scholarly journals The prevalence of abnormal findings in screening CT brains performed on patients admitted with psychiatric symptoms

2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Praniel Bennimahadeo ◽  
Jaynund Maharajh
Keyword(s):  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Cerebral Atrophy ◽  
Psychotic Symptoms ◽  
Extradural Haematoma ◽  
Psychiatric Institute ◽  
Focal Neurological Deficit ◽  
Ct Screening ◽  
Ct Findings ◽  
Gcs Score

Background: No clear guidelines exist regarding the role of computerised tomography (CT) as a screening neuroimaging tool in psychiatric practice. The aim of this study was to evaluate the usefulness of historical and clinical parameters on the CT request form, identify the spectrum of CT findings and correlate these to develop guidelines for the use of screening CT brains in patients who present with psychiatric symptoms.Methods: Requests and reports for the brain CT’s of 507 consecutive patients over a 2-year period, between 2013 and 2014, referred from a psychiatric institute for screening CT brain scans, were reviewed. Analysis was performed for the history of trauma and seizures, Glasgow Coma Scale (GCS) score, focal neurological signs, papilloedema, electroencephalograph, relevant blood results and abnormal CT findings. All reports were approved by a consultant radiologist.Results: No abnormality was noted in 69% of CT scans. Cerebral atrophy, infarcts, cysts and calcific foci were present in 30% of patients. One patient presenting with focal neurology had a CT demonstrating an extradural haematoma which required neurosurgical intervention. No focal brain lesions, potentially responsible for the psychosis, were identified in any other patient.Conclusion: Routine CT screening of patients who present with psychotic symptoms, in the absence of focal neurological deficit, does not add value to patient outcome, but rather contributes to the escalating health care expenses and unnecessary radiation dose. CT screening of psychiatric patients should be reserved for patients with reliable predictors of intracranial abnormalities such as lateralising signs, seizures, persistent or worsening headaches; decrease in GCS, papilloedema and in patients where the onset of symptoms occurred at an age above 50.

Hypothyroidism and psychosis: a case report

2011 ◽  
Vol 26 (S2) ◽  
pp. 1753-1753
Author(s):  
M. Salinas ◽  
V. Barrau ◽  
S. Yelmo ◽  
E. Santana ◽  
J. Monzón ◽  
...  
Keyword(s):  
Case Report ◽  
Thyroid Hormone ◽  
Thyroid Dysfunction ◽  
Psychiatric Symptoms ◽  
Medical Condition ◽  
Psychiatric Patients ◽  
Current Treatment ◽  
Hormone Deficiency ◽  
Psychotic Symptoms ◽  
Significant Past Medical History

IntroductionHypothyroidism is a medical condition commonly found in a variety of clinical settings. Physical complaints of thyroid hormone deficiency are many, and psychiatric symptoms include cognitive dysfunction, affective disorders and psychosis.ObjectivesTo study the possible relationship between psychotic symptoms and secondary to treatment with radioiodine hypothyroidism, presenting a case report.MethodsWe report a 32 year-old woman without known significant past medical history (except Graves Basedow disease with no current treatment) that came to clinical attention due to psychotic symptoms. The patient was admitted to the hospital and laboratory values revealed hypothyroidism secondary to treatment with radioiodine (which was required six months before for a Graves Basedow disease). We considered the possibility that thyroid dysfunction was the cause of the psychiatric symptoms.ResultsAfter giving neuroleptic treatment with increasing doses of risperidone (up to 9 mg/day), clinical improvement was observed, with a diminishment of psychiatric symptoms. At the same time, supplementary treatment with thyroid hormone was given, which did not manage to normalize the hormone function at the moment of discharge.ConclusionIn our patient we cannot establish a definite link between psychotic and clinical thyroid dysfunction, because six months after replacement therapy the hormonal function has not yet been completely standardized. The patient was psychopathologically stable (although treatment was maintained with quetiapine 600 mg/day). There is no doubt that thyroid hormone plays a key role in the regulation of mood, cognition and behavior; we must not ignore this, and always check thyroid function in psychiatric patients.

