Psychiatry (Edgmont (Pa. : Township))最新文献

Objective. To assess the characteristics and correlates of sleep problems in patients with lifetime posttraumatic stress disorder and ongoing sleep disturbance not due to obstructive sleep apnea or other diagnosed sleep disorders.Sample. Twenty-six veterans receiving psychiatric care at the Minneapolis Veterans Affairs Medical Center in Minneapolis, Minnesota.Data collection instruments. The Pittsburgh Sleep Quality Index, sleep logs, and actigraph along with three symptom ratings scales-posttraumatic checklist, clinician-administered posttraumatic stress disorder scale, and Beck Depression Inventory-were used.Results. Univariate analysis associated three symptom complexes with poorer sleep quality: posttraumatic avoidance, posttraumatic hypervigilance, and depressive symptoms. Borderline trends also existed between worse sleep quality and more severe clinician-rated posttraumatic stress, more self-reported awakenings from sleep, and greater actigraphy-determined sleep duration. Using linear regression, only posttraumatic hypervigilance symptoms were associated with sleep quality.Conclusion. Sleep quality among posttraumatic stress disorder patients in active treatment is worse in direct relation to more severe posttraumatic hypervigilance symptoms.

Demoralization is a dysphoric state encountered in both psychiatric and medical populations, and is characterized by the individual's sense of disempowerment and futility. While depression may coexist with demoralization, they appear to be distinct clinical entities, with the former being characterized by anhedonia and the latter being characterized by helplessness. Assessment measures for demoralization are available, such as the Diagnostic Criteria for Psychosomatic Research and the Demoralization Scale of the Minnesota Multiphasic Personality Inventory version 2 restructured clinical scales. However, the administration requirements of these measures tend to limit them to research environments. As for prevalence, demoralization is commonplace in medical populations, perhaps even normative. However, up to one-third of physically ill patients experience clinically meaningful demoralization. Identification by the clinician is important as there are several proposed interventions that may be helpful in alleviating demoralization in medically compromised patients.

The authors present a patient with multiple pontine lesions who exhibited symptoms consistent with delusional parasitosis. The trigeminal nerve nuclei are located throughout the brainstem. Pathology in either the nuclei or the branches of the fifth cranial nerve has been associated with both sensory and motor disturbances. Delusional parasitosis is a condition in which the patient has the firm belief that small, living organisms have infested his or her skin or other organs. To our knowledge, this is the first case report of delusional parasitosis associated with lesions at the root of the trigeminal nerve.

In this article, we investigated the current practice for treatment of schizophrenia. According to our data, physicians consider one-product regimens 53 percent of the time. Two-product regimens are considered 29 percent of the time, and regimens of three or more products are considered 18 percent of the time. At the point of the patient visit, antipsychotic medications comprise 97 percent of treatment regimens. Fifty-six percent of treatment regimens involve only antipsychotic medications. Classes used to supplement antipsychotic medications in the treatment of schizophrenia include antidepressants (20%), mood stabilizers (15%), anti-anxiety (7%) drugs, and drugs to treat extrapyramidal symptoms (6%). An expert commentary is also included with the data.

Yoga is being used by a growing number of youth and adults as a means of improving overall health and fitness. There is also a progressive trend toward use of yoga as a mind-body complementary and alternative medicine intervention to improve specific physical and mental health conditions. To provide clinicians with therapeutically useful information about yoga, the evidence evaluating yoga as an effective intervention for children and adolescents with health problems is reviewed and summarized. A brief overview of yoga and yoga therapy is presented along with yoga resources and practical strategies for clinical practitioners to use with their patients. The majority of available studies with children and adolescents suggest benefits to using yoga as a therapeutic intervention and show very few adverse effects. These results must be interpreted as preliminary findings because many of the studies have methodological limitations that prevent strong conclusions from being drawn. Yoga appears promising as a complementary therapy for children and adolescents. Further information about how to apply it most effectively and more coordinated research efforts are needed.

Implementing harm reduction is among the administrative tasks used for maintaining a safe unit for psychiatric in-patients. Such harm may be potentially caused by patients themselves or others. Included in nursing procedures implemented for observing suicidal patients is the practice of 15-minute checks. In reviewing the standard forms used for such procedures in several major hospitals across the United States, we noticed a wide variation in the format and use of 15-minute checks, as well as poor guidelines for their termination. We recommend that the observation practice of 15-minute checks be eliminated from the repertoire of nursing protocols for suicidal patients who are assessed to be at imminent risk for self harm on inpatient units.