Background ICD–10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs; F23). Aims To validate the nosological distinctiveness of ICD–10 ATPDs by following up an inception cohort with first-episode... more
Background ICD–10 has introduced the diagnostic group acute and transient psychotic disorders (ATPDs; F23).
Aims To validate the nosological distinctiveness of ICD–10 ATPDs by following up an inception cohort with first-episode psychosis.
Method All patients with first-episode psychosis identified in Nottingham between 1992 and 1994 and diagnosed using ICD–10 criteria were reassessed 3 years later. ATPD outcomes were compared with schizophrenia and affective psychosis. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable 3-year outcome in first-episode psychosis.
Results Of 168 cases of first-episode psychosis, 32 (19%) received an intake diagnosis of ATPD. The diagnosis of ATPD was stable in women over 3 years, but not in men. Outcomes in ATPD were better than in schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and premorbid functioning rather than acute onset and early remission.
Conclusions The ICD–10 criteria for ATPDs identify a diagnostically unstable group of disorders. Acute onset and early remission do not independently predict favourable outcome over 3 years in first-episode psychosis.
Резюме. Прегабалин является новым анксиолитиком, механизм действия которого связан со снижением повышенного выброса возбуждающих нейромедиаторов, в том числе глутамата. Вместе с тем нарушения глутаматергической нейро-трансмиссии в... more
Резюме. Прегабалин является новым анксиолитиком, механизм действия которого связан со снижением повышенного выброса возбуждающих нейромедиаторов, в том числе глутамата. Вместе с тем нарушения глутаматергической нейро-трансмиссии в настоящее время рассматриваются в качестве основного патогенетического механизма шизофрении. Эти данные наряду с тем, что феномен тревоги занимает видное место в клинической картине формирующихся психозов, поз-волили сформулировать гипотезу о перспективности применения при них прегабалина в комбинации с антипсихотика-ми. В качестве иллюстрации приведен доклад о серии случаев успешного усиления прегабалином стабильной антипсихо-тической терапии на ранних этапах экзацербаций шизофренического процесса. Ключевые слова: прегабалин, атипичные антипсихотики, шизофрения. Summary. Pregabalin is the novel anxiolytic drug which mechanism of action associated with normalization of increased release of exciting neuromediators including glutamate. At the same time disturbances of glutamatergic neurotransmission nowadays are thought as the major pathogenetic mechanism of schizophrenia. These considerations along with that anxiety phenomenon is prominent in the clinical picture of early phases of psychotic exacerbations allowed to hypothesize the effectiveness of combination of antipsychotics with pregabalin in the treatment of such states. This hypothesis is illustrated by report of a case series of successful augmentation of stable antipsychotic treatment with pregabalin in the treatment of early stages of schizophrenic exacerbations.
The main objective of this study was to learn more about what increases or decreases the likelihood of patient conflict (such as verbal abuse, violence, and rule breaking) and containment (such as seclusion, manual restraint, and enforced... more
The main objective of this study was to learn more about what increases or decreases the likelihood of patient conflict (such as verbal abuse, violence, and rule breaking) and containment (such as seclusion, manual restraint, and enforced medication) events in acute inpatient psychiatric wards. Line graphs that mapped the total conflict and containment scores over two years on 16 acute inpatient psychiatric wards in the United Kingdom (London) were matched with chronological events that were documented in 120 qualitative semistructured interviews with ward managers and consultant psychiatrists during the same two-year period. Conflict and containment scores were derived from the validated Patient-Staff Conflict Checklist-Shift Report, which was completed by nurses at the end of each shift to log the frequency of conflict behaviors of patients and the staff containment measures. A total of 463 score transitions (upturns and downturns) were identified in the graphs. A total of 323 eve...
Introduction: The insular cortex is a hidden structure located in the Sylvian fissure surrounded by the temporal, frontal, and parietal lobes. It is a complex structure interconnecting various brain regions. The insular lobe plays... more
Introduction: The insular cortex is a hidden structure located in the Sylvian fissure surrounded by the temporal, frontal, and parietal lobes. It is a complex structure interconnecting various brain regions. The insular lobe plays multiple roles including visceromotor, viscerosensory and limbic functions. These roles contribute to control autonomic, memory, behavior and language system. The arteries supplying the insular area are mainly originate from the M2 segment of the middle cerebral artery. The isolated insular infarction stroke is extremely rare. The objective was to report this case study with literature reviewed. Clinical study: The 60-year-old patient was admitted to our tertiary hospital with behavioral complains symptoms. He had a pass history of essential thrombocythemia under hydroxyurea. The disorders were started suddenly and marked by behavioral disturbances such as self runaways, aggression and a feeling of strangulation. The clinical examination revealed personality disorders with delusions of persecution type, auditory hallucinations, unmotivated laughing and crying, and speech disorders such as tachylalia and paraphasia. There was an unpleasant sensation of the left hemi-body and no motor deficit or cranial nerves involvement. Brain magnetic resonance imaging revealed isolated infarction of the left insular cortex (Figure 1). The diagnostic of left insular infarction with psychiatric manifestations was made and the patient underwent anti platelet treatment and remote psychiatric control drugs. After three months of follow up, the patient had got good recovery of language, mood and behavioral disorders. Conclusion: The polymorphism of insular stroke clinical presentation raises the major interest of after stroke clinical and neuropsychological follow up to improve the quality of life of patient. The prognosis of the isolated insular infarction is often favorable but under appropriate diagnostic.
Objective: The main objective of this study was to learn more about what increases or decreases the likelihood of patient conflict (such as verbal abuse, violence, and rule breaking) and containment (such as seclusion, manual restraint,... more
Objective: The main objective of this study was to learn more about what increases or decreases the likelihood of patient conflict (such as verbal abuse, violence, and rule breaking) and containment (such as seclusion, manual restraint, and enforced medication) events in acute inpatient psychiatric wards.
Methods: Line graphs that mapped the total conflict and containment scores over two years on 16 acute inpatient psychiatric wards in the United Kingdom (London) were matched with chronological events that were documented in 120 qualitative semistructured interviews with ward managers and consultant psychiatrists during the same two-year period. Conflict and containment scores were derived from the validated Patient-Staff Conflict Checklist—Shift Report, which was completed by nurses at the end of each shift to log the frequency of conflict behaviors of patients and the staff containment measures.
Results: A total of 463 score transitions (upturns and downturns) were identified in the graphs. A total of 323 events were matched to these transitions. A thematic analysis of these events produced 40 themes, which were organized into four categories: patient centered, staff centered, practice or ward centered, or other themes. Thirteen themes were significantly associated with conflict and containment score transitions, 11 of which were staff centered. For example, negative staff morale and staffing change resulting in a negative impact significantly increased the likelihood that conflict and containment would occur, whereas report of positive staff practice significantly decreased the likelihood of such events occurring.
Conclusions: The results support the theory that ward staff play a crucial role in influencing the likelihood that conflict or containment events will occur in inpatient psychiatric settings. (Psychiatric Services 63:40–47, 2012)
