scholarly journals Perioperative mental status assessment of patients undergoing general surgical procedures

2018 ◽  
Vol 5 (8) ◽  
pp. 2788
Author(s):  
Prem Kumar A. ◽  
Raksha Nadig ◽  
Shashikala V. ◽  
Vikram Arunachalam
Keyword(s):  
Mental Status ◽  
Surgical Procedures ◽  
Surgical Procedure ◽  
Rating Scale ◽  
Psychological Status ◽  
Low Mood ◽  
Number Of Patients ◽  
Significant Difference ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Background: The past few decades have seen an enormous increase in the number of patients undergoing curative and palliative surgical procedures. The objective of the present study was to assess the mental status in a patient undergoing a general surgical procedure perioperatively.Methods: 105 patients admitted in a surgical ward, posted to undergo an elective surgical procedure were evaluated to assess their psychological status. Each patient was subjected to a Brief Psychiatric Rating Scale questionnaire twice, once preoperatively and postoperatively. Both sessions were conducted in a calm environment and the patient was administered adequate analgesia to eliminate bias due to pain. The preoperative and postoperative scores were calculated and compared.Results: BPRS is a psychiatric rating scale used in various psychiatric conditions. Using this scale, we were able to detect the presence of a baseline low mood in a patient undergoing a surgical procedure. The average score preoperatively was 35.84 and postoperatively was 32.68. These scores were higher in patients undergoing surgeries for malignant conditions and also in those with co-morbid conditions like diabetes mellitus. Although there was an improvement in the postoperative scores, there was no significant difference between the preoperative and postoperative scores.Conclusions: A surgical procedure puts a patient through immense psychological stress manifested as low mood and reduced motivation on the part of the patient to participate in their own rehabilitation programme. This affects the overall outcome of a surgical procedure and increases the morbidity. Knowledge of this on part of the operating surgeon and thus proper counselling of the patient, addressing both the psychological and surgical aspects of the disease process will help improve the overall surgical experience.

Oxcarbazepine as an Adjunct of Antipsychotic Therapy in Acute Schizophrenia: A Double-blind, Randomised Placebo-controlled Clinical Trial

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Koethe ◽  
L. Kranaster ◽  
M. Hellmich ◽  
B.M. Nolden ◽  
J. Klosterkoetter
Keyword(s):  
Rating Scale ◽  
Rate Of Change ◽  
Controlled Clinical Trial ◽  
Antipsychotic Therapy ◽  
Double Blind ◽  
Parallel Group ◽  
Significant Difference ◽  
Mixed Regression ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

The outcome in treatment of schizophrenia is still not satisfactorily, and using the adjunctive administration of various anticonvulsant drugs adjunctive to antipsychotics has become widely distributed. This study determines the efficacy of oxcarbazepine combined to olanzapine in treatment of schizophrenia in a double-blind, randomized, placebo-controlled, parallel-group, add-on therapy, 7 week study in 54 patients suffering schizophreniform disorder or schizophrenia. Patients were randomized to oxcarbazepine or placebo and titrated up to 1800 mg/ day in week 1 and maintained at that dose for another 6 weeks. Treatment of olanzapine started at week 2 with 5 mg/day. According to weekly improvement in Brief Psychiatric Rating Scale (BPRS), olanzapine dose was maintained constant or escalated in regular steps of 2.5 mg. Main outcome measure was the cumulative olanzapine dose from beginning administration of oxcarbazepine/placebo for a period of 42 days. Comparing treatment of oxcarbazepine and olanzapine with placebo and olanzapine, there was no difference in cumulative olanzapine doses in both groups. in the oxcarbazepine group was not significantly more rescue medication given. A mixed regression model was used to assess time trends in BPRS over the treatment period: the differences in the rate of change of BPRS in the two treatment groups suggested that the scores sank more rapidly in the oxcarbazepine group (p=0.063). Mean post-treatment aggression score also showed no significant difference. Results from this study do not support the use of OXC as an adjunct to atypical antipsychotics in patients with schizophrenia.

