Suicidal behavior in Indian adolescents

Suicide is both a public and mental health problem, and is a leading cause of deaths, especially among adolescents. Two factors that contribute to the decision of adolescents to commit suicide are having a primary mood disorder and/or substance use. In the Indian culture, the family unit has both a positive and negative impact on suicide. The family serves as a protective factor that provides a strong support for the individual, but alternately creates an inseparable individual when seeking mental health care, which often complicates the situation. Due to the stigma, Indians typically perceive having a mental illness as shameful. Religion is integral to the Indian culture so much so that individuals often use herbal remedies, seek help from religious leaders, and attend religious establishments prior to obtaining a mental health evaluation in those that are subsequently deemed as mentally ill. Despite the fact that suicides are underreported and misdiagnosed in India, it is known that the highest rates are among those <30 years old. The methods most commonly used to commit suicide in India include the ingestion of poison (often pesticides), hanging, burning, and drowning. When immigrating, Indians tend to switch the methods they use to commit suicide from ingestion of poison to hanging, which may reflect a lack of available poisonous substances or the influence of the host culture. Considering the high suicide rates in adolescents, the importance of providing psychoeducation, restricting access to lethal means, and promoting social integration in immigrants are various ways by which suicides in Indian adolescents can be avoided.

Child sexual abuse and the pathophysiology of suicide in adolescents and adults

BACKGROUND

Child sexual abuse (CSA) is widespread and is associated with various psychopathologies, including Axis I and II disorders, maladaptive and impulsive behaviors, and suicidal behavior in adolescence and adults. The pathophysiology of this association is not well understood; however, it is clear that suicidal behavior in individuals with a history of CSA is a significant social and medical problem that warrants further investigation.

METHODS

An electronic search of the major behavioral science databases (limited to the most recent studies in the last 20 years) was conducted to retrieve studies detailing the social, epidemiological, and clinical characteristics of child sexual trauma and their relation to suicidal behavior in adolescents and adults.

RESULTS

Studies indicate that CSA is related to an increase in Axis I and II diagnoses, including depression, post-traumatic stress disorder, conduct disorders, eating disorders, alcohol and drug abuse, panic disorders, and borderline personality disorder. CSA not just related to an increase in impulsivity and risky behaviors, it has also been linked to an increase in suicidality as well.

CONCLUSION

CSA makes both direct and indirect contributions to suicidal behavior. It is a complex process involving multiple variables, which include psychopathology, maladaptive personality features and the direct contribution of CSA itself. Psychopathologies, such as impulsivity and mood and personality disorders, may modulate the relationship between CSA and suicidal behavior. Some preventive measures for decreasing the prevalence of CSA and suicidality may include education as well as increased access to mental health services.

Brain structural and functional changes in adolescents with psychiatric disorders

During adolescence, hormonal and neurodevelopmental changes geared to ensuring reproduction and achieving independence are very likely mediated by the growth of neural processes, remodeling of synaptic connections, increased myelination in prefrontal areas and maturation of connecting subcortical areas. These processes, greatly accelerated in adolescence, follow an asynchronous pattern in different brain areas. Neuroimaging research using functional and structural magnetic resonance imaging has produced most of the insights regarding brain structural and functional neuropathology in adolescent psychiatric disorders. In schizophrenia, first episodes during adolescence are linked to greater-than-normal losses in gray matter density and white matter integrity and show a divergence of maturational trajectories from normative neural development in a progression similar to that of adult-onset schizophrenia. Anxiety and mood disorders in adolescence have been linked to abnormally increased activity in the amygdala and ventral prefrontal cortical areas, although some data suggest that neural abnormalities in the amygdala and anxiety maybe particularly more frequent in adolescents than in adults. Alcohol misuse in adolescence results in reduced integrity in the white matter and reduced gray matter density that, given the high intensity of adolescent synaptic and myelin remodeling, may result in persistent and profound changes in circuits supporting memory and emotional and appetitive control. The interaction of persistent changes due to prenatal exposure with the contemporaneous expression of genetic factors and disturbing environmental exposure may be an important factor in the appearance of psychiatric disorders in adolescence. Further progress in understanding adolescent psychopathology will require postmortem research of molecular and cellular determinants in the adolescent brain.

[The structure of psychopathology associated with addictive disorders, against alcohol addiction and the possibility of its neurometabolic correction of the elderly]

The article considers the actual problem in modern medicine, the study of psychiatric symptoms associated with addictive disorders on the background of alcohol abuse in the elderly. It is shown that neurotic pathology in elderly patients with alcohol dependence is characterized by the presence of six major symptoms, reflecting the excitation processes, overcoming compensation, deficit symptoms, irritation and stabilization of the pathological state. It is proved that Cytoflavin, maintaining a certain level of excitement in the cerebral cortex, provides the optimal voltage of compensatory mechanisms in older people in overcoming their psychiatric symptoms, connected with addictive disorders.

Skin conductance levels may reflect emotional blunting in behavioral variant frontotemporal dementia

Emotional blunting is a core diagnostic feature of behavioral variant frontotemporal dementia (bvFTD). The authors evaluated skin conductance as a measure of emotional blunting among 10 patients with bvFTD compared with 10 with Alzheimer's disease and 14 healthy control subjects. Despite responses to an auditory startle stimulus, skin conductance levels (SCLs) were lower in the patients with bvFTD compared with the other groups. The low SCLs significantly correlated with ratings of emotional blunting. The authors conclude that low SCLs in bvFTD indicate a low resting sympathetic state and low emotional arousal. The measurement of SCLs may be a useful noninvasive diagnostic test for bvFTD.

Clinical presentation of chronic traumatic encephalopathy

OBJECTIVE

The goal of this study was to examine the clinical presentation of chronic traumatic encephalopathy (CTE) in neuropathologically confirmed cases.

METHODS

Thirty-six adult male subjects were selected from all cases of neuropathologically confirmed CTE at the Boston University Center for the Study of Traumatic Encephalopathy brain bank. Subjects were all athletes, had no comorbid neurodegenerative or motor neuron disease, and had next-of-kin informants to provide retrospective reports of the subjects' histories and clinical presentations. These interviews were conducted blind to the subjects' neuropathologic findings.

