scholarly journals Multidisciplinary and differentiated approach in the treatment of psychotic disorders with comorbid somatic states

2021 ◽  
pp. 52-56
Author(s):  
Yevgen Oprya ◽  
Mykhailo Pustovoit
Keyword(s):  
Psychological Functioning ◽  
Psychotic Disorders ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Psychopathological Symptoms ◽  
Somatic Comorbidity ◽  
Complex Therapy ◽  
Somatic Disorders ◽  
The Stability

The article presents the results of a comprehensive clinical and psychopathological study of the features of clinical manifestations of psychotic patients with schizophrenia with somatic disorders. It has been proven that disorders in schizophrenia are associated with a negative clinical-psychopathological and socio-personal prognosis, leading to increase of severity of psychopathological symptoms and a decrease in the level of socio-psychological functioning. The identified features of the clinical course have become the leading target features, a system of multidisciplinary and differentiated approach in the complex therapy of patients taking into account somatic comorbidity has been developed and implemented in practice. The proposed system is a set of activities, including a combination of pharmacotherapeutic, psychoeducational, psychotherapeutic and psychosocial activities, selected taking into account the specifics of the psychopathological process modified by somatic pathology. According to the results of testing, its effectiveness has been proven, and it has been established that its use can significantly improve the condition of patients and their level of socio-psychological functioning, increase the stability of remission and reduce the number of hospitalizations.

scholarly journals Elderly patients with no previous psychiatric history: suicidality and other factors relating to psychiatric acute admissions

BJPsych Open ◽  
2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Hallvard Lund-Heimark ◽  
Eirik Kjelby ◽  
Lars Mehlum ◽  
Rolf Gjestad ◽  
Geir Selbæk ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Psychiatric History ◽  
Cross Sectional ◽  
Somatic Comorbidity ◽  
Somatic Disorders ◽  
The Common ◽  
Cognitive Problems ◽  
Acute Admissions

Background The common recommendation that adults with onset of mental illness after the age of 65 should receive specialised psychogeriatric treatment is based on limited evidence. Aims To compare factors related to psychiatric acute admission in older adults who have no previous psychiatric history (NPH) with that of those who have a previous psychiatric history (PPH). Method Cross-sectional cohort study of 918 patients aged ≥65 years consecutively admitted to a general adult psychiatric acute unit from 2005 to 2014. Results Patients in the NPH group (n = 526) were significantly older than those in the PPH group (n = 391) (77.6 v. 70.9 years P < 0.001), more likely to be men, married or widowed and admitted involuntarily. Diagnostic prevalence in the NPH and PPH groups were 49.0% v. 8.4% (P < 0.001) for organic mental disorders, 14.6% v. 30.4% (P < 0.001) for psychotic disorders, 30.2% v. 55.5% (P < 0.001) for affective disorders and 20.7% v. 13.3% (P = 0.003) for somatic disorders. The NPH group scored significantly higher on the Health of the Nation Outcome Scale (HoNOS) items agitated behaviour; cognitive problems; physical illness or disability and problems with activities of daily living, whereas those in the PPH group scored significantly higher on depressed mood. Although the PPH group were more likely to report suicidal ideation, those in the NPH group were more likely to have made a suicide attempt before the admission. Conclusions Among psychiatric patients >65 years, the subgroup with NPH were characterised by more physical frailty, somatic comorbidity and functional and cognitive impairment as well as higher rates of preadmission suicide attempts. Admitting facilities should be appropriately suited to manage their needs.

scholarly journals Pecularities of mental pathology at psychiatric patient with the comorbid somatic disorders

2021 ◽  
Vol 11 (5) ◽  
pp. 348-355
Author(s):  
Ye. Oprya ◽  
M. Pustovoyt ◽  
Ya. Biesieda ◽  
Ye. Kozishkurt
Keyword(s):  
Mental Disorders ◽  
Emotional Disorders ◽  
Psychotic Disorders ◽  
Treatment Strategies ◽  
Emotional Reactions ◽  
Risk Markers ◽  
Psychopathological Symptoms ◽  
Somatic Disorders ◽  
Somatic Diseases ◽  
Mental Pathology