Risperidone for Treatment-Resistant Schizophrenia: Initial Clinical Experience in a State Hospital

1996 ◽  
Vol 12 (6) ◽  
pp. 271-275 ◽  
Author(s):  
Peter F Buckley ◽  
Karl Donenwirth ◽  
Kenneth E Bayer ◽  
Christine Lys ◽  
Zafar Ibrahim ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
State Hospital ◽  
Chronic Treatment ◽  
Rating Scale ◽  
Treatment Resistant ◽  
Brief Psychiatric Rating Scale ◽  
Number Of Patients ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Modest Reduction

Objective: To examine the efficacy of risperidone, a new antipsychotic with combined serotonergic-dopaminergic antagonism, in patients with treatment-resistant schizophrenia in state facilities. Methods: Brief Psychiatric Rating Scale (BPRS) evaluations were performed on 21 patients with schizophrenia who had received risperidone therapy for 10 weeks in a state facility. Results: Five patients showed a 20% reduction on their pretreatment BPRS score. A corresponding number of patients showed an increased BPRS score during treatment, and the remainder attained a modest reduction (2–17%) in symptoms on the BPRS. Conclusions: Although risperidone was an effective antipsychotic for patients with chronic treatment-resistant schizophrenia, only a subgroup of these patients achieved substantial clinical improvement over a 10-week period.

Comparison of Pimozide and Chlorpromazine in Acute Schizophrenia

1982 ◽  
Vol 27 (3) ◽  
pp. 208-212 ◽  
Author(s):  
J.C. Pecknold ◽  
D.J. Mcclure ◽  
T. Allan ◽  
L. Wrzesinski
Keyword(s):  
Dopamine Receptor ◽  
Adverse Reactions ◽  
Rating Scale ◽  
Double Blind Study ◽  
Onset Of Action ◽  
Double Blind ◽  
Acute Schizophrenia ◽  
Significant Difference ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

A four week double-blind study comparing pimozide and chlorpromazine was designed to test the hypothesis that pimozide, a powerful dopamine receptor blocker, is more effective in the treatment of acute schizophrenia than chlorpromazine. Twenty patients, 13 males and 7 females ranging in age from 21 to 53 years (mean age 33 years) admitted to St. Mary's Hospital with acute schizophrenia were placed on the study. They were treated on an individual titrated dosage of either chlorpromazine 300 mg to 2100 mg, or pimozide 10 to 70 mg. The results revealed that on the Brief Psychiatric Rating Scale, the chlorpromazine group significantly improved after one week, whereas the pimozide group showed no statistical improvement until the third week. By the end of the study no significant differences were apparent between the two groups. In the Clinical Global Impression Scale, a significant difference between the two groups was found at week 4 showing a greater improvement in the chlorpromazine group. In terms of adverse reactions, the chlorpromazine group had significantly fewer extrapyramidal symptoms than the pimozide group (Simpson and Angus Scale) and in addition 15 adverse reactions were noted for the pimozide group as compared with 8 for the chlorpromazine group. This study shows that chlorpromazine has an earlier onset of action than pimozide in the acute schizophrenic patient despite the fact that it has a weaker effect on the dopamine receptor than has pimozide. In view of this finding, the dopamine theory of schizophrenia should be critically re-examined.

Homocysteine levels in schizophrenia patients newly admitted to an acute psychiatric ward

2015 ◽  
Vol 27 (6) ◽  
pp. 336-344 ◽  
Author(s):  
Rosaria Di Lorenzo ◽  
Alessandra Amoretti ◽  
Samantha Baldini ◽  
Marcello Soli ◽  
Giulia Landi ◽  
...  
Keyword(s):  
Rating Scale ◽  
Control Group ◽  
Blood Levels ◽  
Psychiatric Ward ◽  
Specific Marker ◽  
Significant Difference ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
And Gender ◽  
Acute Psychiatric Ward

ObjectiveAfter the discovery of ‘homocystinuria syndrome’, many studies have suggested that high blood levels of homocysteine may be associated with schizophrenia. The aim of this study was to analyse the association between hyperhomocysteinaemia and schizophrenia.MethodsIn a population of inpatients suffering from exacerbated schizophrenic disorders (N=100), we evaluated homocysteine levels the day after their admission to an acute psychiatric ward and compared it with that of a non-patient control group (N=110), matched for age and gender. We statistically analysed the correlation between homocysteine levels and selected variables: gender, age, years of illness and number of previous psychiatric admissions as well as Brief Psychiatric Rating Scale, Positive Negative Syndrome Scale and Global Assessment Functioning (GAF) Scores.ResultsWe observed elevated homocysteine levels (an increase of 7.84 µM on average per patient) in 32% of the patients, but we did not find any statistically significant difference between the homocysteine levels of our patients and controls. Hyperhomocysteinaemia presented a positive statistically significant correlation with years of illness (p<0.005) and a negative statistically significant correlation with GAF score (p<0.001), but not with other clinical variables.ConclusionsHyperhomocysteinaemia, which occurred in our schizophrenia patients with poor social and relational functioning after many years of illness, could represent an effect of altered lifestyle due to psychosis, but not a specific marker for schizophrenia.