RESULTS

A triad of cognitive, behavioral, and mood impairments was common overall, with cognitive deficits reported for almost all subjects. Three subjects were asymptomatic at the time of death. Consistent with earlier case reports of boxers, 2 relatively distinct clinical presentations emerged, with one group whose initial features developed at a younger age and involved behavioral and/or mood disturbance (n = 22), and another group whose initial presentation developed at an older age and involved cognitive impairment (n = 11).

CONCLUSIONS

This suggests there are 2 major clinical presentations of CTE, one a behavior/mood variant and the other a cognitive variant.

Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review

BACKGROUND

Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC.

METHODS

We searched MEDLINE, EMBASE, PsychINFO, and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC. Study quality was described using the Cochrane collaboration risk of bias tool. The efficacy of medications was evaluated using NPS symptom rating scales. Safety was evaluated through rates of trial withdrawals, trial withdrawals due to adverse events, and mortality.

RESULTS

A total of 29 studies met inclusion criteria. The most common medications evaluated in studies were atypical antipsychotics (N = 15), typical antipsychotics (N = 7), anticonvulsants (N = 4), and cholinesterase inhibitors (N = 3). Statistically significant improvements in NPS were noted in some studies evaluating risperidone, olanzapine, and single studies of aripiprazole, carbamazepine, estrogen, cyproterone, propranolol, and prazosin. Study quality was difficult to rate in many cases due to incomplete reporting of details. Some studies reported higher rates of trial withdrawals, adverse events, and mortality associated with medications.

CONCLUSIONS

We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations. However, the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.

Problem based review: a patient with Parkinson's disease

Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease characterized by bradykinesia, tremor and/ or rigidity, often with gait disturbance and postural instability. In addition to these typical features, patients with PD may experience further problems related to the disease itself or to the medications used to treat it. These comorbid problems include neuropsychiatric conditions (including psychosis, hallucinations, excessive daytime sleepiness, anxiety, depression, fatigue and dementia) as well as problems associated with autonomic nervous system function such as bowel and bladder function. PD can also present in emergency situations with a 'neuroleptic malignant like picture' and acute psychosis. It is not uncommon to see motor fluctuations due to drug interactions and 'withdrawal' symptoms following dose reduction of dopamine agonists. In patients with PD, disturbances of mental state constitute some of the most difficult treatment challenges of advanced disease, often limiting effective treatment of motor symptoms and leading to increased disability and poor quality of life. While some of these symptoms may be alleviated by antiparkinsonian medication, especially if they are 'off-period' related, treatment-related phenomena are usually exacerbated by increasing the number or dosage of antiparkinsonian drugs. Elimination of exacerbating factors and simplification of drug regimens are the first and most important steps in improvement of such symptoms.

[Features of psychopharmacotherapeutic correction of alcohol dependence in the elderly]

The article is devoted to the actual in modern medicine problem as the study of the prevalence of alcohol dependence and its psyhofarmacological correction in the elderly. It is shown that elderly and old age as a result of reduction of the reserve capacity of the organism for clinical pathology becomes addictive specific psychopathological features that affect the course of disease and maintenance of preventive treatment. On the basis of empirical evidence the authors prove that at the border severity of alcohol withdrawal syndrome the drug "Cytoflavin" has a fairly pronounced psyhofarmacological activity for older people with alcohol dependence.

[Approaches to cognitive-behavioral features in the treatment of obsessive-compulsive disorder]

The author has extensive clinical experience in the treatment of refractory obsessive-compulsive disorder (OCD). There appear to be numerous clinical factors affecting the treatment responses of OCD patients, but the cognitive-behavior features of these patients could also be contributory. In this article, the author reports a man with OCD who had cognitive-behavioral features affecting the severity of OCD. There was no definitive diagnosis of developmental disorder. However, approaches to cognitive-behavioral features were effective. It became much easier for the patient to suppress his compulsions. The author speculates that approaches to cognitive-behavioral features are both important and useful for the treatment of patients with OCD regardless of whether or not developmental disorders are present.

[The structure of psychopathology associated with addictive disorders, against alcohol addiction and the possibility of it's neurometabolic correction in the elderly]

The article presents the analysis of the structure and dynamics of psychopathology associated with addictive disorders in elderly patients with alcohol dependence. In terms of syndromic approach the structure of neurotic disease in elderly patients with a verified diagnosis of mental and behavioral disorders associated with alcohol consumption was evaluated. In the overall structure of neurotic pathology in these patients the analysis of symptoms of neurotic diseases, the research of the structure of syndromes and their dynamics were carried out, as well as the patient's attitude to the disease and to its manifestations was determined. A factor model of the pathogenesis of neurotic pathology connected with mental and behavioral disorders due to alcohol use in elderly patients was developed. The high clinical effectiveness of the drug "Cytoflavin" used in the reduction of psychiatric symptoms in patients aged from 62 to 74 years with a diagnosis of mental and behavioral disorders associated with alcohol consumption has been shown.

[Rate and characteristics of dementia patients who visit psychiatric emergency hospitals for the treatment of behavioral and psychological symptoms of dementia (BPSD) in Japan]

BACKGROUND

Neuropsychiatric symptoms and behavioral changes, known as behavioral and psychological symptoms of dementia (BPSD), are often observed in patients with dementia. BPSD impairs a patient's quality of life, increases the burden on the caregivers, and can be a predictor of the need for institutionalization. BPSD can aggravate on holidays or at night, when general psychiatric clinics are closed. When psychiatric symptoms aggravate on holidays or at night in patients with psychiatric disorders other than dementia, such as schizophrenia and manic psychosis, the patients visit psychiatric emergency hospitals. However, it has not been assessed whether patients with dementia visit psychiatric emergency hospitals for the treatment of BPSD on holidays or at night, although dementia patients are increasing and account for 10.5% of psychiatric outpatients in Japan.

