of the major diagnostic categories. There was no significant difference in the proportion of patients screened versus not screened for mood, adjustment or schizophrenia/psychosis. There were however, significantly fewer patients with anxiety disorder screened compared with mood disorder. Those non-screened patients in major psychiatric groups had significantly shorter hospital stays than their diagnostic counterparts who were screened. The major reason for non-screening in all groups was due to patients leaving the psychiatric facility before they could be accessed. This included discharge before screening, transfer to another psychiatric facility and short admission. To a lesser extent cognitive dysfunction accounted for non-screening among major diagnostic groups. Conclusions: Failure to screen patients was largely due to short hospital stays. Screening was impeded by the brief window period, commonly 1 or 2 days, between the absence of acute psychiatric sequelae and discharge. This situation contrasts dramatically to the medical or surgical admission where major sequelae are largely resolved in 2–3 days and AUDIT screening can take place over the remaining 3–4 days prior to discharge. To be effective in the general hospital psychiatric setting, alcohol screening needs to be incorporated into the routine ward assessment procedures. The brevity of the AUDIT makes this possible. This would maximize the time available to implement an intervention programme to those found to be consuming alcohol at a hazardous or harmful level.

Errata

2008 ◽  
Vol 13 (2) ◽  
pp. 5-5
Keyword(s):  
Psychotic Disorders ◽  
Pain Syndrome ◽  
Vestibular Disorders ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Neurologic Disorders ◽  
Upper And Lower Extremities ◽  
Impairment Ratings ◽  
Extensive List ◽  
Mental And Behavioral Disorders

Abstract Although most chapters in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, instruct evaluators to perform impairment ratings by first assigning a diagnosis-based class and then assigning a grade within that class, Chapter 13, The Central and Peripheral Nervous System, continues to use a methodology similar to that of the fifth edition. The latter was criticized for duplicating materials that were presented in other chapters and for producing different ratings, so the revision of Chapter 13 attempts to maintain consistency between this chapter and those that address mental and behavioral disorders, loss of function in upper and lower extremities, loss of bowel control, and bladder and sexual function. A table titled Summary of Chapters Used to Rate Various Neurologic Disorders directs physicians to the relevant chapters (ie, instead of Chapter 13) to consult in rating neurologic disorders; the extensive list of conditions that should be addressed in other chapters includes but is not limited to radiculopathy, plexus injuries and other plexopathies, focal neuropathy, complex regional pain syndrome, visual and vestibular disorders, and a range of primary mood, anxiety, and psychotic disorders. The article comments in detail on sections of this chapter, identifies changes in the sixth edition, and provide guidance regarding use of the new edition, resulting in less duplication and greater consistency.

scholarly journals The effects of intensive home treatment on self-efficacy in patients recovering from a psychiatric crisis

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ansam Barakat ◽  
Matthijs Blankers ◽  
Jurgen E Cornelis ◽  
Nick M Lommerse ◽  
Aartjan T F Beekman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Disorders ◽  
Self Efficacy ◽  
Psychotic Disorders ◽  
Rating Scale ◽  
Small Sample ◽  
Home Treatment ◽  
Differential Effects ◽  
Psychiatric Crisis

Abstract Background This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined. Methods Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy. Results Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = − 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = − 0.01, SE = 0.12, t (103.95) = − 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = − 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001). Conclusions Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020.

