scholarly journals Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Katerina Kaikoushi ◽  
Maria Karanikola ◽  
Nicos Middleton ◽  
Evanthia Bella ◽  
Andreas Chatzittofis
Keyword(s):  
Psychiatric Treatment ◽  
Male Gender ◽  
Psychotic Symptoms ◽  
High Dose ◽  
Psychiatric History ◽  
Cross Sectional ◽  
Prescription Patterns ◽  
Syndrome Scale ◽  
History Of ◽  
Compulsory Care

Background Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care although there is lack of evidence to support this practice and related risks for patients. Aims We aimed to investigate prescription patterns in patients with psychosis under compulsory psychiatric treatment in Cyprus and to identify predictors for pharmaceutic treatment patterns. Method This was a nationwide, descriptive correlational study with cross-sectional comparisons, including 482 patients with compulsory admission to hospital. Sociodemographic and clinical data were collected. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Prescribed medication patterns, including use of medication pro re nata (PRN, when required), were recorded. Results Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants. Polypharmacy without a PRN schema was reported in 5.6% (n = 27) of the participants. We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included. In the logistic regression analyses, predictors for prescription of high-dose antipsychotics were male gender, positive psychiatric history, receiving state benefits and a negative history of substance use. Male gender was the only predictor for polypharmacy without a PRN schema whereas male gender, negative family psychiatric history, receiving state benefits and the total score on the positive symptoms PANSS subscale were predictors for polypharmacy with a PRN schema included. Conclusions A high frequency of polypharmacy and use of medication PRN beyond clinical guidelines has been reported for the first time in psychiatric compulsory care in Cyprus; revision in antipsychotic prescription is needed.

scholarly journals MON-252 Pituitary Tumor Apoplexy Presenting with Acute Psychosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Mercedes Pineyro ◽  
Patrica Agüero ◽  
Florencia Irazusta ◽  
Claudia Brun ◽  
Paula Duarte ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Pituitary Tumor ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Sellar Mass ◽  
History Of ◽  
Pituitary Tumor Apoplexy

Abstract Background: Pituitary tumors (PT) can present with neuropsychiatric symptoms. It has been associated with hormonal changes, as well as extension of the tumor to the diencephalon. Psychopathology has been reported in up to 83% in Cushing Disease (CD) and 35% in acromegaly (ACR). Psychiatric disorders (depression, anxiety and psychosis) have been reported up to 77% in CD and 63% in ACR. We present a rare case of a patient presenting with acute psychosis and a PT apoplexy. Case: A 27 year-old Caucasian female with a PMH of primary hypothyroidism presented with a 15-day history of delusions. She had delusional ideas on the subject of harm and prejudice, persecutory and mystical-religious. The mechanism was mainly intuitive and interpretive with false acknowledgments. She also had sleep disturbance, death ideation and subacute alteration of consciousness. There was no history of substance abuse or psychiatric disorders. She did not report headaches, visual disturbances, symptoms of hormone hypersecretion or hypopituitarism. She had regular menses on BCP. She had no family history of mental illnesses. Physical exam revealed reluctance, latency in responses and bradypsychia. She did not have acromegalic or cushingoid features. She was diagnosed with acute psychosis with atypical features so a brain CT was performed, which showed a sellar mass. Pituitary MRI revealed a sellar mass measuring 15x12x13 mm, with suprasellar extension, optic chiasm compression, hyperintense on T1- and hypointense on T2-weighted imaging compatible with subacute hemorrhage. She was treated with neuroleptics and benzodiazepines. Lab work revealed high prolactin (PRL) (114ng/dl), and normal 8 AM cortisol, FT4, LH, FSH and IGF-1 levels. Repeated PRL was 31,6 ng/dl after changing psychiatric treatment to aripiprazole. Her psychiatric symptoms improved. We postulate a diagnosis of PT apoplexy that presented with acute psychosis. In relation to the nature of the PT we postulate a non functioning pituitary adenoma (NFA) or a partial resolution of a prolactinoma after apoplexy. A follow up MRI is pending. Discussion: Infrequently, psychiatric symptoms may be the primary manifestation of brain tumors. Patients with PT have been reported to have altered quality of life, reduced coping strategies, increased prevalence of psychopathological alterations and maladaptive personality disorders. In addition, they can present with psychotic symptoms, mostly reported with hormone excess (GH and cortisol). Psychiatric symptoms such as anxiety and neurosis have been reported in NFA and prolactinomas. However, it is not clear a higher prevalence of psychiatric illnesses in these tumors. To our knowledge this is the first case of a pituitary tumor apoplexy presenting with acute psychosis. Conclusion: Psychiatric symptoms can be the first manifestation of PT, so atypical presentations should warrant further workup with brain imaging.

