1
|
Nakken EI, Grinde F, Vaaler A, Drange OK, Brodtkorb E, Sæther SG. Epilepsy and other seizure disorders in acute psychiatric inpatients. BMC Psychiatry 2021; 21:626. [PMID: 34911471 PMCID: PMC8672464 DOI: 10.1186/s12888-021-03619-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well known that patients with epilepsy have a high rate of psychiatric comorbidity. However, studies exploring epilepsy in psychiatric cohorts are scarce. The aim of this study was to examine the prevalence of seizure disorders in acute psychiatric inpatients. METHODS This is a cross-sectional study performed in a catchment-area based acute psychiatric department. All patients (age > 18) admitted during September 2011 - March 2012 were eligible for inclusion. Consenting patients were screened for a life-time history of epilepsy or seizures using self-reported questionnaire data and diagnostic codes for epilepsy in hospital and National registries. Patients scoring positive to one or more of these screening criteria underwent a thorough diagnostic validation (chart review), and the seizure disorders were classified as epilepsy, acute symptomatic seizures and/or psychogenic non-epileptic seizures according to current definitions. RESULTS A total of 380 out of 591 (64.3%) consecutively admitted patients consented to participate in the study. Eighty-nine patients (23.4%) scored positive to one or more screening criteria. Fifteen (3.9%) were classified with epilepsy, 21 (5.5%) with acute symptomatic seizures and 9 (2.4%) with psychogenic non-epileptic seizures. CONCLUSIONS This is the first study to report on the prevalence of seizure disorders in acute psychiatric inpatients. The life-time prevalence of epilepsy in this cohort of patients is five - six times as high as reports in the general population. These findings underscore the need for the clinical psychiatrist to have comprehensive knowledge on the interface between epileptology and psychiatry. TRIALS REGISTRATION ClinicalTrials.gov identifier NCT01415323 .
Collapse
Affiliation(s)
- Erlend Iversen Nakken
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frithjof Grinde
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Vaaler
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Healthcare, St. Olavs University Hospital, Trondheim, Norway
| | - Ole Kristian Drange
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Healthcare, St. Olavs University Hospital, Trondheim, Norway ,grid.417290.90000 0004 0627 3712Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Eylert Brodtkorb
- grid.52522.320000 0004 0627 3560Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | |
Collapse
|
2
|
Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
Collapse
Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| |
Collapse
|
3
|
Schou MB, Sæther SG, Drange OK, Krane-Gartiser K, Reitan SK, Vaaler AE, Kondziella D. The significance of anti-neuronal antibodies for acute psychiatric disorders: a retrospective case-controlled study. BMC Neurosci 2018; 19:68. [PMID: 30390633 PMCID: PMC6215671 DOI: 10.1186/s12868-018-0471-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
Background The clinical significance of anti-neuronal antibodies in patients with psychiatric disorders, but without encephalitis, remains unknown. In patients admitted to acute psychiatric inpatient care we aimed to identify clinical features distinguishing anti-neuronal antibody positive patients from matched controls. Results Patients who were serum-positive to N-methyl d-aspartate receptor (NMDAR) (n = 21), contactin-associated protein 2 (CASPR2) (n = 14) and/or glutamic acid decarboxylase 65 (GAD65) (n = 9) antibodies (cases) were age and sex matched (1:2) with serum-negative patients from the same cohort (controls). The prevalence and severity of psychiatric symptoms frequently encountered in NMDAR, CASPR2 and GAD65 antibody associated disorders were compared in cases and controls. NMDAR, CASPR2 and GAD65 antibody positive patients did not differ in their clinical presentation from matched serum negative controls. Conclusion In this cohort, patients with and without NMDAR, CASPR2 and GAD65 antibodies admitted to acute psychiatric inpatient care had similar psychiatric phenotypes. This does not exclude their clinical relevance in subgroups of patients, and studies further investigating the clinical significance of anti-neuronal antibodies in patients with psychiatric symptomatology are needed. Electronic supplementary material The online version of this article (10.1186/s12868-018-0471-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Morten B Schou
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Division of Mental Health Care, St Olavs Hospital HF, avd Østmarka, Trondheim University Hospital, Postboks 3250, Torgarden, 7006, Trondheim, Norway.
