Clinical Medicine Insights: Psychiatry最新文献

{"title":"The Management of Long-Term Psychiatric Sequelae in a Young Woman Who Suffered From Suspected Autoimmune Limbic Encephalitis","authors":"L. Fusar-Poli, A. Gabbiadini, Giulia Battaglia, M. Signorelli, E. Aguglia","doi":"10.1177/1179557320962520","DOIUrl":"https://doi.org/10.1177/1179557320962520","url":null,"abstract":"We report the case of a 23-year-old woman who presented to our Psychiatry Unit with a complex psychiatric symptomatology, 6 years after suffering from a form of encephalopathy which was retrospectively and hypothetically labeled as autoimmune limbic encephalitis. Over the years, several psychopharmacological therapies had been initiated, but none of them led to substantial remission of symptomatology. During the first visit, symptoms were characterized by dysphoric mood with suicidal ideation, anxiety, delusional thoughts. Self-harm and psychogenic seizures with daily frequency were also reported. A therapy with slow-release lithium sulfate, lurasidone, and lorazepam was prescribed. After 6 months of treatment, psychopathological manifestations significantly improved.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76243076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain and Depression Are Associated With More Anxiety in ME/CFS: A Cross-Sectional Cohort Study Between Norway and Spain","authors":"E. Strand, J. Castro-Marrero, I. Helland, J. Alegre, A. Mengshoel","doi":"10.1177/1179557320941478","DOIUrl":"https://doi.org/10.1177/1179557320941478","url":null,"abstract":"Objectives: Lasting, unexplained and high levels of pain may cause anxiety in patients with chronic fatigue syndrome. The objectives of the current study were to test assumptions of the association between pain and anxiety in patients diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and to clarify the role of depression in this relationship. Methods: Data were collected from 664 participants (age 18-65 years) with 133 ME/CFS patients and 201 healthy controls from Norway and 330 CFS patients from Spain. Binary logistic regression model was applied to test relationships between the included variables in the samples. Results: Both pain and depression made significant direct contributions to the level of anxiety. The strongest risk for higher levels of anxiety was the combination of high levels of depression and high levels of pain in the overall sample (OR = 49.70; P < 0.001), not so much in the Spanish cohort (OR = 11.99; P < 0.0001) and most of all in the Norwegian cohort (OR = 88.21; P < 0.001) sample. Conclusions: It was the combination of high pain levels and high levels of depression that to the greatest extent increased the risk of anxiety in patients with CFS/ME. Whatever diagnostic criterion that is applied, anxiety and depression should be mandatory to assess in the clinical assessments performed for diagnosing the ME/CFS. Approaches addressing anxiety-related pain and treatment of depression should be warranted.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90158313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ramelteon for Decreasing Delirium in Surgical Intensive Care Unit Patients","authors":"Chelsea N Lopez, A. Fuentes, A. Dhala, Jonathan Balk","doi":"10.1177/1179557320951221","DOIUrl":"https://doi.org/10.1177/1179557320951221","url":null,"abstract":"In intensive care unit (ICU) patients, delirium contributes to prolonged hospitalization, long-term cognitive impairment and increased mortality. Sleep disturbance, a risk factor for delirium, has been attributed to impaired melatonin secretion in critically ill patients. Ramelteon, a synthetic melatonin receptor agonist, is indicated for insomnia; there is limited, but growing evidence, to support its use for the prevention of delirium. The primary objective of this study is to describe the use of ramelteon and the incidence of delirium, assessed by Confusion Assessment Method for the ICU (CAM-ICU) scores, in adult surgical ICU patients from May 22, 2016 to June 30, 2018. The primary endpoint is the number of delirium free days in the week prior to and post first ramelteon administration. A total of 231 patients were included in the study with 201 (87%) positive for delirium at least once during the study timeframe. The median number of CAM-ICU negative days in the week pre-ramelteon administration was 4 days (IQR 2-7 days) compared to 6 days (IQR 3-7 days) in the week post-first ramelteon administration (P < .05). The time to CAM-ICU positive increased slightly to 3 days (IQR 1-7 days) following ramelteon initiation compared to 2 days (IQR 1-5 days) from initial ICU admission. Additionally, the median number of antipsychotic doses per patient decreased from 4 doses (IQR 1.25-14 doses) prior to ramelteon to 2 doses (IQR 1-4 doses) after ramelteon. Ramelteon administration was associated with a greater number of CAM-ICU negative days in surgical ICU patients. These findings describe a potential role for ramelteon in mitigating delirium in this patient population.