AIMS

To determine the percentage of dementia patients with BPSD in all psychiatric patients who visit psychiatric emergency hospitals, and the characteristics of patients with BPSD in Japan.

METHOD

We developed two questionnaires. One was for psychiatric emergency hospitals and assessed the numbers of all patients, patients over 65 years old, and patients over 65 years and with BPSD or BPSD-like symptoms, who visited the psychiatric emergency hospitals on holidays or at night. The other questionnaire was for each patient over 65 years and with BPSD, and assessed the patients' characteristics, including their diagnosis, sex, what kinds of BPSD or BPSD-like symptoms brought them to the hospital, and whether they had visited a psychiatric clinic or hospital during the preceding 12 months. The questionnaires were sent to 360 hospitals that belong to the Japan Psychiatric Hospitals Association and treat patients with acute psychotic symptoms or dementia. This prospective survey was conducted from October 1 to November 30, 2009.

RESULTS

One hundred and forty-three hospitals returned the questionnaires (response rate: 39.7%). In the survey period, 3,527 patients visited the psychiatric emergency hospitals on holidays or at night, but only 67 patients over 65 years old (1.9%) visited the hospitals for BPSD or BPSD-like symptoms. Thirty-four of the 67 patients were men, and their average age was 79.4 +/- 6.4 years old. Thirty-five patients had visited but 25 patients had never visited psychiatric clinics or hospitals during the preceding 12 months. Eight patients had physical complications that required examination for several days, while 57 patients did not require such treatment. Forty-seven patients were diagnosed with dementia. Patients with Alzheimer's disease (AD) (29 patients) were the most common, followed by those with vascular dementia (VaD) (8 patients) and those with dementia with Lewy bodies (DLB) (4 patients). Among the 47 patients with dementia, agitation/aggression was the most frequent BPSD symptom (30 patients), followed by irritability (18 patients) and aberrant motor behaviors (17 patients). The BPSD symptoms observed at the psychiatric emergency hospitals differed due to the causative dementia. Agitation/aggression, aberrant motor behaviors, and irritability were the most frequent causative symptoms in AD, agitation/aggression and irritability were the most frequent causative symptoms in VaD, and hallucinations and illusions were the most frequent causative symptoms in DLB.

CONCLUSIONS

Our survey revealed that few patients over 65 years old visited psychiatric emergency hospitals for BPSD on holidays or at night in Japan, and that many of them had not regularly visit psychiatric clinics or dementia hospitals in the preceding 12 months. These results indicate that dementia patients need to visit their doctors regularly to avoid visiting psychiatric emergency hospitals on holidays or at night, and caregivers should be aware that they can visit psychiatric emergency hospitals for the treatment of BPSD on holidays or at night.

Validating the Center for Epidemiological Studies Depression Scale for Children in Rwanda

OBJECTIVE

We assessed the validity of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) as a screen for depression in Rwandan children and adolescents. Although the CES-DC is widely used for depression screening in high-income countries, its validity in low-income and culturally diverse settings, including sub-Saharan Africa, is unknown.

METHOD

The CES-DC was selected based on alignment with local expressions of depression-like problems in Rwandan children and adolescents. To examine criterion validity, we compared CES-DC scores to depression diagnoses on a structured diagnostic interview, the Mini International Neuropsychiatric Interview for Children (MINI KID), in a sample of 367 Rwandan children and adolescents aged 10 through 17 years. Caregiver and child or adolescent self-reports endorsing the presence of local depression-like problems agahinda kenshi (persistent sorrow) and kwiheba (severe hopelessness) were also examined for agreement with MINI KID diagnosis.

RESULTS

The CES-DC exhibited good internal reliability (α = .86) and test-retest reliability (r = .85). The area under the receiver operating characteristic curve for the CES-DC was 0.825 when compared to MINI KID diagnoses, indicating a strong ability to distinguish between depressed and nondepressed children and adolescents in Rwanda. A cut point of≥30 corresponded with a sensitivity of 81.9% and a specificity of 71.9% in this referred sample. MINI KID diagnosis was well aligned with local expressions of depression-like problems.

CONCLUSION

The CES-DC demonstrates good psychometric properties for clinical screening and evaluation in Rwanda, and should be considered for use in this and other low-resource settings. Population samples are needed to determine a generalizable cut point in nonreferred samples.

Evidence of a distinct behavioral phenotype in young boys with fragile X syndrome and autism

OBJECTIVE

How does the behavioral expression of autism in fragile X syndrome (FXS + Aut) compare with idiopathic autism (iAut)? Although social impairments and restricted, repetitive behaviors are common to these variants of autism, closer examination of these symptom domains may reveal meaningful similarities and differences. To this end, the specific behaviors comprising the social and repetitive behavioral domains in young children with FXS + Aut and iAut were profiled.

METHOD

Twenty-three male subjects 3 to 5 years old with FXS + Aut were matched by age to a group of 38 boys with iAut. Repetitive behavior was assessed using the Repetitive Behavior Scales-Revised. Social behavior was evaluated using Autism Diagnostic Observation Schedule social item severity scores.

RESULTS

Rates of stereotypy, self-injury, and sameness behaviors did not differ between groups, whereas compulsive and ritual behavior scores were significantly lower for subjects with FXS + Aut compared with those with iAut. Those with FXS + Aut scored significantly lower (less severe) than the iAut group on five Autism Diagnostic Observation Schedule measurements of social behavior: gaze integration, quality of social overtures, social smile, facial expressions, and response to joint attention.

CONCLUSIONS

The behavioral phenotype of FXS + Aut and iAut are most similar with respect to lower-order (motoric) restricted, repetitive behaviors and social approach, but differ in more complex forms of restricted, repetitive behaviors and some social response behaviors. These findings highlight the phenotypic heterogeneity of autism overall and its unique presentation in an etiologically distinct condition.

Treatments for the challenging behaviours of adults with intellectual disabilities

OBJECTIVE

To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs).

METHOD

Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies.

RESULTS

Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs.

CONCLUSIONS

One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.