| | - Sverre Georg Sæther
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Mental Health Care, St Olavs Hospital HF, Nidaros DPS, Trondheim University Hospital, Postboks 3250, Torgarden, 7006, Trondheim, Norway
| | - Ole Kristian Drange
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Mental Health Care, St Olavs Hospital HF, avd Østmarka, Trondheim University Hospital, Postboks 3250, Torgarden, 7006, Trondheim, Norway
| | - Karoline Krane-Gartiser
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Mental Health Care, St Olavs Hospital HF, avd Østmarka, Trondheim University Hospital, Postboks 3250, Torgarden, 7006, Trondheim, Norway
| | - Solveig K Reitan
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Mental Health Care, Tiller DPS, St Olavs Hospital HF, Trondheim University Hospital, Postboks 3250, Torgarden, 7006, Trondheim, Norway
| | - Arne E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Mental Health Care, St Olavs Hospital HF, avd Østmarka, Trondheim University Hospital, Postboks 3250, Torgarden, 7006, Trondheim, Norway
| | - Daniel Kondziella
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Neurology Department, Rigshospitalet, Copenhagen University Hospital, Blegdamsvei 9, 2100, København Ø, Denmark
| |
Collapse
|
4
|
Schou M, Sæther SG, Borowski K, Teegen B, Kondziella D, Stoecker W, Vaaler A, Reitan SK. Prevalence of serum anti-neuronal autoantibodies in patients admitted to acute psychiatric care. Psychol Med 2016; 46:3303-3313. [PMID: 27609625 DOI: 10.1017/s0033291716002038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autoimmune encephalitis associated with anti-neuronal antibodies may be challenging to distinguish from primary psychiatric disorders. The significance of anti-neuronal antibodies in psychiatric patients without clear evidence of autoimmune encephalitis is unknown. We investigated the serum prevalence of six anti-neuronal autoantibodies in a cohort of unselected patients admitted to acute psychiatric care. METHOD Serum was drawn from 925 patients admitted to acute psychiatric in-patient care. Psychiatric diagnoses were set according to International Classification of Diseases (ICD)-10 criteria. Antibody analysis was performed with an indirect immunofluorescence test for N-methyl d-aspartate receptor (NMDAR) antibodies and five other anti-neuronal autoantibodies of the immunoglobulin (Ig) classes IgA, IgG and IgM isotype. RESULTS Anti-neuronal autoantibodies were found in 11.6% of patients: NMDAR antibodies in 7.6%, contactin-associated protein-like 2 (CASPR2) antibodies in 2.5%, glutamic acid decarboxylase-65 (GAD65) antibodies in 1.9%, and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antibodies in 0.1%. Leucine-rich glioma-inactivated protein-1 (LGI1) and γ-aminobutyric acid B (GABAB) receptor antibodies were not detected. NMDAR antibodies of class IgG were present in five patients only (0.5%). NMDAR antibodies of all Ig classes were equally prevalent in patients with and without psychosis. There were no significant differences in antibody prevalence in the different diagnostic categories, except for a higher odds ratio of being NMDAR antibody positive for patients without a specific psychiatric diagnosis. CONCLUSIONS NMDAR IgG autoantibodies, which are known to be strongly associated with anti-NMDAR encephalitis, were rarely found. CASPR2 and GAD65 antibodies were more frequently encountered in the present study than previously reported. Further research on the clinical significance of anti-neuronal autoantibodies in patients with acute psychiatric symptoms is needed.