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"249 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76988723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and Feasibility of Group Interpersonal Therapy (IPT-G) for Depressed HIV+ Postpartum Adolescents Delivered by Community Health Workers: A Protocol Paper","authors":"O. Yator, L. Khasakhala, G. John-Stewart, Manasi Kumar","doi":"10.1177/1179557320951222","DOIUrl":"https://doi.org/10.1177/1179557320951222","url":null,"abstract":"Introduction: Postpartum depression affects mothers at 4 to 6 weeks after delivery. Adolescent pregnancy can lead the expectant girl to drop out of school, receive poor obstetric care, and family support. Adolescent mothers are prone to severe postpartum depression as compared to older women. Early sexual initiation increases the risk of unintended pregnancies and potentially increases HIV exposure. WHO recommends Group interpersonal psychotherapy (IPT-G) as an evidence-based intervention for use in both primary care and community settings. We will assess the acceptability and feasibility of community health workers (CHWs), delivering IPT-G among postpartum adolescents (PPA) living with HIV. Method: This is a pilot feasibility study testing CHWs’ delivery of IPT-G to postpartum adolescents and young women living with HIV who will be attending the prevention of mother-to-child HIV transmission (PMTCT) clinics in 2 primary care health centers. Young women aged 15 to 24 years and 6 to 12 weeks postpartum will be eligible for participation. Our study is a two-arm intervention implementation study with one receiving group IPT and another one treatment-as-usual (TAU). We intend to treat the TAU group so that we will offer IPT-G post-intervention. There will be 2 groups running in the 2 facilities. Depression will be assessed using the Edinburgh postnatal depression scale (EPDS); those with EPDS >10 become eligible for the intervention. Besides, HIV-related stigma would be screened using HIV/AIDS Stigma Instrument (HASI–P), and social functioning rated using the World Health Organization’s Disability Assessment Schedule 2.0 (WHODAS 2.0). CHWs will deliver IPT-G for 8 sessions (1 session per week). The intervention group will receive immediate IPT-G, and the wait-list control group will receive deferred IPT-G as part of our intent to treat the group. Primary outcome measure and analysis: Descriptive statistics will be used to compare changes in depressive symptoms, HIV-related stigma, and social functioning between baseline and 8 weeks, and between 16 weeks and 24 weeks. The changes will be explored along with the differences between intervention and treatment as usual groups reporting effect sizes (Cohen’s d). Longitudinal continuous outcome variables across the time points will be analyzed using the Generalized Linear Model. For qualitative data, any emerging themes from KIIs and FGDs will be identified: framework matrixes, queries, and cross-tabulations will be used to analyze and interpret the data in view of assessing acceptability and feasibility of IPT-G. Ethics and dissemination The Kenyatta National Hospital-University of Nairobi approved this study of Nairobi Ethics and Research Committee (Approval No. P97/02/2018). The findings will be published in peer-reviewed journals and also shared with Kenya’s National AIDS Control Council.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"10 9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75096486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Perspective on Burnout: Snapshots of the Medical Resident Experience","authors":"J. Harsh, Tyler J Lawrence, Jessica B Koran-Scholl, R. Bonnema","doi":"10.1177/1179557319858991","DOIUrl":"https://doi.org/10.1177/1179557319858991","url":null,"abstract":"Background: Burnout is harmful and frequently experienced by medical residents. Causes of burnout are numerous. To date, there have been no qualitative studies incorporating semistructured interviews and resident-taken photographs on their perspectives of burnout. This method is advantageous for its ability to explore the lived experience of burnout, in depth. Objective: The purpose of this study is to discover, through photographs and semistructured interviews, medical residents’ perspectives on what burnout means in their lives and how they manage burnout experiences. Methods: In 2017, 8 residents from Internal Medicine and Family Medicine Residency Programs at a large, Midwestern academic medical center participated in this study. The Transcendental Phenomenological Method was used to analyze the data collected through semistructured interviews, which used resident photographs as a guide. Results: Residency training was often described as a challenging experience, particularly because it took away residents’ ability to focus on their personal lives due to long work hours. This often resulted in exhaustion, self-doubt, and damaged or neglected relationships. Despite this, residents took active steps to mitigate burnout through a variety of coping strategies. In addition, residents found camaraderie, joy, and personal growth during their residency experience. Conclusion: Burnout continues to be an important topic in medical education and specifically for medical residents. Learning more about how burnout is perceived and the effects of burnout on residents day-to-day lives can guide the future development of strategies to promote wellness and minimize the impact of burnout.