PP159 Telemedicine In Paraguay: Contributions Of The Institute Of Health Sciences Research, National University Of Asunción

2020 ◽  
Vol 36 (S1) ◽  
pp. 18-18
Author(s):  
Ronald Rivas ◽  
Pedro Galván
Keyword(s):  
Public Health ◽  
Biomedical Engineering ◽  
List Type ◽  
Telemedicine System ◽  
Cellular Telephony ◽  
Imaging Department ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
National University ◽  
Development And Validation

IntroductionThe modalities of telemedicine that have been developed and applied so far by the Department of Biomedical Engineering and Imaging at the National University of Asunción (IICS-UNA) are as follows: (i) telediagnosis: the remote sending of data, signals, and images for diagnostic purposes; (ii) general telediagnostic imaging; (iii) telemonitoring (including telemetry): remote monitoring of vital parameters to provide automatic or semi-automatic surveillance or alarm services in emergencies, epidemiology, or tele-public health; and (iv) tele-education: the use of telematic networks to provide virtual platforms for educating and training health professionals.MethodsWe conducted a comprehensive review of the scientific works developed by the IICS-UNA in order to evaluate the systematic implementation of Telemedicine in Paraguay. Documents, pilot projects (satellite telegraphy), telediagnostic research, telematics, tele-education, published articles, and statistical data (number of patients attending or studies performed, etcetera) relating to the implementation of the National Telemedicine System by the Ministry of Public Health and Social Welfare since 1999 were reviewed.ResultsImplementation of the telemedicine system has meant that 472,038 patients have attended referral centers nationwide, with 297,999 electrocardiographs, 165,323 computed tomography scans, and 8,697 electroencephalograms being conducted. Projects developed within the framework of the Telemedicine Research Line have included the following: (i)Development and validation of a clinical telemicroscopy system based on cellular telephony;(ii)Implementation of a telemetry system for temperature monitoring of the collection of biological samples from a biomedical research center; and(iii)Production and development of a virtual campus at the National University of Asunción.ConclusionsGiven the current healthcare environment, developing a line of research based on telemedicine is a proactive step, since telemedicine provides an alternative solution to the problem of access to the health system. That is why the IICS-UNA Biomedical Engineering and Imaging Department has developed telemedicine as one of its main lines of research.

scholarly journals Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingvild Kjeken ◽  
Kjetil Bergsmark ◽  
Ida K. Haugen ◽  
Toril Hennig ◽  
Merete Hermann-Eriksen ◽  
...  
Keyword(s):  
Health Care ◽  
Disease Activity ◽  
Primary Outcome ◽  
Hand Osteoarthritis ◽  
List Type ◽  
Specialist Care ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Specialist Health Care ◽  
And Function

Abstract Background Current health policy states that patients with osteoarthritis (OA) should mainly be managed in primary health care. Still, research shows that patients with hand OA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. In this randomized controlled non-inferiority trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy (OT) specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist. More specifically, we will answer the following questions: What are the characteristics of patients with hand OA referred to specialist health care with regards to joint affection, disease activity, symptoms and function? Is OT-led hand OA care as effective and safe as rheumatologist-led care with respect to treatment response, disease activity, symptoms, function and patient satisfaction? Is OT-led hand OA care equal to, or more cost effective than rheumatologist-led care? Which factors, regardless of hand OA care, predict improvement 6 and 12 months after baseline? Methods Participants will be patients with hand OA diagnosed by a general practitioner and referred for consultation at one of two Norwegian departments of rheumatology. Those who agree will attend a clinical assessment and report their symptoms and function in validated outcome measures, before they are randomly selected to receive their first consultation by an OT specialist (n = 200) or by a rheumatologist (n = 200). OTs may refer patients to a rheumatologist consultation and vice versa. The primary outcome will be the number of patients classified as OMERACT/OARSI-responders after six months. Secondary outcomes are pain, function and satisfaction with care over the twelve-month trial period. The analysis of the primary outcome will be done by logistic regression. A two-sided 95% confidence interval for the difference in response probability will be formed, and non-inferiority of OT-led care will be claimed if the upper endpoint of this interval does not exceed 15%. Discussion The findings will improve access to evidence-based management of people with hand OA. Trial registration ClinicalTrials.gov, NCT03102788. Registered April 6th, 2017, https://clinicaltrials.gov/ct2/show/NCT03102788?term=Kjeken&draw=2&rank=1 Date and version identifier: December 17th, 2020. First version.

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