Dual diagnosis (DD) at first admission (FA) in three different periods: An epidemiological study

2011 ◽  
Vol 26 (S2) ◽  
pp. 589-589
Author(s):  
P. Zeppegno ◽  
M. Porro ◽  
A. Lombardi ◽  
A. Feggi ◽  
E. Torre
Keyword(s):  
Dual Diagnosis ◽  
Psychiatric Diagnosis ◽  
Medical Records ◽  
Psychiatric Illness ◽  
Progressive Increase ◽  
Legal Issues ◽  
Drug Abusers ◽  
Affective Psychosis ◽  
Adequate Treatment ◽  
History Of

IntroductionDD represents a common issue in clinical practice, with relevant effects on symptoms, course and treatment of disease. It's often associated with negative outcome as a greater severity of symptoms and resistance to drug treatment.ObjectivesTo assess how the characteristics (sociodemographic, clinical and related to substance abuse) of patients discharged with DD have changed taking into account the FA occurred in three different five-year periods (1990–1994, 2000–2004, 2005–2009). We also compared the characteristics of patients discharged with only psychiatric diagnosis with those of patients with DD to look for possible risk factors for abuse among people with psychiatric illness.MethodsWe conducted a retrospective study of medical records of patients at FA to our Institute in three different periods. We divided the patients discharged with DD from those discharged with only psychiatric diagnosis.ResultsAmong the FA occurred in the periods examined we noticed an increase of DD cases (12% from 1990 to 1994, 21% 2000–2004, 28% 2005–2009). The incidence of each diagnosis was changed in several years, but each time the diseases more represented remain schizophrenic or affective psychosis and personality disorders. Alcohol is the most widely used psychotropic drug in each period. There is also a progressive increase in the abuse of cannabis, cocaine and in the incidence of multi-drug abusers. Compared with patients discharged with only a psychiatric diagnosis, patients with DD were more frequently:male, younger, unmarried, unemployed, with legal issues, grown up in a family with serious problems, and history of etero-aggressive episodes.ConclusionsDue to continued increase in cases of DD, we want to highlight the importance of early identification of cases of comorbidity in order to provide adequate treatment and support.

Predictors of Improvement in Tardive Dyskinesia Following Discontinuation of Neuroleptic Medication

1990 ◽  
Vol 157 (4) ◽  
pp. 585-592 ◽  
Author(s):  
William M. Glazer ◽  
Hal Morgenstern ◽  
Nina Schooler ◽  
Cathy S. Berkman ◽  
Daniel C. Moore
Keyword(s):  
Tardive Dyskinesia ◽  
Outcome Measures ◽  
Psychiatric Diagnosis ◽  
Psychiatric Illness ◽  
Model Fitting ◽  
First Year ◽  
Neuroleptic Medication ◽  
Younger Age ◽  
Noticeable Improvement ◽  
History Of

Forty-nine chronic psychiatric out-patients (ten were schizophrenic) with tardive dyskinesia (TD) were examined monthly for a mean of 40 weeks (range 1–59 months) after discontinuation of neuroleptic medication. Complete and persistent reversibility of TD was rare (2%), but many patients showed noticeable improvement in movements within the first year of discontinuation, which was sometimes interrupted by psychological relapse. Using three separate outcome measures and appropriate model-fitting techniques for each, we identified several predictors of improvement in TD, including an affective or schizoaffective psychiatric diagnosis, chronic (over 20 years) psychiatric illness, being employed, younger age, and increased neuroleptic dose before discontinuation. Consistent findings emerging from these analyses suggest that the type and history of psychiatric illness affect the course of TD.

scholarly journals Mastoiditis in adults: Diagnostic and therapeutic aspects

2004 ◽  
Vol 51 (1) ◽  
pp. 109-112
Author(s):  
S. Krejovic-Trivic ◽  
Dragoslava Djeric ◽  
Aleksandar Trivic
Keyword(s):  
Hearing Loss ◽  
Early Diagnosis ◽  
Middle Ear ◽  
Medical Records ◽  
Pathological Process ◽  
The Other ◽  
Adequate Treatment ◽  
Long Period ◽  
Intravenous Antibiotics ◽  
History Of