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90057049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Continuation of Atypical Antipsychotics at Hospital Discharge in Two Intensive Care Unit Cohorts","authors":"Alexander R. Levine, Steven M. Lemieux, D. D'Aquino, Analise Tenney, M. Pisani, Syed Ali","doi":"10.1177/1179557319863813","DOIUrl":"https://doi.org/10.1177/1179557319863813","url":null,"abstract":"Introduction: Atypical antipsychotics are frequently initiated in the intensive care unit (ICU) to treat delirium. Many patients continue on these agents at hospital discharge despite a lack of data to support long-term use. Objectives: The primary aim of this study was to determine underlying risk factors for continuation of antipsychotics at hospital discharge in medical intensive care unit (MICU) and surgical intensive care unit (SICU) patients when evaluated as separate cohorts. Methods: A single-center, retrospective study in patients newly initiated on quetiapine, risperidone, or olanzapine in a 22-bed mixed medical-surgical ICU admitted from January 2017 to July 2018. Results: A total of 78 (62.9%) MICU patients and 46 (37.1%) SICU patients met the inclusion criteria during this time frame. A total of 29 MICU patients (37.2%) were prescribed antipsychotics at hospital discharge compared to 25 SICU patients (54.3%), P = .063. The percentage of MICU patients prescribed antipsychotics at hospital discharge was significantly higher in patients ⩾60 years of age (22 [75.9%] vs 26 [53.1%], P = .045), with a history of dementia (5 [17.2%] vs 1 [2%], P = .015), admitted with hemorrhagic stroke (5 [17.2%] vs 2 [4.1%], P = .049), and initiated on risperidone (3 [10.3%] vs 0%, P = .022). The risk of pre-existing dementia remained significant in a multivariate logistic regression that controlled for confounding variables, odds ratio (OR) = 10 (95% confidence interval [CI]: 1.11-90.5, P = .040). The percentage of SICU patients prescribed antipsychotics at discharge was significantly higher in those with severe traumatic brain injury (TBI; 8 [72.7%] vs 0%, P = .004) and initiated on quetiapine (19 [76%] vs 9 [42.9%], P = .022). Conclusion: Antipsychotics were commonly continued at hospital discharge in both MICU and SICU patients. Several risk factors for continuation of antipsychotics were identified in these two cohorts. Future efforts assessing the appropriateness of antipsychotics at transitions of care are warranted.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80921467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Photovoice to Document Living With Mental Illness on a College Campus","authors":"Elizabeth Skoy, Amy Werremeyer","doi":"10.1177/1179557318821095","DOIUrl":"https://doi.org/10.1177/1179557318821095","url":null,"abstract":"Almost one-fourth of college students are living with a mental illness. Although much discussion has taken place on the mental health of today’s students, information from the students living with mental illness is lacking. The purpose of this study was to allow college students living with mental illness to document and communicate their realities with peers and university stakeholders through the participatory action research methodology, Photovoice. Seventeen college students who were prescribed at least one medication used to treat mental illness were given disposable cameras and asked to take photographs reflecting their realities of living with mental illness. Students met individually with researchers for reflection and as a focus group with other participants to discuss their photographs. All meetings were audio recorded, transcribed and qualitatively analysed. An additional meeting was held to communicate the students’ realities with campus stakeholders. Main themes identified were: insights into campus services, increasing awareness and educating others, support, and barriers to getting better. Photovoice was an effective methodology to allow college students living with mental illness to communicate with campus stakeholders to increase awareness and education. Through the sharing of photographs and reflections, policies and practices affecting students living with mental illness are being examined.