scholarly journals Mental health in COVID-19 survivors from a general hospital: association with sociodemographic, clinical, and inflammatory variables

2021 ◽  
Author(s):  
Jeff Huarcaya-Victoria ◽  
Jesica Barreto ◽  
Lucia Aire ◽  
Angela Podestá ◽  
Mónica Caqui ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Psychiatric Treatment ◽  
Significant Proportion ◽  
Somatic Symptoms ◽  
Cross Sectional ◽  
Telephone Interviews ◽  
Distress Symptoms ◽  
Mental Symptoms ◽  
History Of

Abstract Background: The current COVID-19 (coronavirus disease 2019) pandemic constitutes a significant problem for the world's public health and generates mental health problems.Objective: To describe the characteristics of mental health in survivors of COVID-19 and the main sociodemographic, clinical, and immune factors related.Method: A Cross-sectional and correlational study was conducted on 318 patients (196 women, mean age 54.4 ± 15.1 years) surviving COVID-19 from one hospital in Peru in which sociodemographic, clinical, and immune characteristics were explored. Through telephone interviews, an evaluation of the presence of depressive, anxious, somatic, and distress symptoms was carried out using standardized scales. Adjusted prevalence ratios (PRa) were estimated.Results: A significant proportion of the patients have depressive (30.3%), anxious (29.9%), somatic (33.7%), and distress (28.7%) symptoms. In the regression analysis, the variables associated with a higher frequency of clinically relevant mental symptoms were female sex (depression: aPR = 2.29; anxiety: PRa = 2.71; somatic symptoms: PRa = 2.04; distress: PRa = 2.11), proceeding outside the capital (depression: PRa = 1.61; anxiety: PRa = 1.53), the self-perception of a greater severity of the infection (depression: PRa = 5.53; anxiety: PRa = 2.29; distress: PRa = 14.78), the presence of persistent COVID-19 symptoms (depression: PRa = 8.55; anxiety: PRa = 11.38; somatic symptoms: PRa = 5.46; distress: PRa = 20.55), a history of psychiatric treatment (depression: PRa = 2.29; somatic symptoms: PRa = 2.90 ; distress: PRa = 3.80), the history of a family member infected by COVID-19 (anxiety: PRa = 4.71; somatic symptoms: PRa = 1.99), and a neutrophil-lymphocyte index greater than 6.5 (depression: PRa = 1.67; anxiety: PRa = 1.82).Conclusion: COVID-19 survivors show a high prevalence of negative mental symptoms. Some useful variables have been found when identifying vulnerable patients requiring psychiatric care.

scholarly journals High dose neuroleptics – who gives them and why?

2001 ◽  
Vol 25 (5) ◽  
pp. 179-183 ◽  
Author(s):  
Alcuin Wilkie ◽  
Neil Preston ◽  
Roger Wesby
Keyword(s):  
Case Note ◽  
Clinical Implications ◽  
High Dose ◽  
Retrospective Case ◽  
Cross Sectional ◽  
History Of ◽  
Relationship Of ◽  
The Relationship ◽  
Higher Doses ◽  
Current Behaviour

Aims and MethodNeuroleptic medication is often used in excess of the BNF maximum. The purpose of this study was to examine the relationship of neuroleptic dose to patient, prescriber and environmental factors, by using a cross sectional ‘snapshot’ study of psychiatric in-patient prescriptions combined with a retrospective case note survey.ResultsIt was found that certain consultants prescribe higher doses of neuroleptics than others. Patients with a history of aggression had a nine and a half times higher chance of being prescribed higher doses of neuroleptics. Patients with a greater than 5-year history of neuroleptic prescription received higher doses.Clinical ImplicationsHigh neuroleptic prescription is related more to patients' past reputation and prescriber differences than to patients' current behaviour.

Unexpected Death of Psychiatric Patients: Suicide, Misadventure, Accident or Unsolved Mystery?

1997 ◽  
Vol 37 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Emad Salib ◽  
Ann Joseph ◽  
Sheila Cawley
Keyword(s):  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Psychiatric History ◽  
Unexpected Death ◽  
Related Condition ◽  
Condition Method ◽  
Duration Of Illness ◽  
History Of ◽  
Main Factors

We examined the association between the psychiatric history of patients who were the subjects of a coroner's inquest and the recorded verdict, in a seven-year retrospective review. A suicide verdict was less frequently returned on patients who had inpatient psychiatric treatment compared to other unexpected deaths. History and diagnosis of an alcohol-related condition, method of death and intimation of intent were the main factors that appeared to be associated with the coroner's verdict. Age, sex, duration of illness, time and number of admissions, previous suicide attempts and treatment received did not appear to be significantly associated with the recorded verdict.