Collapse
Affiliation(s)
- M Schou
- Department of Neuroscience,Norwegian University of Science and Technology,Trondheim,Norway
| | - S G Sæther
- Department of Neuroscience,Norwegian University of Science and Technology,Trondheim,Norway
| | - K Borowski
- Institute for Experimental Immunology,Euroimmun AG,Lübeck,Germany
| | - B Teegen
- Institute for Experimental Immunology,Euroimmun AG,Lübeck,Germany
| | - D Kondziella
- Department of Neuroscience,Norwegian University of Science and Technology,Trondheim,Norway
| | - W Stoecker
- Institute for Experimental Immunology,Euroimmun AG,Lübeck,Germany
| | - A Vaaler
- Department of Neuroscience,Norwegian University of Science and Technology,Trondheim,Norway
| | - S K Reitan
- Department of Neuroscience,Norwegian University of Science and Technology,Trondheim,Norway
| |
Collapse
|
5
|
Sallaup TV, Vaaler AE, Iversen VC, Guzey IC. Challenges in detecting and diagnosing substance use in women in the acute psychiatric department: a naturalistic cohort study. BMC Psychiatry 2016; 16:406. [PMID: 27855664 PMCID: PMC5114750 DOI: 10.1186/s12888-016-1124-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/10/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study examines sex differences in substance use and substance use disorder in the acute psychiatric department, and possible interactions between sex and clinical and social factors associated with this phenomenon. METHODS Data concerning substance use were collected in a naturalistic cohort study (n = 384, 51.6% male, 48.4% female) in an acute psychiatric department. Recent intake of substances at admission, diagnosis of substance use disorder and demographic and socioeconomic information were recorded. At admission, serum and urine samples were analysed for substance use and breath analysis was performed for alcohol levels. RESULTS Twice as many men as women were diagnosed with substance use disorder, whereas there were no gender differences in the number of positive toxicology screenings. Toxicology screening revealed the use of non-prescribed medication with addiction potential in 40% of both female and male patients many of whom did not report this in the admission interview. A low level of education in men and absence of parental responsibility in women showed a statistically significant interaction with a current diagnosis of substance use disorder. CONCLUSIONS Despite no sex differences in positive toxicology screenings in the acute psychiatric department, twice as many men as women are diagnosed with substance use disorders. The use of prescription drugs with addiction potential was widely under-reported by both sexes, in patients with no prescriptions for the medications. Women with no parental responsibility are overrepresented among those diagnosed with substance use disorder, as are men with a low level of education. TRIAL REGISTRATION The study is registered with the ClinicalTrials.gov identifier NCT01415323.
Collapse
Affiliation(s)
- Torill Vassli Sallaup
- Department of Tiller DPS, St Olavs University Hospital, Trondheim, Norway. .,Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Einar Vaaler
- Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway ,Department of Østmarka, St Olavs University Hospital, Trondheim, Norway
| | - Valentina Cabral Iversen
- Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway ,Department of Østmarka, St Olavs University Hospital, Trondheim, Norway
| | - Ismail Cuneyt Guzey
- Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway ,Department of Østmarka, St Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
6
|
Stewart D, Warren J, Odubanwo A, Bowers L. Nursing interventions for substance use during psychiatric hospital admissions: Clinical context and predictors. Int J Ment Health Nurs 2015; 24:527-37. [PMID: 26300518 DOI: 10.1111/inm.12152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London. Searches were conducted for all patients admitted during 2012 and details of incidents and patient characteristics were extracted for analysis. Substance use was reported for 291 patients, with 25 incidents per 100 patients admitted to hospital. Only half of the incidents were followed by a response that specifically addressed the patients' substance use behaviour. These interactions usually concerned the circumstances and reasons for use, but rarely involved specific support for patients' substance use problems. The likelihood of staff taking any form of action was increased if the patient had been formally admitted, and was reduced if the patient was subject to containment during the shift or had a history of self-harm. The results demonstrate that nurses require specific training and guidance on supporting substance using patients.
Collapse
Affiliation(s)
- Duncan Stewart
- School of Psychology, Social Work and Human Sciences, University of West London, London, UK
| | | | | | - Len Bowers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|