Symptom Dimensions as Predictors of Clinical Outcome, Duration of Hospitalization, and Aggressive Behaviours in Acutely Hospitalized Patients with Psychotic Exacerbation

Object Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%–41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

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Vitamin D Status and Severe COVID-19 Disease Outcomes in Hospitalized Patients

Journal of Primary Care & Community Health ◽

10.1177/21501327211041206 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110412

Author(s):

Jennifer L. Pecina ◽

Stephen P. Merry ◽

John G. Park ◽

Tom D. Thacher

Keyword(s):

Vitamin D ◽

Assisted Ventilation ◽

Vitamin D Supplementation ◽

Hospitalized Patients ◽

Vitamin D Status ◽

Icu Admission ◽

Hydroxyvitamin D ◽

Duration Of Hospitalization ◽

D Values ◽

Relationship Of

Background: Vitamin D deficiency may increase the risk of severe COVID-19 disease. Objectives: To determine if 25-hydroxyvitamin D [25(OH)D] levels in patients hospitalized for COVID-19 were associated with the clinical outcomes of days on oxygen, duration of hospitalization, ICU admission, need for assisted ventilation, or mortality. Methods: We conducted a retrospective study of 92 patients admitted to the hospital with SARS-CoV-2 infection between April 16, 2020 and October 17, 2020. Multivariable regression was performed to assess the independent relationship of 25(OH)D values on outcomes, adjusting for significant covariates and the hospitalization day the level was tested. Results: About 15 patients (16.3%) had 25(OH)D levels <20 ng/mL. Only 1 patient (3.4%) who had documented vitamin D supplementation prior to admission had 25(OH)D <20 ng/mL. Serum 25(OH)D concentrations were not significantly associated with any of our primary outcomes of days on oxygen, duration of hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, or mortality in any of the adjusted multivariable models. Adjusting for the hospital day of 25(OH)D sampling did not alter the relationship of 25(OH)D with any outcomes. Conclusion: Vitamin D status was not related to any of the primary outcomes reflecting severity of COVID-19 in hospitalized patients. However, our sample size may have lacked sufficient power to demonstrate a small effect of vitamin D status on these outcomes.

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Changing the structure of the hospitalized patients at the Psychiatric clinic Vrapce

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh11s1033b ◽

2011 ◽

Vol 139 (suppl. 1) ◽

pp. 33-35 ◽

Cited By ~ 1

Author(s):

Petar Bilic ◽

Ana Ivanis ◽

Domagoj Vidovic ◽

Vlado Jukic

Keyword(s):

Psychiatric Treatment ◽

Average Duration ◽

Developed Countries ◽

International Classification Of Diseases ◽

Hospitalized Patients ◽

Personality Change ◽

Psychiatric Clinic ◽

New Therapeutic Approaches ◽

Number Of Patients ◽

Duration Of Hospitalization

Introduction. Psychiatric treatment in developed countries has significantly changed in the last few decades, with a significant shortening of the duration of hospitalization. Numerous West European countries are undertaking health system reforms to improve treatment efficiency. Objective. The aim of the study was to present the structure of hospitalized patients according to diagnostic categories of International Classification of Diseases and Related Health Problems - 10th Revision (ICD-10), and average duration of hospitalization from 2001 till 2010. Methods. Data was collected from hospital medical charts for the period from 2001 till 2010 on the number of hospitalized patients, diagnosis and duration of hospitalization. Results. Number of hospitalized patients increased by 27% (6309 vs. 8032). Average duration of hospitalization decreased for 45.1% (72.3 vs. 39.7 days), while the number of hospitalized patients decreased from 1284 (20.4%) in 2001 to 995 (12.4%) in 2010, the number of patients hospitalized because of depressive disorder increased from 309 (4.9%) in 2001 to 994 (12.4%) in 2010. The number of patients hospitalized because of enduring personality changes increased from 104 (1.7%) in 2001 to 449 (5.6%) in 2010. Conclusion. In the last decade the number of hospitalized patients suffering from schizophrenia at the Psychiatric Clinic Vrapce decreased, while the number of those suffering from depression and enduring personality change increased. The number of hospitalizations in the observed period increased overall. Observed changes can be explained by new therapeutic approaches, but also by objective social and economic factors and organization of the healthcare system.

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Clinical characteristics and outcomes of symptomatic and asymptomatic hypoglycemia in hospitalized patients with diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2018-000607 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000607 ◽

Cited By ~ 5

Author(s):

Saumeth Cardona ◽

Patricia C Gomez ◽

Priyathama Vellanki ◽

Isabel Anzola ◽

Clementina Ramos ◽

...

Keyword(s):

Clinical Outcome ◽

Clinical Characteristics ◽

Glycosylated Hemoglobin ◽

General Medicine ◽

Signs And Symptoms ◽

Male Gender ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Insulin Regimen ◽

Patients With Diabetes

ImportanceThe frequency and impact of asymptomatic hypoglycemia in hospitalized patients with diabetes is not known.ObjectiveWe determined the clinical characteristics and hospital outcomes of general medicine and surgery patients with symptomatic and asymptomatic hypoglycemia.Research design and methodsProspective observational study in adult patients with diabetes and blood glucose (BG) <70 mg/dL. Participants were interviewed about signs and symptoms of hypoglycemia using a standardized questionnaire. Precipitating causes, demographics, insulin regimen, and complications data during admission was collected.ResultsAmong 250 patients with hypoglycemia, 112 (44.8%) patients were asymptomatic and 138 (55.2%) had symptomatic hypoglycemia. Patients with asymptomatic hypoglycemia were older (59±11 years vs 54.8±13 years, p=0.003), predominantly males (63% vs 48%, p=0.014), and had lower admission glycosylated hemoglobin (8.2%±2.6 % vs 9.1±2.9%, p=0.006) compared with symptomatic patients. Compared with symptomatic patients, those with asymptomatic hypoglycemia had higher mean BG during the episode (60.0±8 mg/dL vs 53.8±11 mg/dL, p<0.001). In multivariate analysis, male gender (OR 2.08, 95% CI 1.13 to 3.83, p=0.02) and age >65 years (OR 4.01, 95% CI 1.62 to 9.92, p=0.02) were independent predictors of asymptomatic hypoglycemia. There were no differences in clinical outcome, composite of hospital complications (27% vs 22%, p=0.41) or in-hospital length of stay (8 days (IQR 4–14) vs 7 days (IQR 5–15), p=0.92)) between groups.ConclusionsAsymptomatic hypoglycemia was common among insulin-treated patients with diabetes but was not associated with worse clinical outcome compared with patients with symptomatic hypoglycemia. Older age and male gender were independent risk factors for asymptomatic hypoglycemia.

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