Transition to Psychosis: 6-Month follow-up of a Chinese High-Risk Group in Hong Kong

2006 ◽  
Vol 40 (5) ◽  
pp. 414-420 ◽  
Author(s):  
May M.L. Lam ◽  
Se-Fong Hung ◽  
Eric Y.H. Chen
Keyword(s):  
At Risk ◽  
High Risk ◽  
Mental State ◽  
Functional Decline ◽  
High Risk Group ◽  
Psychotic Symptoms ◽  
Syndrome Scale ◽  
History Of ◽  
At Risk Mental State

Objectives: The identification of individuals at high risk of becoming psychotic within the near future creates opportunities for early intervention before the onset of psychosis. This study sets out to identify a group of symptomatic young people in a Chinese population with the high likelihood of transition to psychosis within a follow-up period of 6 months, and to determine the rate of transition to psychosis in this group. Method: Symptomatic individuals with a family history of psychotic disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were identified using the operationalized criteria of an ‘At Risk Mental State’. The individuals were prospectively assessed monthly on a measure of psychopathology for 6 months. Results: Eighteen out of 62 individuals (29%) made the transition to frank psychosis within a 6 month follow-up period, with the majority occurring within 3 months. In addition, significant differences were found in the intake Positive and Negative Syndrome Scale, Comprehensive Assessment of ‘At Risk Mental State’ and Global Assessment of Functioning scores between the group that ultimately became psychotic and the group that did not. Conclusion: The period of the highest risk of transition to psychosis was within the 3 months after the study began. Thus, distressed youths in our outpatient clinic, who meet the high-risk criteria should be monitored most closely in the initial 3 months, particularly those individuals with high levels of psychopathology and functional decline.

scholarly journals Symptoms and Etiological Attribution: A Cross-Sectional Study in Mexican Outpatients with Psychosis and Their Relatives

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Lizzette Gómez-de-Regil ◽  
Agnès Ros-Morente ◽  
Gisela Rodríguez-Hansen
Keyword(s):  
Clinical Status ◽  
Cross Sectional Study ◽  
Mental Condition ◽  
Psychotic Symptoms ◽  
Sectional Study ◽  
Cross Sectional ◽  
Persistent Symptoms ◽  
Current Symptom ◽  
Syndrome Scale ◽  
Axis I

This cross-sectional study aimed at identifying the most common attributions of their mental disorder in a Mexican patients who have experienced psychosis and their relatives and exploring how having experienced or not characteristic psychotic symptoms and their present clinical status might affect their etiological attributions. Past and current symptom profiles of 66 patients were as assessed with the SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) and the PANSS (Positive and Negative Syndrome Scale), respectively. The etiological attribution of psychosis of patients (n=62) and the relatives (n=65) was assessed with the Angermeyer and Klusmann scale comprising 30 items into five categories: biology, personality, family, society, and esoteric. Patients and relatives attribute psychosis mainly to social factors. Relatives’ attributions were not influenced by clinical profile of patients, whereas in the case of patients it was only current clinical status that showed a difference, with those in nonremission scoring higher personality and family factors. Acknowledging patients’ and relatives’ beliefs about mental disorders at onset and later on is particularly important in psychosis, a mental condition with severe and/or persistent symptoms, in order to promote better involvement in treatment and in consequence efficacy and recovery.

scholarly journals STUDI KARAKTERISTIK PASIEN TUBERKULOSIS DI PUSKESMAS SEBERANG ULU 1 PALEMBANG

2017 ◽  
Vol 6 (4) ◽  
pp. 218-224
Author(s):  
Zata Ismah ◽  
Emma Novita
Keyword(s):  
Health Status ◽  
Family History ◽  
Physical Examination ◽  
Cross Sectional Study ◽  
Male Gender ◽  
Age Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Low Socioeconomic ◽  
History Of