What are the barriers to performing nonpharmacological interventions for behavioral symptoms in the nursing home?

OBJECTIVE

Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms.

DESIGN

A descriptive study of barriers to intervention delivery in a controlled trial.

SETTINGS

The study was conducted in six nursing homes in Maryland.

PARTICIPANTS

Participants were 89 agitated nursing home residents with dementia.

INTERVENTION

Personalized interventions were developed using the Treatment Routes for Exploring Agitation decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined.

MEASUREMENTS

Barriers to Intervention Delivery Assessment, activities of daily living, cognitive functioning, depressed affect, pain, observed agitation, and observed affect.

RESULTS

Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, whereas higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment.

CONCLUSION

Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery.

Symptoms at presentation in children with sleep-related disorders

OBJECTIVE

To assess the link between sleep-disordered breathing and cognitive function in children. To identify correlations among polysomnography, upper respiratory infections, or cephalometric as well as rhinometric measures.

METHODS

This study is based on a questionnaire survey of snoring in a population cohort of 2100 children. Altogether, 44 snorers and 51 non-snorers participated in this community based clinical study. All children underwent polysomnography, cephalometry and rhinometric measurements. In addition, a standardized test of intelligence (WPPSI-R), a neuropsychological test battery (NEPSY) and a parental questionnaire on behavioral symptoms (CBCL) were administered.

RESULTS

Frequently snoring children scored lower in Language functions (Comprehension of Instructions, P=0.01; Speeded naming, P=0.007) and had more internalizing problems, P=0.04 than did the non-snoring group. However, the polysomnography parameters of these snoring children revealed no major sleep-related breathing disorder. OAHI, mean lowest SpO(2) and respiratory effort correlated with Auditory Attention (P<0.05), Body Part Naming (P<0.05) and Memory (P<0.05). Tonsillar size correlated with OAHI (P<0.01) and respiratory effort (P=0.01) and respiratory airflow (P<0.01). In cephalometry, the minimal distance from velum to posterior wall was shorter showing the shorter length among snorers than non-snorers, 5.5mm vs. 6.6mm, respectively (P<0.05). Recurrent upper respirataory infections (URIs) were common among the snoring than non-snoring children (P=0.01). Children suffering recurrent URIs have more somatic complaints than children without recurrent URIs (P<0.01).

CONCLUSIONS

Snoring children with apparently normal and/or no obstructive apnea, hypopnea, or marked SpO(2) desaturations appear to suffer impairment in neurocognitive and behavioral functions compared to non-snoring children. These snoring children did not reveal any major abnormalities of polysomnographic parameters, such as sleep-related breathing disorder, including partial upper airway obstruction. Polysomnographic parameters also correlated poorly with neurocognitive test results in these snoring children. The correlations between polysomnography and upper respiratory infections, with cephalometric and rhinometric measures, were also poor.

Attention bias modification treatment for pediatric anxiety disorders: a randomized controlled trial

OBJECTIVE

While attention bias modification (ABM) is a promising novel treatment for anxiety disorders, clinical trial data remain restricted to adults. The authors examined whether ABM induces greater reductions in pediatric anxiety symptoms and symptom severity than multiple control training interventions.

METHOD

From a target sample of 186 treatment-seeking children at a hospital-based child anxiety clinic, 40 patients with an ongoing anxiety disorder who met all inclusion criteria were enrolled in the study. Children were randomly assigned to one of three conditions: ABM designed to shift attention away from threat; placebo attention training using stimuli identical to those in the ABM condition; and placebo attention training using only neutral stimuli. All participants completed four weekly 480-trial sessions (1,920 total trials). Before and after the attention training sessions, children's clinical status was determined via semistructured interviews and questionnaires. Reduction in the number of anxiety symptoms and their severity was compared across the three groups.

RESULTS

Change in the number of anxiety symptoms and their severity differed across the three conditions. This reflected significant reductions in the number of anxiety symptoms and symptom severity in the ABM condition but not in the placebo attention training or placebo-neutral condition.

CONCLUSIONS

ABM, compared with two control conditions, reduces pediatric anxiety symptoms and severity. Further study of efficacy and underlying mechanisms is warranted.

[Analysis of postoperative quality of life and survival of patients after surgical interventions on carotid arteries]

The authors analysed the quality of life and survival of patients from 1 to 4 years after operative treatment for stenosmg lesions of internal carotid arteries (Group One) or pathological kinking of internal carotid arteries (Group Two). The highest frequency of the problems in the first group was in the components pain/discomfort (91.7%) and motility (88.9% of the interviewed). In the second group of patients, the most commonly encountered disorders were pain/ discomfort (66.7%) and anxiety/depression (66.7% of the interviewed). Also analysed was the influence of the duration of anaesthesia and the type of an anaesthetic used to maintaining anaesthesia (sodium thiopental or propofol) on the postoperative quality of life. There were no statistically significant differences in the postoperative quality of life by the health index and EQVAS in the groups of the patients having received various anaesthetics in order to maintain anaesthesia (p=0.541 and p=0.148, respectively).

[Characteristics of psychologic features of tantalum production workers]

The article covers results of psychologic examination of apparently healthy workers of contemporary tantalum production. The authors describe changes in psychoemotional state of workers engaged into major tantalum production workshops, in accordance with occupational length of service.

[Psycho-emotional state of workers engaged into chlorine and soda production through electrolysis with mercury-pool cathode]

Workers engaged into the studied production are exposed to occupational factors complex as vapor, gas and aerosol mixture. Metallic mercury vapors and its compounds exceed MAC over 10 times in this mixture, noise level at the enterprise is 10 dB over the maximal allowable level, general vibration is 8 dB over the MAL, the occupational hazards also include unfavorable microclimate, work hardiness and intensity. Psychoemotional state of the workers demonstrate significantly disordered emotions and will, premorbid personality changes, lower memory and attention level, indisposition and mood changes, increased reactive and personal anxiety, decreased performance level. Informative parameter in occupational examination of workers is memory and attention level evaluation.