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90185667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Blurred Line between Physical Ageing and Mental Health in Older Adults: Implications for the Measurement of Depression","authors":"Cassie M. Hazell, Helen E. Smith, Christina J. Jones","doi":"10.1177/1179557319885634","DOIUrl":"https://doi.org/10.1177/1179557319885634","url":null,"abstract":"Objectives: Depression in older adults is assessed using measures validated in the general adult population. However, such measures may be inappropriate in the elderly due to the similarities between ageing and the symptoms of depression. This article discusses whether these measures are fit for the purpose and the implications of using inappropriate tools. Methods: A commentary on measuring depression in older adults. Results: Depression symptoms may be mistaken for signs of ageing. Several measures of depression include items that may have a physical cause and thus generate measurement error. Those studies that have assessed the psychometric properties of depression measures in older adults have failed to conduct appropriate assessments of discriminant validity. Discussion: Research is needed to determine whether the conceptual similarity between some symptoms of depression and the effects of ageing translate to factorial similarity. If so, there may be a need for a specific depression measure for older adults that prioritises psychological symptoms.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89351145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between living with a spouse and mental health in the elderly population: Moderated mediation effects of loneliness and perceived problems","authors":"Lin Ken Soh, J. Pang","doi":"10.1177/1179557319876646","DOIUrl":"https://doi.org/10.1177/1179557319876646","url":null,"abstract":"Objectives: Study 1 investigated if the elderly’s perception of experiencing life problems moderates the effect of spousal living arrangements on their mental health, while study 2 first assessed loneliness as a mediator on the spousal living arrangements and mental health relationship, and then tested 2 moderated-mediation models whereby perceived problems moderates the mediation. Methods: Study 1 involved 135 participants aged 60 years and above (mean = 70.96; SD = 6.16); Study 2 involved 122 participants aged 65 years and above (mean = 74.85; SD = 6.91). Results: This study found simple moderation and mediation effects of perceived problems and loneliness, respectively, on the spousal living arrangements and mental health relationship. Furthermore, results showed that perceived problems moderate the loneliness and mental health link in a moderated-mediation model. Discussion: Findings inform potential interventions for elderly mental health. Interventions could focus on reducing loneliness and problems faced by the elderly, especially those with nonspousal living arrangements.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84391634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Examination of the Relationship Between Insomnia and Tinnitus: A Review and Recommendations","authors":"G. Asnis, Kiran Majeed, Margaret A. Henderson, Clewert Sylvester, Manju Thomas, Richard De La Garza","doi":"10.1177/1179557318781078","DOIUrl":"https://doi.org/10.1177/1179557318781078","url":null,"abstract":"Tinnitus is a prevalent medical disorder which frequently becomes chronic and severe. Furthermore, quality of life can become compromised with many experiencing comorbid insomnia. We hypothesize that insomnia is a highly prevalent symptom and diagnostic category accompanying tinnitus. Our article reviews the tinnitus literature examining the prevalence of insomnia, the sleep disturbances found, and any methodological issues. Our literature search included a number of databases such as PubMed, Cochrane, and Embase. We found that 16 prior studies had sufficient data presented that allowed for an assessment of the prevalence rate of insomnia in tinnitus; the prevalence rate ranged from 10% to 80% (most rates were over 40%). The overwhelming majority of these studies inadequately defined insomnia as a diagnosis but described it only as a symptom. They focused predominantly on questionnaires (sent via the mail) asking only 1 to 4 questions on whether tinnitus disturbs sleep. Frequently, the only question asked was whether tinnitus disturbed a patient’s sleep without clarifying whether there were problems with daytime functioning. Thus, a valid insomnia diagnosis could not be established. Even in the few studies that asked the necessary information to establish a diagnosis of insomnia, only 1 study provided it. The presence of insomnia in tinnitus was associated with a more severe form of tinnitus. Alarmingly, insomnia was mainly untreated despite evidence supporting that successful treatment of insomnia might also help comorbid tinnitus. Because insomnia is significantly prevalent in tinnitus patients and appears to potentially further impact negatively on one’s quality of life, clinicians should address this possibility with a detailed clinical evaluation; incorporating self-rating questionnaires on sleep could be clinically helpful. If insomnia is present, therapy should be considered.","PeriodicalId":10437,"journal":{"name":"Clinical Medicine Insights: Psychiatry","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89723161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}