Ambulatory Patients with Medical and Psychiatric Illness: Care in a Special Medical Clinic

1978 ◽  
Vol 8 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Claire M. Hossenlopp ◽  
Jimmie Holland
Keyword(s):  
Psychiatric Illness ◽  
Psychiatric Symptoms ◽  
Case Reports ◽  
Medical Clinic ◽  
Patient Relationship ◽  
Traditional Role ◽  
Psychiatric Symptomatology ◽  
Psychiatric Illnesses ◽  
Ambulatory Patients ◽  
Total Care

Patients who have both medical and psychiatric illnesses often present very difficult diagnostic and treatment problems. Cross referrals by the two or more specialties necessarily involved in their management are often perceived by these patients as rejection and not only may induce in them feelings of frustration, helplessness and anger, but may also lead to a worsening of their medical and psychiatric symptomatology. This paper describes the organization and operation of a comprehensive clinic, staffed by both internists and psychiatrists, designed to provide total care for these patients. The patient population comprises patients with independent or unrelated medical and psychiatric illnesses, patients with interdependent medical and psychiatric symptoms, patients with reactive psychological problems and patients with somatizations as an expression of psychological conflicts. Case reports illustrate the approach used in patient management and some of the encouraging results that can be achieved at such a clinic. The special nature of the clinic presented a challenge to the physician's traditional role and required careful attention to specific aspects of the doctor-patient relationship, which are briefly discussed.

scholarly journals Psychiatric Symptomatology in Early-Onset Binswanger’s Disease: Two Case Reports

1995 ◽  
Vol 8 (1) ◽  
pp. 43-46 ◽  
Author(s):  
R. M. Lawrence ◽  
J. C. Hillam
Keyword(s):  
Early Identification ◽  
Psychiatric Illness ◽  
Case Reports ◽  
Accurate Diagnosis ◽  
Psychotic Symptoms ◽  
Psychiatric Symptomatology ◽  
Neurological Signs ◽  
Binswanger’S Disease ◽  
History Of ◽  
Binswanger's Disease

We describe two cases of Binswanger's disease of pre-senile onset which presented with affective and psychotic symptoms well before the appearance of cognitive deterioration and neurological signs, initially evading an accurate diagnosis. Psychiatrists should be aware of white matter disease and its role in the pathogenesis of psychiatric illness. Particular attention should be given to a history of hypertension as a risk factor in the early identification of these cases.

Pre-Existing Psychiatric Illness Is Associated With an Increased Risk of Delirium in Patients With Acute Respiratory Distress Syndrome

2021 ◽  
pp. 088506662110190
Author(s):  
Saminder Singh Kalra ◽  
Johnny Jaber ◽  
Bashar N. Alzghoul ◽  
Ryan Hyde ◽  
Sarina Parikh ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Psychiatric Illness ◽  
Distress Syndrome ◽  
Multivariable Logistic Regression Analysis ◽  
Psychiatric Illnesses ◽  
Increased Risk ◽  
Icu Delirium ◽  
The Impact

Background: Patients with acute respiratory distress syndrome (ARDS) are highly susceptible to developing delirium for a multitude of reasons. Previous studies have linked pre-existing depression with an increased risk of postoperative delirium in patients undergoing cardiac and non-cardiac surgery. However, the evidence regarding the association between pre-existing psychiatric illnesses and delirium in ARDS patients is unknown. In this study, we aim to determine the relationship between pre-existing psychiatric illness and the risk of development of delirium amongst ARDS patients. Study Design and Methods: We performed a retrospective study of a mixed group of patients admitted to the intensive care unit (ICU) between January 2016 and December 2019 with a diagnosis of ARDS per the Berlin definition. The study group was divided into 2 cohorts: subjects with delirium and subjects without delirium. Comparison between the 2 groups was conducted to examine the impact of pre-existing psychiatric illnesses including major depressive disorder (MDD), generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, or post-traumatic stress disorder. Multivariable logistic regression analysis was performed adjusting for benzodiazepine use, sedatives, analgesics, sequential organ failure assessment score, and corticosteroid use to determine the association between pre-existing psychiatric disorders and delirium. Results: 286 patients with ARDS were identified; 124 (43%) of whom were diagnosed with ICU delirium. In patients diagnosed with ICU delirium, 49.2% were found to have preexisting psychiatric illnesses, compared to 34.0% without any preexisting psychiatric illness (OR = 1.94, P = 0.01). In a subgroup analysis of individual psychiatric illnesses, GAD and MDD were associated with the development of delirium (OR = 1.88, P = 0.04 and OR = 1.76, P = 0.05 respectively). Interpretation: ARDS patients with preexisting psychiatric illnesses, particularly GAD and MDD are associated with an increased risk of developing ICU delirium. Clinicians should be aware of the effect of psychiatric co-morbidities on developing delirium in critically ill patients.