Psychotic symptoms in young adults exposed to childhood trauma--a 20 year follow-up study

Childhood adversity has been shown to increase the risk of psychotic symptoms in adult life. However, there are no previous studies looking at the association between experiencing a natural disaster during childhood and the development of psychotic symptoms in young adulthood. Eight hundred and six bushfire-exposed children and 725 control children were evaluated following the 1983 South Australian bushfires. Five hundred and twenty nine (65.6%) of the bushfire group and 464 (64%) controls participated in a follow up study 20 years later. Childhood data on emotional and behavioural disorders and dysfunctional parenting was available. The adult assessment included the Australian National Health and Well-Being psychosis screen and detailed information about trauma, childhood adversity and alcohol and cannabis abuse. 5.6% of subjects responded positively to the psychosis screen and 2.6% responded positively to a further probe question. Psychotic symptoms were more common in subjects exposed to a greater number of traumas, and were associated with higher rates of childhood adversity, emotional and behavioural disturbance, dysfunctional parenting, and alcohol and cannabis abuse. Subjects exposed to bushfires as children did not have a greater risk of psychosis. Our results indicate that exposure to multiple traumas, rather than a single major trauma, increases the risk of later psychosis.

The aging of Anna Freud's diagnostic profile: a re-examination and re-application of the psychoanalytic assessment for older adults

In 1962 Anna Freud published her pioneering paper on the Diagnostic Profile, proposing a framework for organizing relevant clinical material and observations for the assessment of a child's inner world. Since that time, the Profile has been applied, with modifications, to work with babies, adolescents, adults, blind children, and others. This paper strives to demonstrate the Profile's applicability to a group often neglected in the psychoanalytic literature, namely the older population, a vibrant group frequently seeking psychotherapy and even psychoanalysis. A case study of a woman in her 70s is used to illustrate the advantages for clinicians of the Profile for a clearer understanding, both diagnostically and intrapsychically, of the older adult.

NeuroVR 2--a free virtual reality platform for the assessment and treatment in behavioral health care

At MMVR 2007 we presented NeuroVR (http://www.neurovr.org) a free virtual reality platform based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtual environments to the specific needs of the clinical or experimental setting. Following the feedbacks of the 2000 users who downloaded the first versions (1 and 1.5), we developed a new version--NeuroVR 2 (http://www.neurovr2.org)--that improves the possibility for the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, by using external sounds, photos or videos. More, when running a simulation, the system offers a set of standard features that contribute to increase the realism of the simulated scene. These include collision detection to control movements in the environment, realistic walk-style motion, advanced lighting techniques for enhanced image quality, and streaming of video textures using alpha channel for transparency.

Neuropsychological functioning in PLS: a comparison with ALS

OBJECTIVE

In order to characterize the nature and extent of neuropsychological dysfunction in primary lateral sclerosis (PLS), we studied prospectively cognitive, emotional, and behavioral functioning in PLS, and compared performances to functioning in amyotrophic lateral sclerosis (ALS).

METHODS

Eighteen patients with PLS and 13 patients with ALS completed a neuropsychological test battery assessing both cognitive skills and emotional/behavioral functioning.

RESULTS

Both PLS and ALS groups scored broadly within normal limits (mean T-scores greater than 40) on all cognitive measures and no significant between-group differences were found with the exception of one variable. However, when examined on a case by case basis, the data revealed considerable heterogeneity amongst patients in both groups. Overall, 39% of PLS patients and 31% of ALS patients were considered cognitively impaired. Ahigher than expected frequency of abnormal scores was noted for several tests of executive function in both groups, and a majority of PLS patients also exhibited abnormal behavioural symptoms. There was no relationship in PLS or ALS groups between cognitive functioning and disease duration, current site of disease, site of onset, functional status, and respiratory variables. Comparison between the PLS and ALS groups indicated virtually no differences in cognitive test scores and overall emotional/behavioural symptoms.

CONCLUSIONS

We observed deficits in cognition and behaviour in a significant proportion of PLS patients which were comparable to those observed in ALS cases. Although deficits were not in the range of frontotemporal dementia, both ALS and PLS cases demonstrated deficits most prominently on tests of executive functioning.

[Behavioral and psychological symptoms of dementia and their management]

The decline in cognitive function is a core feature of dementias. However, other symptoms of the disease are also crucial. These symptoms are the behavioral and psychological manifestations of dementia and include symptoms such as delusions, hallucinations, delusional misindentification syndromes (DMS), illusions, anxiety, aggression, depression, personality changes, disinhibition-impulsivity, violation of social and moral norms, changes in dietary or eating behavior and repetitive behaviors. Delusions, hallucinations, anxiety, depression and aggression are highly prevalent in Alzheimer's disease, vascular dementia and dementia with Lewy bodies, whereas symptoms that include severe disturbance of behavior are highly prevalent in frontotemporal dementias. Psychotic symptoms are associated with subcortical disturbances mainly of the limbic system. Patients with depression present greater loss of noradrenergic cells in the locus coeruleus and loss of serotonergic nuclei of dorsal raphe. Furthermore, disturbances of behavior are associated with frontal lobe dysfunction. Atypical antipsychotics is the first treatment option for delusions, hallucinations, misidentifications, anxiety and aggression. Furthermore, antidepressants may be useful for moderate or severe depression as well as for disinhibition-impulsivity, aggression, changes in dietary or eating behavior and repetitive behaviors. Cholinesterase inhibitors may also improve apathy, anxiety, disinhibition, aberrant behavior, mood disorders and hallucinations. Moreover, non-pharmacological methods alone or in combination with psychotropic drugs may also improve patient's symptomatology.

Adult outcomes of childhood dysregulation: a 14-year follow-up study

OBJECTIVE

Using a general population sample, the adult outcomes of children who presented with severe problems with self-regulation defined as being concurrently rated highly on attention problems, aggressive behavior, and anxious-depression on the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) were examined.