The Importance of Context: An ESM Study in Forensic Psychiatry

2021 ◽  
pp. 0306624X2098653
Author(s):  
P. Habets ◽  
Ph. Delespaul ◽  
I. Jeandarme
Keyword(s):  
Negative Affect ◽  
Forensic Psychiatry ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Compliance Rate ◽  
Psychotic Symptoms ◽  
Ample Evidence ◽  
General Psychiatry ◽  
Forensic Psychiatric ◽  
Related Stress

Experience Sampling Method (ESM) is a structured diary technique assessing variations in thoughts, mood, and psychiatric symptoms in everyday life. Research has provided ample evidence for the efficacy of the use of ESM in general psychiatry but its use in forensic psychiatry has been limited. Twenty forensic psychiatric patients participated. The PsyMate™ Device emitted a signal 10 times a day on six consecutive days, at unpredictable moments. After each “beep,” the patients completed ESM forms assessing current context, thoughts, positive and negative affect, and psychotic experiences. Stress was measured using the average scores of the stress related items. Compliance rate was high (85% beeps responded). Activity stress was related to more negative affect, lower positive affect, and more psychotic symptoms. This finding was restricted to moments when a team member was present; not when patients were alone or with other patients. ESM can be useful in forensic psychiatry and give insights into the relationships between symptoms and mood in different contexts. In this study activity-related stress was contextualized. These findings can be used to personalize interventions.

Psychosocial Profiles of Patients Admitted to Psychiatric Emergency Services: Results from the Signature Biobank Project: Profils Psychosociaux de Patients Admis Dans des Services d’Urgence Psychiatrique : Résultats du Projet Banque Signature

2021 ◽  
pp. 070674372110187
Author(s):  
Steve Geoffrion ◽  
Kévin Nolet ◽  
Charles-Édouard Giguère ◽  
Tania Lecomte ◽  
Stéphane Potvin ◽  
...  
Keyword(s):  
Childhood Abuse ◽  
Indirect Effect ◽  
Structural Equation ◽  
Emergency Services ◽  
Psychiatric Patients ◽  
Evaluation Process ◽  
Psychiatric Emergency ◽  
Psychotic Symptoms ◽  
Psychiatric Emergency Services ◽  
Targeted Interventions

Objectives: Patients admitted to psychiatric emergency services (PES) are highly heterogenous. New tools based on a transdiagnosis approach could help attending psychiatrists in their evaluation process and treatment planning. The goals of this study were to: (1) identify profiles of symptoms based on self-reported, dimensional outcomes in psychiatric patients upon their admission to PES, (2) link these profiles to developmental variables, that is, history of childhood abuse (CA) and trajectories of externalizing behaviours (EB), and (3) test whether this link between developmental variables and profiles was moderated by sex. Methods: In total, 402 patients were randomly selected from the Signature Biobank, a database of measures collected from patients admitted to the emergency of a psychiatric hospital. A comparison group of 92 healthy participants was also recruited from the community. Symptoms of anxiety, depression, alcohol and drug abuse, impulsivity, and psychosis as well as CA and EB were assessed using self-reported questionnaires. Symptom profiles were identified using cluster analysis. Prediction of profile membership by sex, CA, and EB was tested using structural equation modelling. Results: Among patients, four profiles were identified: (1) low level of symptoms on all outcomes, (2) high psychotic symptoms, (3) high anxio-depressive symptoms, and (4) elevated substance abuse and high levels of symptoms on all scales. An indirect effect of CA was found through EB trajectories: patients who experienced the most severe form of CA were more likely to develop chronic EB from childhood to adulthood, which in turn predicted membership to the most severe psychopathology profile. This indirect effect was not moderated by sex. Conclusion: Our results suggest that a transdiagnostic approach allows to highlight distinct clinical portraits of patients admitted to PES. Importantly, developmental factors were predictive of specific profiles. Such transdiagnostic approach is a first step towards precision medicine, which could lead to develop targeted interventions.

scholarly journals Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study

2021 ◽  
pp. 025371762199953
Author(s):  
Bhavneesh Saini ◽  
Pir Dutt Bansal ◽  
Mamta Bahetra ◽  
Arvind Sharma ◽  
Priyanka Bansal ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychiatric Disorders ◽  
Psychotic Disorders ◽  
Age Of Onset ◽  
Psychiatric Patients ◽  
Cross Sectional Study ◽  
Psychotic Symptoms ◽  
Sectional Study ◽  
Cross Sectional ◽  
Neurotic Disorders

Background: Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted. Methods: This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18–45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission. Results: Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others. Conclusions: PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.