Abstrak Analisis karakteristik penderita TB selain berguna untuk pengobatan juga berguna dalam memudahkan penemukan tersangka TB. Penelitian ini bertujuan untuk menganalisis karakteristik penderita TB. Desain studi yang digunakan adalah crossectional dengan sampel sebanyak 40 pasien TB yang berobat 3 bulan terakhir di Puskesmas Seberang Ulu 1 Palembang. Pengumpulan data dilakukan dengan kunjungan rumah ke pasien lalu dilakukan wawancara serta pemeriksaan fisik dan status kesehatan.  Hasil penelitian didapatkan bahwa karakteristik penderita TB paling banyak pada kelompok : usia produktif usia 12 – 35 tahun  dan  rentang usia dewasa 49 -  61 tahun; jenis kelamin laki-laki; pendidikan sekolah tingkat dasar; pekerjaan buruh; sosial ekonomi rendah; perokok aktif. Ditemukan 13.2% pasien TB dengan DM, 45% pasien TB dengan hipertensi, 47.5% pasien TB dengan anemia, 55% pasien TB dengan gizi kurang, 17.5% pasien memiliki riwayat keluarga menderita TB. Pasien kambuh sebanyak 12.5%; pasien yang putus OAT 17.5%; serta ditemukan tidak minum OAT sebanyak 15%.   Kata kunci: Karakteristik, Deskriptif, Tuberkulosis,                            Abstracts Analysis of characteristics TB disease besides useful for treatment is also useful to finding TB cases. This study aims to analyze characteristic of TB patients. This research used cross sectional study design with 40 TB patients treated last 3 months at Puskesmas Seberang Ulu 1 Palembang. Data collection was done with patient home visits, interview, physical examination health status. The results was most of characteristic TB patients in productive age group, maximum age 35 years, male gender, primary education, occupation was coolie, low socioeconomic, active smokers. TB Patients was founded 13.2% with DM; 45% TB patients with hypertension; 47.5% TB patients with anemia; 55% TB patients with malnutrition; 17.5% of patients had a family history of TB. Patients relapsed were 12.5%; OAT dropout patients were founded 17.5%; 15% patients were not OAT.   Keywords: Characteristics, Descriptive, Tuberculosis

scholarly journals Socio-Demographic and Clinical Characteristics of Adults With Psychotic Symptomatology Under Involuntary Admission and Readmission for Compulsory Treatment in a Referral Psychiatric Hospital in Cyprus

2021 ◽  
Vol 12 ◽  
Author(s):  
Katerina Kaikoushi ◽  
Nicos Middleton ◽  
Andeas Chatzittofis ◽  
Evanthia Bella ◽  
Giorgos Alevizopoulos ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Suicidal Behavior ◽  
Clinical Characteristics ◽  
Mental Health Problems ◽  
Psychiatric Treatment ◽  
Positive Family History ◽  
Compulsory Treatment ◽  
Cross Sectional ◽  
History Of

Socio-demographic and clinical characteristics of adults under compulsory psychiatric treatment, have not been reported adequately in Southern European countries. We investigated the socio-demographic and clinical characteristics of adults with psychotic symptomatology who were involuntarily treated in the acute Mental Health Services in Cyprus. A descriptive cross-sectional study was applied. Data collection (December 2016 to February 2018) achieved via a structured questionnaire including demographic and clinical variables. Census sampling was applied in Cyprus referral center for compulsory psychiatric treatment. The sample included 406 individuals (262 males, 144 females). Approximately 86.2% were single, 77.6% were unemployed, and 24.9% held a bachelor's degree. The most frequent clinical diagnosis was schizophrenia or a relevant psychotic disorder (86.4%). The most frequent admission cause was non-adherence to pharmacotherapy along with disorganized behavior (agitation and/or self-care deficit, and/or aggressive behavior, and/or suicidal behavior) (53.6%). Moreover, 70.7% of the sample reported a positive personal history of mental health problems, while 42.1% reported a positive family history of mental health disorders. Half of the participants (52%) were previously involuntarily admitted for compulsory treatment. Adjusted associations of readmission status were reported with Cypriot ethnicity (OR: 4.40, 95%CI: 2.58–7.50), primary education only (OR: 3.70, 95%CI: 1.64–8.37), readmission due to disorganized behavior along with non-adherence to pharmacotherapy (OR: 10.84, 95%CI: 2.69–43.72), as well as along with substance use (OR: 6.39, 95%CI: 1.52–26.82). Readmission was almost five times more likely to occur due to suicidal behavior (OR: 5.01, 95%CI: 1.09–22.99) compared to disorganized behavior not otherwise specified. Additionally, those with a diagnosis of schizophrenia were more than 12 times more frequently readmitted for compulsory treatment compared to other diagnoses (OR 12.15, 95%CI: 1.04–142). Moreover, the participants with higher secondary education had 54.6% less odds to be involuntarily re-admitted compared to Bachelor degree holders (OR 0.442, 95%CI: 0.24–0.79). A high percentage of involuntary treatment was noted due to non-adherence to pharmacotherapy and substance use. Re-evaluation of the effectiveness of relevant community interventions is suggested, as well as implementation of structured educational programs on therapy adherence during psychiatric hospitalization.