METHOD

Two thousand seventy-six children from 13 birth cohorts 4 to 16 years of age were drawn from Dutch birth registries in 1983. CBCLs were completed by parents at baseline when children from the different cohorts were 4 to 16 years of age and sampled every 2 years for the next 14 years. At year 14 the CBCL and DSM interview data were collected. Logistic regression was used to compare and contrast outcomes for children with and without dysregulation, as measured by the latent-class-defined CBCL-DP. Sex and age were covaried and concurrent DSM diagnoses were included in regression models.

RESULTS

Presence of childhood CBCL-DP at wave 1 was associated with increased rates of adult anxiety disorders, mood disorders, disruptive behavior disorders, and drug abuse 14 years later. After controlling for co-occurring disorders in adulthood, associations with anxiety and disruptive behavior disorders with the CBCL-DP remained, whereas the others were not significant.

CONCLUSIONS

A child reported to be in the CBCL-DP class is at increased risk for problems with regulating affect, behavior, and cognition in adulthood.

Frequency and perceived effectiveness of coping define important subgroups of patients with chronic pain

OBJECTIVES

Investigate the relationship between frequency and perceived effectiveness of coping strategies used to cope with chronic pain. Examine the association between these variables and pain-related negative mood.

METHODS

Retrospective review of psychological measures completed by 122 adult chronic pain patients seen at a multidisciplinary pain clinic at the University of Florida. Empirical subgroups according to reported frequency and perceived effectiveness of coping strategies used were identified resulting in a 4-group solution based on combinations of high versus low effectiveness and high versus low frequency of use.

RESULTS

Analysis of variance results revealed significantly higher levels of distress (depression and pain-related anxiety) for selected subgroups [F(2,99)=4.902, P<0.05, η2=0.09 and F(2,93)=3.504, P<0.05, η2=0.07, respectively]. Post-hoc analyses revealed significantly more depression (mean=20.20, SD=9.77) and more pain-related anxiety (mean=101.07, SD=35.78) in individuals frequently using ineffective coping as compared with those reporting frequent use of effective coping (Mean(depression)=14.88, SD(depression)=7.40; Mean(pain-related anxiety)=78.93, SD(pain-related anxiety)=32.26) and those reporting infrequent use of ineffective coping (Mean(depression)=13.89, SD(depression)=9.44).

DISCUSSION

Perceived effectiveness and frequency of coping strategy use may influence pain-related negative mood. Maladaptive coping may be a risk factor associated with more emotional distress; it is also possible that more emotional distress predisposes maladaptive coping. Taking into account both the frequency of coping strategy use and the perceived effectiveness of strategy type is suggested for future studies.

'Triage center' takes pressure off EDs

Behavioral health care is a major concern for EDs. Lee Memorial Health System helped relieve the ED burden with a shelter for homeless and uninsured individuals. A former director of emergency services provided ED-specific input into the planning process. A contracted nurse with ED experience provides the initial assessment of patients referred to the shelter. System EDs now have a referral option for patients with behavioral health issues and no longer have to discharge them "onto the street".

Medically Unexplained Symptoms and Neuropsychological Assessment

Several illnesses expressed somatically that do not have clearly demonstrated pathophysiological origin and that are associated with neuropsychological complaints are reviewed. Among them are nonepileptic seizures, fibromyalgia, chronic fatigue syndrome, Persian Gulf War unexplained illnesses, toxic mold and sick building syndrome, and silicone breast implant disease. Some of these illnesses may be associated with objective cognitive abnormalities, but it is not likely that these abnormalities are caused by traditionally defined neurological disease. Instead, the cognitive abnormalities may be caused by a complex interaction between biological and psychological factors. Nonepileptic seizures serve as an excellent model of medically unexplained symptoms. Although nonepileptic seizures clearly are associated with objective cognitive abnormalities, they are not of neurological origin. There is evidence that severe stressors and PTSD are associated with immune system problems, neurochemical changes, and various diseases; these data blur the distinctions between psychological and organic etiologies. Diagnostic problems are intensified by the fact that many patients are poor historians. Patients are prone to omit history of severe stressors and psychiatric problems, and the inability to talk about stressors increases the likelihood of suffering from physiological forms of stress.

Patients' subjective initial response and the outcome of inpatient and day hospital treatment

OBJECTIVE

This study aimed to establish whether psychiatric patients' subjective initial response (SIR) to hospital and day hospital treatment predicts outcomes over a one-year follow-up period.

METHOD

We analysed data from 765 patients who were randomised to acute psychiatric treatment in a hospital or day hospital. SIR was assessed on day 3 after admission. Outcomes were psychiatric symptom levels and social disability at discharge, and at 3 and 12 months after discharge.

RESULTS

After controlling for socio-demographic and clinical characteristics, a more positive SIR was significantly associated with lower symptom levels at discharge and 3 months after discharge and lower social disability at 3 months and 12 months after discharge.

CONCLUSION

SIR can predict outcomes of complex interventions over a one-year period. Patients' initial views of acute hospital and day treatment should be elicited and considered as important.

The structure of risk factors and outcomes for family caregivers: implications for assessment and treatment

PURPOSE

We examined the associations among risk factors (e.g., behavioral problems, family conflict) and outcomes (e.g., overload, depression) commonly used in the research literature in order to inform the design of caregiver assessment and interventions.

METHODS

A sample of 67 caregivers caring for a family member in the middle stages of dementia were assessed on 15 risk factors and six outcome measures.

RESULTS

Risk factors were at best only moderately correlated with one another, suggesting their relative independence. Outcome measures showed somewhat higher correlations with one another, but participants varied in terms of the number and type of outcomes that were elevated. Multivariate results showed that risk factors differed in their contribution to models, predicting various outcomes.

IMPLICATIONS

Caregivers possess unique combinations of risk factors and outcomes that suggest the need for individualized or tailored interventions. Designing an effective caregiver assessment and corresponding targeted intervention requires careful planning and selection of appropriate risk factors and outcomes.