Smoking among Chinese Patients with Schizophrenia

1996 ◽  
Vol 30 (3) ◽  
pp. 350-353 ◽  
Author(s):  
Siow Ann Chong ◽  
Hock Lai Choo
Keyword(s):  
Side Effects ◽  
Racial Difference ◽  
Rating Scale ◽  
Age Of Onset ◽  
Chinese Patients ◽  
Extrapyramidal Side Effects ◽  
Brief Psychiatric Rating Scale ◽  
Significant Difference ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Objectives: This study aimed to determine the prevalence of smoking among Chinese with schizophrenia, and to determine if smokers and nonsmokers differ in their age of onset of illness and neuroleptic requirement. Method: One hundred and ninety-five patients were assessed by a single rater using the Brief Psychiatric Rating Scale (BPRS) and the Simpson-Angus Scale. Other historical, demographic and treatment variables were recorded from case records and interviews with patients and family members. Results: A higher rate of smoking was found in patients with schizophrenia than in the general population. There was no significant difference between the smokers and non-smokers in their respective neuroleptic dosages and extrapyramidal side-effects but the smokers had a significantly higher BPRS score. Conclusions: Racial difference is proposed to account for this discrepancy from other Western studies. The contribution of nicotine towards aggravating schizophrenic symptoms is also considered.

Adjunctive memantine for schizophrenia: a meta-analysis of randomized, double-blind, placebo-controlled trials

2017 ◽  
Vol 48 (1) ◽  
pp. 72-81 ◽  
Author(s):  
W. Zheng ◽  
X-H. Li ◽  
X-H. Yang ◽  
D-B. Cai ◽  
G. S. Ungvari ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Neurocognitive Performance ◽  
Double Blind ◽  
Significant Difference ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Mean Differences

BackgroundDysfunction of N-methyl-D-aspartate receptor (NMDAR) is involved in the pathophysiology of schizophrenia. A meta-analysis of randomized controlled trials (RCTs) was conducted to examine the efficacy and safety of memantine, a non-competitive NMDAR antagonist, in the treatment of schizophrenia.MethodsStandardized/weighted mean differences (SMDs/WMDs), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed.ResultsIncluded in the meta-analysis were eight RCTs (n = 452) of 11.5 ± 2.6 weeks duration, with 229 patients on memantine (20 mg/day) and 223 patients on placebo. Adjunctive memantine outperformed placebo in the measures of Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale negative symptoms [SMD: −0.63 (95% CI −1.10 to −0.16), p = 0.009, I2 = 77%], but not in the total, positive and general symptoms [SMD: −0.46 to −0.08 (95% CI −0.93 to 0.22), p = 0.06–0.60, I2 = 0–74%] or the Clinical Global Impression Severity Scale [WMD: 0.04 (95% CI −0.24 to 0.32), p = 0.78]. The negative symptoms remained significant after excluding one outlying RCT [SMD: −0.41 (95% CI −0.72 to −0.11), p = 0.008, I2 = 47%]. Compared with the placebo group, adjunctive memantine was associated with significant improvement in neurocognitive function using the Mini-Mental State Examination (MMSE) [WMD: 3.09, (95% CI 1.77–4.42), p < 0.00001, I2 = 22%]. There was no significant difference in the discontinuation rate [RR: 1.34 (95% CI 0.76–2.37), p = 0.31, I2 = 0%] and adverse drug reactions between the two groups.ConclusionsThis meta-analysis showed that adjunctive memantine appears to be an efficacious and safe treatment for improving negative symptoms and neurocognitive performance in schizophrenia. Higher quality RCTs with larger samples are warranted to confirm these findings.

