1,721,001 research outputs found
Reply: Atypical Antipsychotics and Neuroleptic Malignant Syndrome
No full textThe epidemiology of Neuroleptic Malignant Syndrome (NMS) has been only recently examine das far as atypical antipsychotics are concerned. Further research is necessary regarding this clinical area, but preliminary data confim the risk of NMS by using atipycal antipsychotics, as well as conventional antipsychotics
Pre-loss symptoms related to risk of complicated grief in caregivers of terminally ill cancer patients
No full textAbstract: Purpose: A number of studies have underlined a 10-20% prevalence of complicated grief
(CG) among caregivers of cancer patients. The study aimed at examining the relationship between preloss
criteria for CG and post-loss diagnosis of CG and at evaluating the validity and factor structure of a
predictive tool, the Inventory of Complicated Grief (ICG), in order to identify the risk of developing CG
in a sample of Italian caregivers.
Methods: Sixty family members of terminally ill patients admitted to hospice and receiving a Palliative
Prognostic Score (PaP) predictive 30 day survival time <30% completed the Pre-Death ICG (ICG-PL)
(T0). Family members were met again six months after the death of their loved one (T1) and
submitted to the interview for Complicated Grief (Post-loss interview-PLI).
Results: Caseness for CG was shown in 18.3% of caregivers at T1. ICG-PL score (T0) were higher
among those who developed CG at T1 than non-cases. A cut off score ≥ 49 on the ICG-PL (AUC= 0.98)
maximized sensitivity (92%) and specificity (98%) on caseness at T1. Pre-loss criteria related to
traumatic distress, separation distress and emotional symptoms in general were significantly related
to a post-loss diagnosis of CG, while no effect was shown on duration of pre-loss distress.
Conclusions: The use of short screening tools, like the ICG-PL, may help health care professionals to
identify subjects at risk for CG
Suspected neuroleptic catatonia induced by clozapine
No full textObjective: The neuroleptic-induced catatonia is an unusual side effect traditionally associated with high potency neuroleptics.
Method: We describe the case of 36-year-old woman suffering from disorganized schizophrenia, without previous history of catatonia, who developed a catatonic reaction secondary to the use of clozapine.
Results: After having been treated with different classes of neuroleptics (i.e. haloperidol, risperidone, clotiapine, olanzapine) with alternate clinical responses, a trial of clozapine was started. Over the next two weeks, the patient’s mental conditions gradually improved but marked catatonic symptoms emerged, in the absence of any symptoms of NMS. In the hypothesis of a NIC secondary to clozapine, all medications were discontinued and lorazepam was started. Catatonic symptoms gradually improved and five days after clozapine discontinuation all symptoms disappeared.
Conclusions: This case report supports that hypothesis that atypical neuroleptics, with weak dopamine-blocking properties, such as clozapine, could also be involved in causing NIC
Factor structure of the Brief Psychiatric Rating Scale in unipolar depression
No full textBackground: In clinical practice patients with unipolar depression present with a variety of symptom clusters that may combine together in many different ways. However, only few factor analytic studies used general psychopathology scales to investigate the symptom structure of unipolar depression.
Methods: The study included 163 consecutive inpatients with an ICD-10 diagnosis of depressive disorder (ICD-10 codes F32 to F33). All patients were assessed with the 18-item version of the Brief Psychiatric Rating Scale (BPRS) within 3 days from admission. Exploratory factor analysis with Varimax rotation was performed on BPRS items.
Results: Four factors were extracted, explaining 52% of total variance. They were interpreted as Apathy, Dysphoria, Depression and Psychoticism. The distribution of factor scores was approximately normal for Apathy, while it displayed a slight negative skewness for Depression, a slight positive skewness for Dysphoria, and a marked positive skewness for Psychoticism. Patient sex, family history of depression, lifetime history of suicide attempt, and recent serious family conflict were not associated with any factor. Occupational status, age, and age at onset displayed a positive correlation with Apathy. Duration of illness and number of previous admissions were positively correlated with Dysphoria.
Limitations: Patients were not administered a structured diagnostic interview, and no detailed assessment of personality disorders was performed; also, patients were recruited only at a single site, which reduces the generalizability of the results.