The purpose of the present study is to report our experience in the diagnosis and treatment of mastoiditis in adults. Five patients with an active chronic otitis and mastoiditis were presented. All of them had a history of chronic ear discharge for long period of time and have been diagnosed and treated sufficiently. All relevant data were analyzed from the medical records. The most common symptoms of the disease were otalgia, otorrhea and hearing loss, but the physical signs of mastoiditis (swelling, erithema and tenderness of the retroauricular region) were presented in all cases. Localization and enlargement of the pathological process within the middle ear spaces was determined by CT. All patients were treated surgically and with intravenous antibiotics. In one patient the other treatment was applied due to a specific (TBC) process in the ear. Early diagnosis and adequate treatment (surgeiy combined with an effective antibiotics therapy) is most important to prevent a serious complications of mastoiditis (extracranial and/or intracranial).

The use of a Domain Ontology for the Management of Essential Hypertension (Preprint)

2020 ◽  
Author(s):  
Emma Chavez ◽  
Vanessa Perez ◽  
Angélica Urrutia
Keyword(s):  
Decision Making ◽  
Essential Hypertension ◽  
Medical History ◽  
Medical Records ◽  
Medical Training ◽  
Relevant Information ◽  
Domain Ontology ◽  
Free Text ◽  
Snomed Ct ◽  
History Of

BACKGROUND : Currently, hypertension is one of the diseases with greater risk of mortality in the world. Particularly in Chile, 90% of the population with this disease has idiopathic or essential hypertension. Essential hypertension is characterized by high blood pressure rates and it´s cause is unknown, which means that every patient might requires a different treatment, depending on their history and symptoms. Different data, such as history, symptoms, exams, etc., are generated for each patient suffering from the disease. This data is presented in the patient’s medical record, in no order, making it difficult to search for relevant information. Therefore, there is a need for a common, unified vocabulary of the terms that adequately represent the diseased, making searching within the domain more effective. OBJECTIVE The objective of this study is to develop a domain ontology for essential hypertension , therefore arranging the more significant data within the domain as tool for medical training or to support physicians’ decision making will be provided. METHODS The terms used for the ontology were extracted from the medical history of de-identified medical records, of patients with essential hypertension. The Snomed-CT’ collection of medical terms, and clinical guidelines to control the disease were also used. Methontology was used for the design, classes definition and their hierarchy, as well as relationships between concepts and instances. Three criteria were used to validate the ontology, which also helped to measure its quality. Tests were run with a dataset to verify that the tool was created according to the requirements. RESULTS An ontology of 310 instances classified into 37 classes was developed. From these, 4 super classes and 30 relationships were obtained. In the dataset tests, 100% correct and coherent answers were obtained for quality tests (3). CONCLUSIONS The development of this ontology provides a tool for physicians, specialists, and students, among others, that can be incorporated into clinical systems to support decision making regarding essential hypertension. Nevertheless, more instances should be incorporated into the ontology by carrying out further searched in the medical history or free text sections of the medical records of patients with this disease.

scholarly journals The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Robert J. Sanchez ◽  
Wenzhen Ge ◽  
Wenhui Wei ◽  
Manish P. Ponda ◽  
Robert S. Rosenson
Keyword(s):  
Acute Pancreatitis ◽  
Medical Records ◽  
Adult Population ◽  
Baseline Period ◽  
Prior History ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Recurrent Acute Pancreatitis ◽  
History Of ◽  
Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

scholarly journals Current understanding on the Cambrian Explosion: questions and answers

PalZ ◽  
2021 ◽  
Author(s):  
Xingliang Zhang ◽  
Degan Shu
Keyword(s):  
Environmental Changes ◽  
Size Variation ◽  
Progressive Increase ◽  
Cambrian Explosion ◽  
Time Interval ◽  
Early Cambrian ◽  
Ecological Processes ◽  
Questions And Answers ◽  
Evolutionary Event ◽  
History Of