scholarly journals Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110038
Author(s):  
Jordan Hauschild ◽  
Jessica C. Rivera ◽  
Anthony E. Johnson ◽  
Travis C. Burns ◽  
Christopher J. Roach
Keyword(s):  
Surgical Procedures ◽  
Laboratory Study ◽  
Surgical Procedure ◽  
Rating Scale ◽  
Shoulder Arthroscopy ◽  
Simulator Training ◽  
Simulation Program ◽  
Global Rating Scale ◽  
Global Rating ◽  
Significant Difference

Background: Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures. Purpose/Hypothesis: To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale. Study Design: Controlled laboratory study. Methods: Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine–trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants’ arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired t tests. Results: There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training ( P = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL ( P = .0045) and VR ( P = .0003), with no significant difference between the groups. Conclusion: A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors’ hypothesis that the VR simulator would be the more effective simulation tool. Clinical Relevance: There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.

Commentary

2008 ◽  
Vol 13 (6) ◽  
pp. 8-8
Author(s):  
Richard T. Katz
Keyword(s):  
Mental Illness ◽  
Behavioral Disorders ◽  
Rating Scale ◽  
Behavioral Disorder ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Mental And Behavioral Disorders

Abstract The author, who is the editor of the Mental and Behavioral Disorders chapter of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, comments on the previous article, Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches in this issue of The Guides Newsletter. The new Mental and Behavioral Disorders (M&BD) chapter, like others in the AMA Guides, is a consensus opinion of many authors and thus reflects diverse points of view. Psychiatrists and psychologists continue to struggle with diagnostic taxonomies within the Diagnostic and Statistical Manual of Mental Disorders, but anxiety, depression, and psychosis are three unequivocal areas of mental illness for which the sixth edition of the AMA Guides provides M&BD impairment rating. Two particular challenges faced the authors of the chapter: how could M&BD disorders be rated (and yet avoid an onslaught of attorney requests for an M&BD rating in conjunction with every physical impairment), and what should be the maximal impairment rating for a mental illness. The sixth edition uses three scales—the Psychiatric Impairment Rating Scale, the Global Assessment of Function, and the Brief Psychiatric Rating Scale—after careful review of a wide variety of indices. The AMA Guides remains a work in progress, but the authors of the M&BD chapter have taken an important step toward providing a reasonable method for estimating impairment.

scholarly journals Evaluation of emotional arousal level and depression severity using voice-derived sound pressure change acceleration

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shuji Shinohara ◽  
Hiroyuki Toda ◽  
Mitsuteru Nakamura ◽  
Yasuhiro Omiya ◽  
Masakazu Higuchi ◽  
...  
Keyword(s):  
Sound Pressure ◽  
Rating Scale ◽  
Characteristic Curve ◽  
Emotional Arousal ◽  
Pressure Change ◽  
Arousal Level ◽  
Depression Severity ◽  
Number Of Patients ◽  
National Defense Medical College ◽  
Significant Difference

AbstractIn this research, we propose a new index of emotional arousal level using sound pressure change acceleration, called the emotional arousal level voice index (EALVI), and investigate the relationship between this index and depression severity. First, EALVI values were calculated from various speech recordings in the interactive emotional dyadic motion capture database, and the correlation with the emotional arousal level of each voice was examined. The resulting correlation coefficient was 0.52 (n = 10,039, p < 2.2 × 10−16). We collected a total of 178 datasets comprising 10 speech phrases and the Hamilton Rating Scale for Depression (HAM-D) score of outpatients with major depression at the Ginza Taimei Clinic (GTC) and the National Defense Medical College (NDMC) Hospital. The correlation coefficients between the EALVI and HAM-D scores were − 0.33 (n = 88, p = 1.8 × 10−3) and − 0.43 (n = 90, p = 2.2 × 10−5) at the GTC and NDMC, respectively. Next, the dataset was divided into “no depression” (HAM-D < 8) and “depression” groups (HAM-D ≥ 8) according to the HAM-D score. The number of patients in the “no depression” and “depression” groups were 10 and 78 in the GTC data, and 65 and 25 in the NDMC data, respectively. There was a significant difference in the mean EALVI values between the two groups in both the GTC and NDMC data (p = 8.9 × 10−3, Cliff’s delta = 0.51 and p = 1.6 × 10−3; Cliff’s delta = 0.43, respectively). The area under the curve of the receiver operating characteristic curve when discriminating both groups by EALVI was 0.76 in GTC data and 0.72 in NDMC data. Indirectly, the data suggest that there is some relationship between emotional arousal level and depression severity.

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