Cocaine Dependence Produce Psychiatric Symptoms - a Case Report

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Stankovic ◽  
S. Vucetic-Arsic ◽  
S. Alcaz ◽  
J. Cvejic
Keyword(s):  
Clinical Features ◽  
Male Patient ◽  
Psychiatric Symptoms ◽  
Cocaine Dependence ◽  
Psychotic Symptoms ◽  
Personal Contact ◽  
Outpatient Unit ◽  
Special Hospital ◽  
First Time ◽  
The Brain

Aim:We want to present a polymorphic clinical features like: hallutinations, paranoid ideas, agitation and violence as a result of prolonged cocaine intranasal consumption.Methods:We exposed a 30-year old male patient with ICD-X diagnostic criteria for cocaine dependence (intranasal consumption) that treated in the outpatient unit of Special Hospital of Addicitons, Belgrade, Serbia from April to July 2008. We used the medical records, psychical examination, psychiatric interwievs, standard blood sampling and cocaine urine detections sample (positive).Results:Observations a specific and polymorphic clinical features with presence of psychotic symptoms after cocaine consumptions in our male patient, for the first time after 5 years of cocaine dependence: auditory hallucinations (two- voice speakers), paranoid persecution ideas and suspiciousness, agitation with appearance of vegetative symptomatology (palpitations, sweating, pupil dilatation), extremely violence behavior to other people, complete social reductions (“armed to the outside world”, refused any personal contact and isolated from friends and family, permanent outdoor checking). There was an intensive fear too and impaired judgment.Conclusions:Permanent cocaine consumption can result with produce a numerous of psychiatric symptoms and syndromes as our experience does. It is similar to the findings of other studies and papers reviewed. It is suppose that cocaine has numerous effects on important neurotransmitters in the brain, such as increase as well as the release of dopamine and it related with aggressiveness, hallucinations and other psychiatric symptoms.

The Practice of Community Psychiatric Nursing and Mental Health Social Work in Salford Some Implications for Community Care

1988 ◽  
Vol 152 (6) ◽  
pp. 783-792 ◽  
Author(s):  
K. Wooff ◽  
D. P. Goldberg ◽  
T. Fryers
Keyword(s):  
Mental Health ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Psychiatric Nurses ◽  
Health Staff ◽  
Mental Health Staff ◽  
Term Care ◽  
Community Psychiatric ◽  
Wide Range

The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.

“organic Personality Disorder” as Part of Early Neuropsychiatric Manifestations in Huntington’s Disease - a Case Report

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
J. Maia
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Psychiatric Symptoms ◽  
Age Of Onset ◽  
Neuropsychiatric Symptoms ◽  
Personality Change ◽  
Psychotic Symptoms ◽  
Autosomal Dominant Disorder ◽  
Neuropsychiatric Manifestations ◽  
Psychiatric Manifestations

Huntington's Disease (HD) is an inherited autosomal dominant disorder characterized by motor, cognitive and psychiatric symptomatology, being considered a paradigmatic neuropsychiatric disorder that includes all three components of the "Triadic Syndromes": dyskinesia, dementia and depression.Firstly described in 1872 as an "Hereditary Chorea" by George Huntington only in 1993 was its responsible gene identified. A person who inherits the HD gene will sooner or later develop the disease. the age of onset, early signs and rate of disease progression vary greatly from person to person.Neuropsychiatric symptoms are an integral part of HD and have been considered the earliest markers of the disease, presenting sometimes more than 10 years before a formal diagnosis is done. Patients may experience dysphoria, mood swings, agitation, irritability, hostile outbursts, psychotic symptoms and deep bouts of depression with suicidal ideation. Personality change is reported in 48% of the cases, with the paranoid subtype being described as the most prevalent. the clinical case presented illustrates a case of HD which started with insidious psychiatric symptoms and an important personality change.Despite a wide number of medications being prescribed to help control emotional, movement and behaviour problems, there is still no treatment to stop or reverse the course of the disease. Furthermore, psychiatric manifestations are often amenable to treatment, and relief of these symptoms may provide significant improvement in patient's and caregivers quality of life.A greater awarness of psychiatric manifestations of HD is essential to an earlier diagnosis and an optimized therapeutic approach.