The paper presents the results of a comprehensive clinical and psychopathological examination of patients with schizophrenia comorbid with somatic pathology. The etiological factors and preconditions for the formation of schizophrenia combined with somatic pathology, general clinical and dynamic characteristics, and features of mental disorders, severity and specificity of clinical and psychopathological manifestations of schizophrenia are analyzed. It was found that the combination of schizophrenia with somatic diseases is more "malignant" variants of the course of psychotic disorders, including an increase in the number of hospitalizations, earlier manifestation, significant increase duration and greater severity of psychopathological symptoms. The specificity of mental disorders in patients with schizophrenia with somatic disorders was manifested by a predominance of disorders of sensation and perception in the form of senestopathy (schizophrenia with CVD and F 20 with obesity), hyperesthesia (schizophrenia with diabetes 2) and complex hallucinations. An important characteristic of mental disorders in patients with schizophrenia with somatic pathology is the presence of emotional disorders in the form of rigidity (in schizophrenia with CVD and obesity) and explosiveness (in schizophrenia with diabetes 2) emotional reactions, as well as depressive and anxiety (schizophrenia with CVD) and dysphoric (in schizophrenia with diabetes 2 and obesity) mood disorders. According to the frequency analysis of clinical-biological and social factors of formation, as well as features of clinical-psychopathological structure of schizophrenia in patients of the examined groups, diagnostic clinical-psychopathological signs (risk markers) of combination of schizophrenia with specific variants of somatic disorders are established. The obtained results show that the combination of schizophrenia with somatic disorders is reflected in the deepening and peculiarities of psychopathological symptoms, reducing the level of social realization of patients and requires the attention of clinicians in developing treatment strategies.

Pathogenetic Therapy of Patients with Recurrent Genital Herpes

2020 ◽  
Vol 65 (5-6) ◽  
pp. 30-34
Author(s):  
L. L. Logvina ◽  
D. N. Bayram ◽  
Z. A. Kambachokova ◽  
F. V. Shavaeva ◽  
Z. S. Krymshokalova ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Blood Plasma ◽  
Genital Herpes ◽  
Antioxidant Defense ◽  
Clinical Manifestations ◽  
Complex Treatment ◽  
Herpesvirus Infection ◽  
Recurrent Genital Herpes ◽  
Complex Therapy ◽  
Pathogenetic Therapy

Evaluation of the effectiveness of aminophthalhydroside in the complex treatment of patients with recurrent genital herpes was carried out. The efficacy of the drug was assessed by clinical, biochemical, and immunological criteria. The inclusion of aminophthalhydrazide in the complex therapy of patients with recurrent herpesvirus infection led to an earlier relief of clinical manifestations of the disease, an increase in the relapse period, a decrease in lipid peroxidation products in the blood plasma, an increase in the content of antioxidant defense components, and correction of immunological disorders.

scholarly journals Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course

2020 ◽  
Vol 10 (01) ◽  
pp. e137-e140
Author(s):  
Mosaad Abdel-Aziz ◽  
Nada M. Abdel-Aziz ◽  
Dina M. Abdel-Aziz ◽  
Noha Azab
Keyword(s):  
Clinical Features ◽  
Clinical Symptoms ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Angiotensin Converting Enzyme 2 ◽  
Compulsory Vaccination ◽  
Specific Factors ◽  
Novel Coronavirus ◽  
Radiographic Data

AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.

scholarly journals AB0249 POSITIVE EFFECT OF ANTIRHEUMATIC THERAPY ON THE COURSE OF CHRONIC HEART FAILURE IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1424.3-1425
Author(s):  
I. Kirillova ◽  
D. Novikova ◽  
T. Popkova ◽  
Y. Gorbunova ◽  
E. Markelova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Disease Activity ◽  
Diastolic Function ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Antirheumatic Therapy ◽  
Early Ra ◽  
Lv Diastolic Function