Conclusions: Our findings suggest that in depressive disorders there are psychopathological dimensions other than depressed mood that are worthy of greater clinical attention and research. Dimensions such as apathy and dysphoria may play an important part in the clinical phenomenology of unipolar depression and deserve systematic and careful assessment in order to provide patients with the best possible treatment and improve clinical outcomes
Affective syndromes and their screening in cancer patients with early and stable disease: Italian ICD-10 data and performance of the Distress Thermometer from the Southern European Psycho-Oncology Study (SEPOS)
No full textBackground: The assessment of mood and anxiety disorders secondary to cancer by using easy-to-administer instruments has been the object of recent research. Methods: The aim of this study was to examine the accuracy of the short screening tool developed by the National Comprehensive Cancer Network Clinical Practice Guidelines for Distress Management, (0-10 point-scale Distress Thermometer) (DT) in detecting affective syndrome disorders in Italian cancer patients. The sample consisted of 109 cancer outpatients who were administered the ICD-10 psychiatric interview (CIDI), the DT and the Hospital Anxiety Depression Scale (HADS). Results: Forty-four patients (40.4%) met the criteria for an ICD-10 diagnosis of affective syndromes. The DT was significantly associated with HADS-Total score (r = 0.66, p = 0.001). A cut-off ≥ 4 on the DT showed a sensitivity of 79.5% and a specificity of 75.4% (positive predictive value - PPV = 68.6%; negative predictive value - NPV = 84.5%). The cut-off score ≥ 10 on the HADS was associated with a sensitivity of 86% and a specificity of 81.5% (PPV = 76%; NPV = 89.9%). A cut-off score ≥ 5 on DT and ≥ 15 on HADS maximized sensitivity (78.6% and 85%, respectively) and specificity (83.1% and 96%, respectively) for patients with more severe affective syndromes (major depression, persistent depressive disorders). Conclusions: The results suggest that simple instruments can be used as feasible tools in the screening of mood and anxiety disorders among cancer patients. © 2008 Elsevier B.V. All rights reserved
Effects of Supportive-Expressive Group therapy in breast cancer patients with affective disorders. A pilot study
No full textBackground: No study has tested Supportive -Expressive Group Therapy (SEGT) in cancer patients with an established psychiatric diagnosis. The aim of this 6-month follow-up study was to evaluate breast cancer patients with an ICD-10 diagnosis of affective syndromes participating to the SEGT, and a group of breast cancer patients with no ICD-10 diagnosis.
Methods: 214 patients were examined by using the ICD-10, the Brief Symptom Inventory (BSI), the Mini-Mental Adjustment-to-Cancer Scale (Mini-MAC), the Multidimensional Scale of Perceived Social Support (MSPSS), the Openness Scale (OS) and the Cancer-Worries Inventory (CWI). Those having an ICD-10 diagnosis of affective syndromes received 16-24 sessions of SEGT (90-minute once a week), while those with no ICD-10 diagnosis were followed-up. A second assessment for both samples took place 6 months later (T1).
Results: 78 (36.4%) patients resulted to be positive for an ICD-10 diagnosis of affective syndromes at T0, while 127 (59.4%) did not report any ICD-10 diagnosis. Among the former, 54 patients participated to the SEGT. At T1 significant differences were observed on all the dimensions of the BSI, Hopelessness and Anxious Preoccupation (Mini-MAC), OS and CWI. No variable at T0 was predictor of BSI-distress as measured at T1. Among those with no ICD-10 diagnosis at T0, 8.2 % resulted positive for an affective disorders at the 6-month follow-up.
Conclusions: This study suggested that SEGT is effective for breast cancer patients with affective disorders and indicated the need for prospective evaluation in order to identify those who may develop psychopathology across time
Gabapentin treatment of impulsive-aggressive behaviour
No full textGabapentin is a relatively new antiepileptic agent structurally similar to gamma-aminobutyric acid (GABA), with unclear mechanisms of action and a good safety profile. It has been used in psychiatric practice, with promising results, for the treatment of several disorders (e.g. bipolar disorder, schizoaffective disorder, obsessive-compulsive disorder, social phobia, behavioral agitation in dementia). With regard to aggressive behavior, a few studies have reported significant improvement in symptoms among demented patients , while in one study it has been indicated a decrease in frequency and intensity of violent episodes in a young patient affected by intermittent explosive disorder, attention deficit hyperactivity disorder, organic mood disorder secondary to a closed head injury, simple partial seizure disorder after treatment with gabapentin (1200mg/day). We report a case of successful treatment of chronic impulsive aggressive behavior by using gababentin in a patient with severe borderline personality disorder
Effect of reboxetine on major depressive disorder in breast cancer patients: An open-label study