AbstractThe Cambrian Explosion by nature is a three-phased explosion of animal body plans alongside episodic biomineralization, pulsed change of generic diversity, body size variation, and progressive increase of ecosystem complexity. The Cambrian was a time of crown groups nested by numbers of stem groups with a high-rank taxonomy of Linnaean system (classes and above). Some stem groups temporarily succeeded while others were ephemeral and underrepresented by few taxa. The high number of stem groups in the early history of animals is a major reason for morphological gaps across phyla that we see today. Most phylum-level clades achieved their maximal disparity (or morphological breadth) during the time interval close to their first appearance in the fossil record during the early Cambrian, whereas others, principally arthropods and chordates, exhibit a progressive exploration of morphospace in subsequent Phanerozoic. The overall envelope of metazoan morphospace occupation was already broad in the early Cambrian though it did not reach maximal disparity nor has diminished significantly as a consequence of extinction since the Cambrian. Intrinsic and extrinsic causes were extensively discussed but they are merely prerequisites for the Cambrian Explosion. Without the molecular evolution, there could be no Cambrian Explosion. However, the developmental system is alone insufficient to explain Cambrian Explosion. Time-equivalent environmental changes were often considered as extrinsic causes, but the time coincidence is also insufficient to establish causality. Like any other evolutionary event, it is the ecology that make the Cambrian Explosion possible though ecological processes failed to cause a burst of new body plans in the subsequent evolutionary radiations. The Cambrian Explosion is a polythetic event in natural history and manifested in many aspects. No simple, single cause can explain the entire phenomenon.

scholarly journals Alcohol Abuse and Stage of HIV Disease in Intravenous Drug Abusers

1996 ◽  
Vol 89 (7) ◽  
pp. 389-392 ◽  
Author(s):  
Gerond Lake-Bakaar ◽  
Roger Grimson
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Abuse ◽  
Hiv Positive ◽  
Drug Abusers ◽  
Hiv Disease ◽  
Needle Sharing ◽  
Heavy Drinkers ◽  
History Of ◽  
Intravenous Drug Abusers ◽  
Hiv Negative

Our objective was to identify factors that might correlate with human immunodeficiency virus (HIV) disease stage in intravenous drug abusers (IVDA). Particular attention was given to alcohol abuse. We accordingly explored in a cross-sectional study the relation between stage of HIV disease and age, sex, needle sharing, ethnicity, self-reported history of alcohol consumption and CAGE scores. IVDA from a single municipal hospital were subdivided into three groups according to HIV disease status. Group 1 comprised 42 individuals with AIDS; group 2 comprised 114 who were HIV positive but without AIDS; and group 3 comprised 52 who were HIV negative. Information on alcohol consumption and CAGE responses were obtained by questionnaire and interview. Discriminant analysis indicated that alcohol abuse, assessed either by self-reported consumption or by CAGE scores, was significantly more common in the AIDS group than in either the HIV positive or the HIV negative groups, when controlled for age, sex, and needle sharing status. The relative risk of AIDS was 3.8 times higher in the heavy drinkers than in moderate drinkers. Needle sharing was also more common in the AIDS group than in the HIV positive or HIV negative groups when the other factors were controlled for. AIDS was more common in black than white IVDA, and this increased frequency did not appear related to alcohol consumption since the distribution of heavy drinkers within each category of HIV disease did not differ within the ethnic groups. These data indicate that a history of heavy alcohol consumption is more common in IVDA with AIDS than in IVDA at earlier stages of HIV disease.