Background:Objectives:to evaluate the effect of antirheumatic therapy according to the “treat to target” strategy on the course of chronic heart failure (CHF) in patients with early RA.Methods:The study included 22 patients CHF with valid diagnosis of RA (criteria ACR / EULAR, 2010), 17 (77%) of women, median (Me) age - 60 years, Me disease duration - 7 months; IgM seropositive for rheumatoid factor 10 (45%) and / or antibodies to the cyclic citrulline peptide 22 (100%), DAS28-5.6 [4,8;6,5]. CHF verified in accordance the recommendations for the diagnosis and treatment of CHF Society of Specialists in Heart Failure (2013). The concentration of NT-proBNP was determined by electrochemiluminescence. For all patients was started methotrexate (MT) therapy with a rapid increase in the dose to 30 mg per week subcutaneously. If the MT was not effective enough, after 3 months a biological Disease-Modifying Anti-Rheumatic Drug (bDMARDs) was added to the therapy, predominantly TNF-alpha inhibitors. After 18 months, 10 (45%) patients were in remission and low disease activity, 6 (60%) of patients underwent MT therapy in combination with bDMARDs.Results:In baseline CHF with preserved EF was revealed in 21 (95%) patients, in 1 patient - CHF with reduced EF. After 18 months there was a positive dynamics of improvement of clinical symptoms, echocardiographic indicators (decrease the size of the left atrium (LА) and the index of end-systolic volume of LА, IVRT, E’ LV), diastolic function of the left ventricle (LV). There was no decompensation of CHF. LV diastolic function normalized in 7 (32%) patients who reached the target level of blood pressure, remission (n = 5) and low (n = 2) disease activity, mainly in the treatment of MT and bDMARDs. In patients with RA and CHF, the level of NT-proBNP decreased from 192.2 [151.4; 266.4] to 114.0 [90.4; 163.4] pg / ml (p <0.001), normalized in 16 of 22 (73%) patients (p <0.001) with remission or low RA activity. In 5 (22%) patients, the clinical manifestations of CHF regressed, LV diastolic function and NT-proBNP level normalized.Conclusion:In patients with early RA and CHF anti-rheumatic therapy improves the clinical course of CHF. There were an improvement in the clinical course of CHF, diastolic function of the left ventricle and a decrease in NT-proBNP.Disclosure of Interests:None declared

CLINIC AND COMPLICATIONS OF COVID-19 CORONAVIRUS DISEASE WITH PATHOGENESIS ELEMENTS

2020 ◽  
pp. 72-79
Author(s):  
I. V. Аndrusovich
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Tract ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Symptoms ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Second Phase ◽  
Upper Respiratory Tract

The longer the COVID−19 coronavirus pandemic lasts, the more information about its clinical manifestations is accumulated. The incubation period of COVID−19 ranges from 2 to 14 days, rarely up to 3 weeks, but in a significant number of cases an infection is not accompanied with the appearance of clinical symptoms. Currently, the following variants of the clinical course of COVID−19 can be identified as follows: viral load; subclinical; slight; uncomplicated with damage to only the upper respiratory tract; mild pneumonia, severe pneumonia, acute respiratory distress syndrome, etc. The clinical course of COVID−19 depends on the severity, the criteria of which are the intoxication manifestation, the degree of fever and the dominant syndrome. Mild / moderate forms are manifested by frequent increase in body temperature up to 38 ° C, respiratory symptoms, headache, myalgias, palpitations and general malaise. Patients stop distinguishing smells and feel the taste of food. Approximately from the 7th to the 9th days of the disease there are problems with breathing, which indicates the impairment of the lower respiratory tract and the beginning of the second phase of the disease, and its course is regarded as severe. Severe forms of the disease can also be manifested by impaired coordination of movements, slurred speech. In 1 to 4 % of patients there is developed the psychosis in the form of hallucinations. In the elderly, COVID−19 may be accompanied by delirium, lowering blood pressure. The risks of adverse disease are associated with somatic diseases: cardiovascular and nervous systems, respiratory tract, hormonal disorders, etc. Otitis, sinusitis, sepsis, bronchopulmonary infection, thrombosis, myocarditis etc. can be the complications of COVID−19. Computer tomography is an instrumental test that demonstrates the damage of lungs with coronavirus and allows to assess its severity. Key words: coronavirus infection, COVID−19, clinical variants, severity, pneumonia, acute respiratory distress syndrome.