scholarly journals Presenting Psychiatric and Neurological Symptoms and Signs of Brain Tumors before Diagnosis: A Systematic Review

2021 ◽  
Vol 11 (3) ◽  
pp. 301
Author(s):  
Fatima Ghandour ◽  
Alessio Squassina ◽  
Racha Karaky ◽  
Mona Diab-Assaf ◽  
Paola Fadda ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Psychiatric Symptoms ◽  
Case Reports ◽  
Neurological Symptoms ◽  
World Health ◽  
Exclusion Criteria ◽  
Comprehensive Description ◽  
Brain Tumor Diagnosis ◽  
Health Organization ◽  
Symptoms And Signs

Brain tumors can present with various psychiatric symptoms, with or without neurological symptoms, an aspect that complicates the clinical picture. However, no systematic description of symptoms that should prompt a neurological investigation has been provided. This review aims to summarize available case reports describing patients with brain tumors showing psychiatric symptoms before brain tumor diagnosis, in order to provide a comprehensive description of these symptoms as well as their potential relationship with delay in the diagnosis. A systematic literature review on case reports of brain tumors and psychiatric symptoms from 1970 to 2020 was conducted on PubMed, Ovid, Psych Info, and MEDLINE. Exclusion criteria comprised tumors not included in the World Health Organization (WHO) Classification 4th edition and cases in which psychiatric symptoms were absent or followed the diagnosis. A total of 165 case reports were analyzed. In a subset of patients with brain tumors, psychiatric symptoms can be the only manifestation or precede focal neurological signs by months or even years. The appearance of focal or generalized neurological symptoms after, rather than along with, psychiatric symptoms was associated with a significant delay in the diagnosis in adults. A timely assessment of psychiatric symptoms might help to improve early diagnosis of brain tumors.

The Reporting of Recent Stress in the Lives of Psychiatric Patients

1970 ◽  
Vol 117 (541) ◽  
pp. 635-643 ◽  
Author(s):  
Richard W. Hudgens ◽  
Eli Robins ◽  
W. Bradford Delong
Keyword(s):  
Life Events ◽  
Psychiatric Illness ◽  
Psychiatric Patients ◽  
Causative Role ◽  
Causal Connection ◽  
Specific Question ◽  
Interpersonal Conflicts ◽  
Positive Evidence ◽  
Medically Ill ◽  
Psychiatric Illnesses

Physicians and patients frequently assume a causal connection between life events and subsequent episodes of psychiatric illness. It seems to ‘make sense’ that an illness which is to some extent manifested by disordered emotions could be caused in part by emotion-producing events. But plausibility alone is no proof of the truth of such an assumption. Realizing this, several investigators have conducted systematic studies of the interrelationships of life events and illnesses, both psychiatric and medical. Such work has been reported by Adamson and Schmale (1), Holmes, et al. (3, 7, 9, 10) Brown and Birley (2) Clayton, et al. (4) Morrison, et al. (11) Murphy, et al. (12, 13) and Hudgens, et al. (8). These authors differed regarding the specific question of whether illnesses may be caused by emotion-producing stress. The first six of the above papers presented positive evidence for such a cause-effect relationship. The last four papers reported that psychiatric patients had significantly more interpersonal conflicts than did well persons or medically ill persons, at least while their psychiatric illnesses were in progress; but the latter authors were unable to find evidence that any type of stress, interpersonal or otherwise, played a causative role in the illnesses. Disagreements among all these workers may be traced to differences in both theoretical approach and methodology.