Anxiety disorders and substance abuse

2016 ◽  
Vol 33 (S1) ◽  
pp. S384-S384
Author(s):  
I. Prieto Sánchez ◽  
M.D.L.C. Ramírez Domínguez ◽  
S. Fernández León ◽  
M. Reina Domínguez ◽  
N. Garrido Torres ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Dual Diagnosis ◽  
Behavioral Problems ◽  
Strong Association ◽  
Epidemiological Studies ◽  
Distinctive Features ◽  
Other Substances ◽  
History Of ◽  
Competing Interest ◽  
Substance Disorder

IntroductionPatients with anxiety disorders are more vulnerable to develop other comorbid conditions. In particular, large epidemiological studies show a strong association between different anxiety disorders and substance use disorders.ObjectivesTo show the prevalence of major anxiety disorders and the consumption of different substances. As well as the particular characteristics of this dual diagnosis and treatments that have proven more effective.MethodsExhaustive review of all the material published on this topic in the recent years.ConclusionsNearly 24% of patients with anxiety disorder suffer from a comorbid substance disorder use in their lifetime (17.9% diagnosis of alcohol abuse or dependence diagnosis and 11.9% of abuse or dependence on other drugs). Dual patients show a number of distinctive features, such as more frequency in males, family history of alcohol or other substances abuse and behavioral problems, early parental loss among others.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Acute Glomerulonephritis Presenting With PRES: A Report of 4 Cases

2007 ◽  
Vol 34 (3) ◽  
pp. 316-321 ◽  
Author(s):  
E C Wirrell ◽  
L D Hamiwka ◽  
L A Hamiwka ◽  
S Grisaru ◽  
X Wei
Keyword(s):  
Immunosuppressive Agents ◽  
Neurological Symptoms ◽  
Acute Glomerulonephritis ◽  
Gross Hematuria ◽  
Adequate Treatment ◽  
Treatment Of Hypertension ◽  
History Of ◽  
Reversible Encephalopathy ◽  
Design And Methods ◽  
Visual Disturbances

Objective:Posterior reversible encephalopathy syndrome (PRES) occurs most commonly in the setting of known hypertension or use of immunosuppressive agents.Design and Methods:We report four previously-well children who presented acutely with altered mentation, seizures and visual disturbances and were diagnosed with PRES.Results:Only one child had a history of gross hematuria prior to the seizure. All four were discovered to be hypertensive only after onset of their neurological symptoms, and were subsequently diagnosed with glomerulonephritis. All four had rapid resolution of neurological symptoms with adequate treatment of hypertension.Conclusions:Blood pressure must be measured promptly in all children presenting with these symptoms. If elevated, the diagnosis of PRES should be strongly considered and a workup for renal disease pursued.

Status Epilepticus in Children With Epilepsy: The Role of Antiepileptic Drug Levels in Prevention

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1119-1121
Author(s):  
Joseph Maytal ◽  
Gerald Novak ◽  
Catherine Ascher ◽  
Robert Bienkowski
Keyword(s):  
Status Epilepticus ◽  
Antiepileptic Drug ◽  
Medical Records ◽  
Clinic Visit ◽  
Drug Levels ◽  
Progressive Encephalopathy ◽  
History Of ◽  
The Mean ◽  
Subtherapeutic Level

Objectives. To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy. Methods. We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records. Results. The mean age at the time of SE was 5.7 years (range, 3 months through 18 years). Forty-three patients had history of remote insult, five had history of progressive encephalopathy, and three patients were classified as idiopathic. At the time of SE all AED levels were therapeutic in 34 (66%) patients and at least one level was therapeutic in 42 (82%) patients. All levels were subtherapeutic in 9 (18%) patients. Four patients had their AED reduced or discontinued less than 1 week before SE. Twelve patients with therapeutic AED levels on their most recent clinic visit had at least one subtherapeutic level at the time of SE. Eight (16%) patients were febrile and one was hyponatremic. Of the 51 patients, 31 (61%) had no obvious explanation for the development of SE, as all known AEDs were therapeutic and there were no known acute insults. Conclusions. Neurologically abnormal children with preexisting epilepsy are at high risk for development of SE despite having therapeutic AED levels at that time. Acute precipitants of SE, such as fever or AED withdrawal, may play a role in inducing SE only in a minority of patients.

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