The characteristics of psychotic features in bipolar disorder

2018 ◽  
Vol 49 (12) ◽  
pp. 2036-2048 ◽  
Author(s):  
Annet H. van Bergen ◽  
Sanne Verkooijen ◽  
Annabel Vreeker ◽  
Lucija Abramovic ◽  
Manon H. Hillegers ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Childhood Maltreatment ◽  
Linear Models ◽  
Disease Onset ◽  
Cross Sectional Study ◽  
Psychotic Symptoms ◽  
Type I ◽  
Cross Sectional ◽  
History Of ◽  
Psychotic Features

AbstractBackgroundIn a large and comprehensively assessed sample of patients with bipolar disorder type I (BDI), we investigated the prevalence of psychotic features and their relationship with life course, demographic, clinical, and cognitive characteristics. We hypothesized that groups of psychotic symptoms (Schneiderian, mood incongruent, thought disorder, delusions, and hallucinations) have distinct relations to risk factors.MethodsIn a cross-sectional study of 1342 BDI patients, comprehensive demographical and clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) interview. In addition, levels of childhood maltreatment and intelligence quotient (IQ) were assessed. The relationships between these characteristics and psychotic symptoms were analyzed using multiple general linear models.ResultsA lifetime history of psychotic symptoms was present in 73.8% of BDI patients and included delusions in 68.9% of patients and hallucinations in 42.6%. Patients with psychotic symptoms showed a significant younger age of disease onset (β = −0.09, t = −3.38, p = 0.001) and a higher number of hospitalizations for manic episodes (F11 338 = 56.53, p < 0.001). Total IQ was comparable between groups. Patients with hallucinations had significant higher levels of childhood maltreatment (β = 0.09, t = 3.04, p = 0.002).ConclusionsIn this large cohort of BDI patients, the vast majority of patients had experienced psychotic symptoms. Psychotic symptoms in BDI were associated with an earlier disease onset and more frequent hospitalizations particularly for manic episodes. The study emphasizes the strength of the relation between childhood maltreatment and hallucinations but did not identify distinct subgroups based on psychotic features and instead reported of a large heterogeneity of psychotic symptoms in BD.

scholarly journals The impact of a history of psychotic symptoms on cognitive function in euthymic bipolar patients: a comparison with schizophrenic patients and healthy controls

2011 ◽  
Vol 33 (4) ◽  
pp. 353-361 ◽  
Author(s):  
Sofia Brissos ◽  
Vasco Videira Dias ◽  
Márcio Gerhardt Soeiro-de-Souza ◽  
Vicent Balanzá-Martínez ◽  
Flavio Kapczinski
Keyword(s):  
Negative Symptoms ◽  
Cross Sectional Study ◽  
Psychotic Symptoms ◽  
Neurocognitive Performance ◽  
Cross Sectional ◽  
Neurocognitive Dysfunction ◽  
Schizophrenic Patients ◽  
History Of ◽  
Bipolar Patients ◽  
The Impact

BACKGROUND: About two-thirds of patients with bipolar disorder (BD) have a lifetime history of at least one psychotic symptom. Objective: To compare the neurocognitive performance of four groups: BD patients with and without a history of psychotic symptoms (BD HPS+ and BD HPS-, respectively); patients with schizophrenia (SZ); and healthy control (HC) subjects. METHOD: In this cross-sectional study, 35 stabilized patients with SZ, 79 euthymic (44 HPS+ and 35 HPS-) patients with BD, and 50 HC were administered a comprehensive battery of neuropsychological tests. RESULTS: There was worse neurocognitive functioning in both BD and SZ patients compared to HC. Overall, data from both groups of BD patients did not differ on sociodemographic, clinical, or neurocognitive variables. However, BD HPS+ patients had significantly more negative symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS), and showed a trend toward worse performance on executive functions compared to BD HPS- patients. Moreover, both BD groups had better performance on all neurocognitive tests compared to SZ group. CONCLUSIONS: Neurocognitive dysfunction may be more marked in SZ than in BD, yet qualitatively similar. A history of past psychotic symptoms in BD was not associated with more severe cognitive impairment during euthymia. Therefore, BD with psychotic symptoms does not appear to be a distinct neurocognitive phenotype.

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