scholarly journals Suicide prevention: A study of patients' views

2003 ◽  
Vol 182 (3) ◽  
pp. 261-265 ◽  
Author(s):  
John M. Eagles ◽  
Dawn P. Carson ◽  
Annabel Begg ◽  
Simon A. Naji
Keyword(s):  
Social Networks ◽  
Mental Illness ◽  
Suicide Prevention ◽  
Psychiatric Illness ◽  
Structured Interview ◽  
Psychiatric Services ◽  
Prevention Strategies ◽  
Psychiatric Illnesses ◽  
Service Models ◽  
The Media

BackgroundSuicide prevention strategies are usually formulated without seeking the views of people with psychiatric illnesses.AimsTo establish what helped patients with severe psychiatric illness when they felt suicidal.MethodA semi-structured interview was constructed following transcribed interviews with 12 patients. This was administered to 59 out-patients with serious and enduring mental illness, focusing on factors they found helpful or unhelpful when at their most despairing.ResultsThree-quarters of patients were in contact with psychiatric services when feeling at their lowest, and this contact was generally deemed to be helpful. Social networks were considered just as helpful as psychiatric services by the half of patients who discussed their feelings with friends or relatives. Religious beliefs and affiliations were helpful. Negative influences included the media and the stigma of psychiatric illness.ConclusionsEfforts at suicide prevention might usefully focus on enhancing patients' social networks, increasing the likelihood of early contact with psychiatric services and decreasing the stigma attached to psychiatric illness. Larger studies of patients exposed to different service models would be informative.

scholarly journals Psychiatric Symptomatology in Medical Students in Lebanon: What about us?

2021 ◽  
Author(s):  
Alfred Chabbouh ◽  
Carmen Al Haddad ◽  
Grace El Bejjani ◽  
Vanessa Daou ◽  
Michele Chahoud
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
Psychiatric Symptoms ◽  
Healthcare Providers ◽  
Private University ◽  
Additional Stress ◽  
Psychiatric Symptomatology ◽  
Dsm 5 ◽  
Being Bullied ◽  
Level 1

Medical students are an at-risk population to develop mental health disorders, especially students in Lebanon who are facing constant additional stress due to the volatile situation in the country. The present study used the APA’s DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure – Adult to screen for psychiatric symptoms in 12 different domains. Out of the sample of 364 students from all universities in Lebanon, only 5.2% had already a psychiatric diagnosis. Of the non-diagnosed subpopulation, a massive percentage of 92.75% screened positive and subsequently, were in need of further mental health evaluation. Roughly half of the participants described the existence of barriers for them to seek mental health services, finances and stigma being major reasons. Predictors of a more severe screen were being from a private university and previously being bullied. The situation in medical schools in Lebanon is profoundly alarming. Shouldn’t the health of future healthcare providers be a priority?

scholarly journals Neuropsychological profile of a male psychiatric patient with a Morgagni-Stewart-Morel syndrome

2014 ◽  
Vol 27 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Aksel Hansen ◽  
Liliana Engelhardt ◽  
Wolfgang Pleschutznig ◽  
Gerhard Dammann ◽  
Stephanie Vietze
Keyword(s):  
Case Report ◽  
Psychiatric Patient ◽  
Neuropsychological Tests ◽  
Psychiatric Symptoms ◽  
Case Reports ◽  
Neuropsychiatric Symptoms ◽  
Pain Syndrome ◽  
Admission Diagnosis ◽  
Neuropsychological Profile ◽  
Definition Of

In 1765 Giovanni Morgagni described a syndrome consisting of hyperostosis frontalis interna (HFI), obesity and hirsutism. In 1928 Stewart and in 1930 Morel added neuropsychiatric symptoms, e.g. depression and dementia, which led to the definition of the Morgagni-Stewart-Morel Syndrome (MSM). Although mostly women were characterized in literature no gender specifity is demanded. This case report presents the rare case of a 66 year old male psychiatric patient with Morgagni-Stewart-Morel Syndrome. The patient complained of loss of concentration and difficulties with activities of daily living. Admission diagnosis was an opioid misuse on the basis of a chronic pain syndrome. In this case report we are describing clinical features, the patient history and technical (MRI) and neuropsychological tests. Although severe psychiatric symptoms and neuropsychological deficits are commonly seen in these patients, our patient showed only mild symptoms. This case reports shows the possibility of a male patient with MSM. If MSM is a separate entity or just an epiphenomena of hormone dysregulation should be investigated in further studies.