No full textBACKGROUND: Depression is a common disorder in cancer patients, and it is associated with reduced quality of life, abnormal illness behavior, pain, and suicide risk. A few studies have investigated the effects of tricyclic antidepressants and serotonin reuptake inhibitors in cancer patients. No data are available regarding the use of reboxetine, a norepinephrine reuptake inhibitor that has been shown to be safe (e.g., absence of clinically significant drug-drug interactions and cytochrome P450 metabolism) and effective in the treatment of depressed patients, including those with medical illness (e.g., Parkinson's disease, human immunodeficiency virus infection). METHOD: The effects of reboxetine were investigated in 20 breast cancer patients with a DSM-IV diagnosis of major depressive disorder in an open, prospective 8-week trial. Severity of depression was assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D). Psychiatric symptoms (Brief Symptom Inventory [BSI]), styles of coping with cancer (Mini-Mental Adjustment to Cancer [Mini-MAC]), quality of life (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 [EORTC-QLQ-C30]), and Clinical Global Impressions scale scores were also monitored. RESULTS: At 8 weeks, a significant (p <.01) reduction was observed in HAM-D scores, several BSI dimension scores, and Mini-MAC hopelessness and anxious preoccupation scores. A significant (p <.05) improvement from baseline to endpoint was found on the EORTC-QLQ-C30 subfactors emotional, cognitive, dyspnea, sleep, and global. Discontinuation was necessary in 1 subject because of hypomanic switch and in another because of side effects (tachycardia, tension). Seven patients experienced transient side effects (e.g., mild anxiety, insomnia, sweating). CONCLUSION: In this open trial, reboxetine appeared to be well tolerated and promising in reducing depressive symptoms and maladjusted coping styles and in improving scores on quality-of-life parameters
Depression or hypoactive delirium? A report of ciprofloxacin-induced mental disorder in a patient with chronic obstructive pulmonary disease
No full textMedically ill patients are at high risk for developing psychiatric disorders, especially major depression and depressive disorders
due to a general medical condition, including depression induced by drugs (e.g. corticosteroids, digoxin, ß-blockers, calcium channel blockers, diuretics, hormonal agents, antibiotics). Differential diagnosis, however, is not always easy because of the multiple interactions between the psychosocial impact of the medical illness and the direct consequences of the illness itself and the drugs on the central nervous system (CNS). Hypoactive delirium shares with depression due to a general medical condition certain symptoms (e.g. psychomotor retardation, apathy, sad appearance and depressed mood) and etiologic causes (e.g. delirium secondary to anti-hypertensives, corticosteroids, antiarrhythmic agents and antibiotics). This makes the problem of accurate diagnosis, by medical staff, of psychiatric comorbidity among physically ill patients complex.
We report a case of a 64 year old woman affected by chronic obstructive pulmonary disease (COPD) who developed delirium (hypoactive type) caused by ciprofloxacin therapy 250 mg t.i.d. per os. Although patients with COPD seem to be at high risk of depression because of the effects of the disease and multiple drugs (e.g. steroids, digoxin, diuretics), used to treat the medical condition and its complications, attention should be exerted towards other significant disorders that, at first glance, may resemble depression, such as hypoactive delirium
Use of the diagnostic criteria for psychosomatic research in oncology
No full textBACKGROUND: Psycho-oncology literature has shown that 30-50% of cancer patients meet the criteria for a psychiatric diagnosis, according to the usual nosographic classification (e.g. DSM). The Diagnostic Criteria for Psychosomatic Research (DCPR) have been shown to be useful in identifying psychological constellations in patients with medical illness. The aims of the study were to compare the DSM-IV and the DCPR in their application to cancer patients. METHOD: One hundred and forty-six patients with cancer underwent semistructured interviews to assess psychiatric morbidity and psychosocial syndromes according to the DSM-IV and the DCPR, respectively. The Brief Symptom Inventory (BSI) was also used to assess psychological stress symptoms. RESULTS: Sixty-five subjects (44.5%) met the criteria for a DSM-IV diagnosis (DSM cases), while 104 patients (71.2%) presented symptoms meeting the criteria for at least one DCPR syndrome. Three DCPR dimensions were more frequent than others, specifically Health Anxiety (37.7%), Demoralization (28.8%) and Alexithymia (26%). Among the subjects with no formal DSM-IV diagnosis (n = 81), 58% had at least one DCPR syndrome. DSM-IV cases had higher scores on several BSI subscales in comparison with patients with only one DCPR syndrome, while no difference was found in patients with more than one DCPR diagnosis. CONCLUSIONS: The DCPR system was found to be useful in oncology in investigating psychological conditions which are not identified by the DSM-IV alone. Assessment of more specific constructs, other than intensity of general stress symptoms, may give more specific information and help in tailoring psychological intervention for patients with cancer
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