scholarly journals Case Report: Severe Adolescent Major Depressive Syndrome Turns Out to Be an Unusual Case of Anti-NMDA Receptor Encephalitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Alexander Moldavski ◽  
Holger Wenz ◽  
Bettina E. Lange ◽  
Cathrin Rohleder ◽  
F. Markus Leweke
Keyword(s):  
Cognitive Deficits ◽  
Psychiatric Symptoms ◽  
Previous History ◽  
Rapid Onset ◽  
Depressive Syndrome ◽  
Psychotic Symptoms ◽  
Major Depressive ◽  
Abnormal Movements ◽  
Nmdar Encephalitis ◽  
Initial Symptoms

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory condition mediated by autoantibodies against the GluN1 subunit of the receptor. Clinically, it is characterized by a complex neuropsychiatric presentation with rapidly progressive psychiatric symptoms, cognitive deficits, seizures, and abnormal movements. Isolated psychiatric manifestations of anti-NMDAR encephalitis are rare and usually dominated by psychotic symptoms. We present a case of an 18-year-old female high school student—without a previous history of psychiatric disorders—with a rapid onset severe depressive syndrome. Surprisingly, we found pleocytosis and anti-NMDAR autoantibodies in the cerebrospinal fluid (CSF), despite an otherwise unremarkable diagnostic workup, including blood test, clinical examination, and cranial magnetic resonance imaging (MRI). After intravenous immunoglobulins treatment, a complete remission of the initial symptoms was observed. In a follow-up 5 years later, the young woman did not experience any relapse or sequelae. Anti-NMDAR encephalitis can present in rare cases as an organic disorder with major depressive symptoms without distinct concomitant psychotic or neurological symptoms. A clinical presentation such as a rapid onset of symptoms, distinct disturbance in the thought process, restlessness, and cognitive deficits should prompt screening for NMDAR- and other neural autoantibodies to rule out this rare but debilitating pathology.

scholarly journals Perceived functioning, well-being and psychiatric symptoms in patients with stable schizophrenia treated with long-acting risperidone for 1 year

2005 ◽  
Vol 187 (2) ◽  
pp. 131-136 ◽  
Author(s):  
W. Wolfgang Fleischhacker ◽  
Jonathan Rabinowitz ◽  
Georg Kemmler ◽  
Mariëlle Eerdekens ◽  
Angelika Mehnert
Keyword(s):  
Mental Component Summary ◽  
Psychiatric Symptoms ◽  
Short Form ◽  
Mental Component Summary Score ◽  
Well Being ◽  
Psychotic Symptoms ◽  
Open Label ◽  
Sf 36 ◽  
Patient Reported ◽  
Long Acting

BackgroundThe extent to which antipsychotics improve patients' well-being is uncertain.AimsTo examine psychopathology and patient-rated functioning and well-being in patients treated with risperidone.MethodIn a 1-year, open-label, international multicentre trial of long-acting risperidone in 615 stable adult patients with schizophrenia, self-rated functioning and well-being were measured every 3 months using the Short Form 36-item questionnaire (SF–36). Psychopathology was quantified using the Positive and Negative Syndrome Scale (PANSS).ResultsSignificant improvements were found on the SF–36 mental component summary score and vitality and social functioning scales. PANSS and mental component summary scores were moderately correlated.ConclusionsPatient-reported functioning and well-being appear to differ from investigator-rated psychotic symptoms. Patient-rated well-being should be assessed with symptoms to help measure treatment outcomes.

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. "

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