Clinical manifestations in patients with acute and transient psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S363-S364
Author(s):  
Á. López Díaz ◽  
A. Soler Iborte ◽  
S. Galiano Rus ◽  
J.L. Fernández González ◽  
J.I. Aznarte López
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Exact Test ◽  
Chi Squared ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Competing Interest

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature

2018 ◽  
Vol 3 (3) ◽  
pp. 104 ◽  
Author(s):  
Valentine Erulu ◽  
Mitchel Okumu ◽  
Francis Ochola ◽  
Joseph Gikunju
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
South African ◽  
Artificial Ventilation ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Hemodynamic Instability ◽  
Rapid Onset ◽  
Sub Saharan Africa ◽  
Sub Saharan

The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 °C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3–5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation.

scholarly journals Association of polymorphic variants of xenobiotic biotransformation genes and glutation metabolizing genes with clinical course of cystic fibrosis, antimicrobial therapy efficacy and adverse reactions

2020 ◽  
pp. 64-65
Author(s):  
О.Г. Новоселова ◽  
Е.И. Кондратьева ◽  
Н.В. Петрова ◽  
В.Д. Шерман ◽  
А.Ю. Воронкова ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Treatment Failure ◽  
Antimicrobial Therapy ◽  
Adverse Reactions ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Therapy Efficacy ◽  
Xenobiotic Biotransformation ◽  
Polymorphic Variants

Тяжесть клинических проявлений муковисцидоза может быть обусловлена действием генов-модификаторов. Выяснение причин неэффективности терапии и нежелательных побочных реакций, определение факторов риска позволит улучшить прогноз для данной категории больных. Исследованы ассоциации 18 полиморфных вариантов 10 генов ферментов первой и второй фазы биотрансформации ксенобиотиков: CYP2C9 (c.430C>T, c.1075A> C), CYP2C19 (c.681G>A), CYP2D6 (1846G>A), CYP3A4 (c-392C>T), GSTT1 (del), GSTM1 (del), GSTP1 (c.313A>C), GCLC (TVR GAG, c.-129C>T), GCLM (c.-588C>T), NAT2 (c.282C>T, c.341T>C, c.434A>C, c.481C>T, c.590G>A, c.845A>C, c.857G>A) с тяжестью клинических проявлений муковисцидоза. CF clinical variability could be associated with interaction of modifier genes. Сlarification of the causes of treatment failure and adverse reactions, prediction of risk factors could improve the outcome of therapy. Association of 18 polymorphic variants of 10 genes of xenobiotic biotransformation: CYP2C9 (c.430C>T, c.1075A> C), CYP2C19 (c.681G>A), CYP2D6 (1846G>A), CYP3A4 (c-392C>T), GSTT1 (del), GSTM1 (del), GSTP1 (c.313A>C), GCLC (TVR GAG, c.-129C>T), GCLM (c.-588C>T), NAT2 (c.282C>T, c.341T>C, c.434A>C, c.481C>T, c.590G>A, c.845A>C, c.857G>A) with severity of clinical manifestations were analyzed in 333 CF patients.

Clinical Course of Unusual Malignant Sarcomas of Head and Neck

1979 ◽  
Vol 88 (4) ◽  
pp. 486-494 ◽  
Author(s):  
Michael Setzen ◽  
Steven Sobol ◽  
James M. Toomey
Keyword(s):  
Head And Neck ◽  
Recent Literature ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Distinct Group ◽  
Host Factors ◽  
Sex Distribution ◽  
Diagnostic Features ◽  
Diagnostic Characteristics ◽  
Therapeutic Responses

The clinical manifestations of 29 recently encountered sarcomas of the head and neck were analyzed in an attempt to define more accurately the diagnostic characteristics and therapeutic responses of these unusual tumors. The host factors of age, sex distribution, race, habits and associated features differ sufficiently to distinguish the sarcoma from the carcinoma population. In addition, the clinical course of sarcoma patients as monitored by mode of presentation, site of involvement, tumor histology, diagnostic features and certain elements of management and outcome, further indicates that these tumors can be defined and managed as a distinct group of lesions. A review of the recent literature supports the major conclusions of this study.

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