[Somatopsychic and cenesthetic types of schizophrenia: common features and discrepancies]

The aim of this paper is to discuss the development of the concepts of cenesthetic type of schizophrenia and somatopsychic type of schizophrenia along with the review of differences between those two diagnostic approaches in scope of their historical background and the current diagnostic concepts. Those independently described diagnostic phenomena have some common features. However, the cenesthetic type of schizophrenia emphasises sensory elements of the disorders and includes a broader spectrum of the psychopathology while the somatopsychic type of schizophrenia focuses on the thought disorders and strictly schizophrenic psychopathology.

[PSYCHOLOGICAL FEATURES IN CHILDREN AND ADOLESCENTS WITH RESPIRATORY TUBERCULOSIS]

The development of a biopsychosocial model of disease acquires a great practical value for modern phthisiology, which presupposes an in-depth study of the psychological and social constituents of disease as important factors of therapy optimization and an increase in the efficiency of the rehabilitative measures being implemented. The problem of psychological causes and factors associated with the occurrence of a tuberculous process in children and adolescents has been inadequately developed in phthisiology. A psychodiagnostic study was conducted in 90 patients from Moscow pediatric tuberculosis facilities. The children and adolescents with respiratory tuberculosis were ascertained to have the personality characteristics distinct them from their somatically healthy coevals: tenderness, responsibility, honesty, diligence, deliberate observance of generally accepted moral rules and regulations, inclination to moralize, anxiety, irritability, infantilism, low frustration tolerance, dependence, sensitivity, and a need for support. The revealed psychological features enhance the pathogenicity of stressors, lead to the tension of adaptive mechanisms and may contribute to the development of the disease. Psychocorrective measures aimed at expanding the behavioral range and molding self-regulation skills in these patients should be developed within the complex rehabilitation system for children and adolescents with respiratory tuberculosis, which will aid in enhancing the efficiency of their psychoemotional adaptation and preventing the recurrences of the underlying disease.

Cognitive-behavioral flexibility in anorexia nervosa

Anorexia nervosa (AN) patients are characterized by perfectionism and obsessional personality traits. This anorectic personality type is associated with an exaggerated cognitive control and impaired cognitive-behavioral flexibility. Neuropsychological studies addressing flexibility have supported an impaired cognitive set-shifting (i.e., concrete and rigid behaviors to changing rules) as well as an impaired behavioral response shifting (i.e., stereotyped or perseverative behaviors) in AN patients independent of nutritional status and body weight. Furthermore, impaired set-shifting was found in healthy sisters of AN patients suggesting that cognitive inflexibility is a trait marker in AN patients. Brain imaging studies have provided new insights in striatocortical circuit dysfunctions that may underlie both the clinical symptoms of obsessive-compulsive personality traits and the neuropsychological observations of impaired cognitive-behavioral flexibility. The conceptualization of AN as a neurodevelopmental striatocortical disorder may help to develop new promising treatment approaches for this severe disorder.

Transient cocaine-associated behavioral symptoms rated with a new instrument, the scale for assessment of positive symptoms for cocaine-induced psychosis (SAPS-CIP)

Chronic use of cocaine is associated with a variety of behavioral symptoms. The current report describes the assessment of cocaine-related behavioral symptoms (CRB) using the Scale for Assessment of Positive Symptoms of Cocaine-Induced Psychosis (SAPS-CIP). The CRB section, one of the three domains in the SAPS-CIP, consists of sub-domains, including Aggressive/Agitated Behavior, Repetitive/Stereotyped Behavior, and Unusual Social or Sexual Behavior. Severity scores are assigned according to operational criteria, and range from 0 (not present) to 5 (severe). We interviewed 261 unrelated cocaine-abusing adults using the SAPS-CIP, and 243 of them met criteria for inclusion in the study. The proportion of subjects endorsing different classes of CRBs varied across categories, with 109 of 243 (44.9%) subjects reporting aggressive and agitated behaviors, 180 subjects (74.1%) repetitive/stereotyped behaviors, and 192 (79.0%) unusual social/sexual behaviors. A substantial minority of the subjects (10.3-25.1%) reported that they experienced marked-to-severe behavioral symptoms associated with cocaine use. The proportions of subjects endorsing CRB did not differ by ethnic/racial group or by sex. Correlations among the different domains of CRB were strong, but behaviors rated in the CRB section were less well correlated with psychotic symptoms, which were rated in the hallucination and delusion sections of the instrument. A variety of CRBs are common in cocaine-dependent subjects, and many of these are highly intercorrelated. CRBs also correlate with hallucinations and delusions induced by cocaine, but to a lesser degree. Our findings suggest that there may be some common vulnerability factors that contribute to both cocaine-induced psychosis and CRBs.

Developing Korean Academy of Medical Sciences Guideline for rating the impairment in mental and behavioral disorders; a comparative study of KNPA's new guidelines and AMA's 6th Guides

Quantifying and rating the impairments due to mental and behavior disorders are difficult for their own characteristics. Korean Academy of Medical Sciences (KAMS) is developing guidelines of rating impairment in mental and behavioral disorders based on Korean Neuropsychiatric Association (KNPA)'s new guidelines. We compared the new KNPA's guidelines and the American Medical Association (AMA)'s 6th Guides in assessing impairment due to mental and behavioral disorders to develop new guidelines of KAMS. Two guidelines are different in diagnosing system, applicable disorders, qualification of assessors, application of scales, contents of assessment and rate of impairment of the whole person. Both AMA's and the proposed guidelines have individual merits and characteristics. There is a limitation in using the 6th AMA's Guides in Korean situation. However to improve objectivity in Korean assessment of psychiatric impairment, the new AMA's Guides can serve as a good reference.