Ethical Aspects of Using Virtual Reality in Psychiatry

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 94-94
Author(s):  
Oana Maria Isailă ◽  
◽  
Sorin Hostiuc ◽  
Filip Curcă ◽  
George Cristian Curcă ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Ethical Issues ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Patient Relationship ◽  
Ethical Aspects ◽  
Physician Patient Relationship ◽  
Additional Layer ◽  
Areas Of Interest ◽  
Physician Patient

"Virtual reality (VR), initially a form of entertainment has begun to find its way in healthcare practice. One of its main areas of interest is the treatment of psychiatric disorders. When using VR, the basic ethical principles underlying the physician-patient relationship should be respected, but they should be customized by the presence of an additional layer of complexity generated by the interposition of the virtual world. The physician-patient relationship is often multidirectional, often including a larger team of healthcare professionals, family members or acquaintances, working conjointly to optimize the medical care. Each time other participants are involved within this relationship, the complexity of the ethical issues tends to increase. For example, if the patient has decreased insight, it is possible that other persons must make some medical decisions – resulting a prioritization of beneficence compared to autonomy. Also, we must take into account the fact that many psychiatric symptoms can be seen as a form of “virtual reality” by the patient. The healthcare provider must take additional safety measures to minimize the harms made by VR techniques in psychiatric patients, by using methods that are individually tailored. The main aim of this paper is to debate the ethical aspects surrounding the applicability of virtual reality in treating psychiatric patients, with an emphasis on the elements that were mentioned earlier. "

Psychiatric disorders

2019 ◽  
pp. 153-176
Author(s):  
Risto Näätänen ◽  
Teija Kujala ◽  
Gregory Light
Keyword(s):  
Psychiatric Illness ◽  
Psychometric Validation ◽  
Repeated Measure ◽  
Post Traumatic Stress ◽  
Brain Functioning ◽  
Psychiatric Illnesses ◽  
Technological Advances ◽  
Post Traumatic ◽  
New Treatments ◽  
Neural Dysfunction

Psychiatric illnesses including schizophrenia, major depressive disorder (MDD), bipolar disorder (BD), post-traumatic stress disorder (PTSD), panic disorder, and alcohol use disorders are common and leading causes of global disability. Conventionally, diagnosis and treatment of these disorders has relied solely on clinicical observation of symptoms and inference of underlying neural dysfunction. Recently, however, technological advances have allowed for direct measurement of brain functioning in these disorders, and there has been increased interest in the exploration of sensory processing deficits involved. In this context, MMN is regarded as a ‘breakthrough biomarker’ for advancing the understanding and treatment of psychiatric illness. As MMN is among the most widely studied translational biomarkers and has already undergone extensive psychometric validation (e.g. reliability, suitability for use as a repeated measure, sensitivity to pharmacologica and non-pharmacological interventions), it is widely used for development of new treatments for brain disorders.

scholarly journals Neurosurgical Treatment for Drug Addiction: Systematic Review

2020 ◽  
Vol 39 (02) ◽  
pp. 116-124
Author(s):  
Patrícia Leonardo Magalhães dos Santos ◽  
Rafaella Oliveira Curti ◽  
Ledismar José da Silva
Keyword(s):  
Systematic Review ◽  
Drug Addiction ◽  
Psychiatric Symptoms ◽  
Case Reports ◽  
Scientific Investigations ◽  
High Refractoriness ◽  
The Social ◽  
Neurosurgical Treatment ◽  
Promising Treatment ◽  
Substance Related Disorders

AbstractSubstance-related disorders are psychiatric conditions that have a worldwide impact. Their multifactorial cycle has been treated pharmacologically and with therapeutic support. However, high refractoriness rates and difficulty to control relapses are among the pitfalls associated with these disorders. Thus, recent studies have shown that deep brain stimulation (DBS) is a promising treatment, with a direct intervention in the neurocircuitry of addiction. The results of the present systematic review of the use of DBS for the treatment of drug addiction show that this surgical procedure can reduce the desire for the drug, and, in some cases, establish abstinence, improve psychiatric symptoms related to mood and quality of life, and reintroduce the patient into the social and family environments. Nevertheless, this approach is still limited to the academic realm, based mainly on case reports, with ethics and therapeutic protocols still to be defined. Further in-depth scientific investigations are required to recommend its clinical application.

Sign in / Sign up

Export Citation Format

Share Document