Behavioral deficits after distal focal cerebral ischemia in mice: Usefulness of adhesive removal test

Distal occlusion of the middle cerebral artery (dMCAo), which closely mimics human stroke, is one of the most used animal models. However, although assessment of histological and functional outcome is increasingly recommended for preclinical studies, the latter is often excluded because of the high difficulties to estimate, especially in mice, behavioral impairments. The aim of our study was to deeply screen functional consequences of distal permanent MCAo in mice to target relevant behaviors for future studies. A set of sensorimotor and cognitive tests were performed during 3 weeks postsurgery in 2 groups of mice. Afterward, brain infarctions were estimated by histological staining or magnetic resonance imaging. Overall, while no long-term functional impairments could be detected, the adhesive removal was the only test showing a deficit. Interestingly, this sensorimotor impairment was correlated to cortical damage 3 weeks after surgery. In conclusion, despite the fact that dMCAo-induced deficits could not be evidenced by most of our behavioral tests, the authors showed that the adhesive removal test was the only one, sensitive enough, to highlight a long-term deficit. This result suggests therefore that this mouse model of ischemia is relevant to efficiently assess therapeutic strategies with histological but also behavioral analysis, provided that relevant tests are used.

[Non-motor disorders in Parkinson's disease]

INTRODUCTION

Parkinson's disease (PD) is a progressive disorder that is strongly linked to non-motor symptoms (NMS). Unfortunately, these symptoms have been almost neglected for many years and only recently have researchers begun to assess how they affect the quality of life in patients with PD.

AIMS

To review our current understanding of the subject and to highlight the importance of NMS in PD.

DEVELOPMENT

Recent studies have emphasised the fact that the basal ganglia play an important role in a number of non-motor functions. At the same time, the exclusive involvement of the substantia nigra in PD is being reviewed and the development of PD has been defined as a continuum that covers a range of different stages, including non-dopaminergic systems and nuclei. This would account for the constellation of non-motor symptoms that do not respond to dopamine replacement therapy and which affect patients with PD, such as depression, apathy, sialorrhea and urinary incontinence, among others.

CONCLUSIONS

NMS make a significant contribution to the morbidity and mortality rates of PD and are often the main cause of hospitalisation of patients with PD. Current evidence suggests that some NMS, such as constipation, hyposmia and REM sleep disorders, could even be preclinical markers of PD. Both of these reasons stress the importance of reaching a diagnosis faster and earlier.

Cognitive and behavioral assessment in the early stages of neurodegenerative extrapyramidal syndromes

Parkinson's disease (PD), Dementia with Lewy Bodies (DLB), Progressive Supranuclear Palsy (PSP) and Corticobasal Degeneration Syndrome (CBDS) are the most common neurodegenerative extrapyramidal syndromes. Beyond motor symptoms, cognitive dysfunctions and behavioral disturbances are reported. Neuropsychological and neuropsychiatry features in the early stages, however, are under-investigated, and few comparison studies are available yet. The aim of the present study was to evaluate the cognitive and behavioral profile in the early stages of neurodegenerative extrapyramidal syndromes. Thirty-nine PD, 27 DLB, 16 CBDS, and 24 PSP were recruited. Groups were matched for global cognitive and motor impairment. The overall sample showed a common neuropsychological core characterized by visuospatial deficits. Although in the early stage of the disease, a high presence of behavioral disturbances was detected, depression and anxiety were the most common disorders, followed by apathy and sleep disturbances. The observation of overlapping clinical entities points the attention on the need of adjunctive diagnostic markers for early differential diagnosis.

Mild parkinsonian signs and psycho-behavioral symptoms in subjects with mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) may be accompanied by extra pyramidal signs (EPS), which are related to the severity and type of cognitive impairment. We aimed to elucidate further the relationship between MCI and EPS, analyzing the correlation between the severity of EPS and cognitive functions, and the presence of EPS and neuro-psychiatric features.

METHODS

Data were obtained from a longitudinal study of 150 MCI outpatients. Participants underwent a clinical assessment including the Unified Parkinson Disease Rating Scale, the Neuropsychiatric Inventory, the Tinetti Scale, and a standardized neuropsychological battery. Mild EPS could be defined as being present (MCI with mild EPS) using a subscale of UPDRS, based on three specific symptoms: bradykinesia, rigidity and tremor.

RESULTS

The two groups, one with mild EPS (24%) and one without EPS (76%), differed in gait abnormalities and presence of extrapyramidal symptoms. Groups did not differ in terms of general cognitive functions evaluated using the Mini-mental State Examination, while subjects with MCI with mild EPS performed significantly worse than those with MCI without EPS in total global score and in non-memory items of the Alzheimer's Disease Assessment Scale. Moreover, severity of EPS was significantly correlated with low performance on executive functions and with high performance on episodic memory. The group with MCI with mild EPS were observed to have a greater prevalence of patients with anxiety, depression, apathy and sleep disturbances than in MCI without EPS.

CONCLUSION

MCI may be associated with mild parkinsonian signs, the severity of which are related to the severity of cognitive impairment, in particular of non-memory functions, and to a differential pattern of psycho-behavioral symptoms.

Relationship between behavioural and psychological symptoms of dementia and cognition in Alzheimer's disease

BACKGROUND

Behavioural and psychological symptoms of dementia (BPSDs) are common. It is unclear whether associations are stronger with the absolute cognitive level or that relative to premorbid mental ability.

METHODS

The Neuropsychiatric Inventory (NPI) was administered to carers of patients with Alzheimer's disease (AD). Patients underwent cognitive testing with the National Adult Reading Test (NART) to estimate premorbid IQ and 6 tests of current cognitive function.

RESULTS

556 patients, mean age 77.3 years, had NPI scores. The total NPI score correlated significantly with most cognitive test scores, but multi-linear regression identified NART-IQ as the only significant cognitive predictor (beta=-0.17, p=0.008). Principal component analysis of the 10 NPI domains extracted 3 components corresponding to mood, frontal and psychotic factors. The NPI mood factor correlated significantly with NART-IQ (rho=-0.14, p=0.014) and lexical verbal fluency (rho=-0.09, p=0.034) only. The NPI frontal factor correlation with NART-IQ approached significance (rho=-0.11, p=0.053). The NPI psychotic factor correlated significantly with the Mini-Mental State Examination (rho=-0.15, p<0.001) and the Hopkins verbal learning test (rho=-0.11, p=0.013) scores.

CONCLUSION

The relationship between BPSDs and cognition in AD is weak and largely explained by premorbid IQ. There is a stronger relationship between current cognition and psychotic symptoms.