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

Individuals with autism spectrum disorders have deficits in communication, social interactions, and emotional regulation and exhibit repetitive behaviors. These individuals can become very reactive to their environment and at times may engage in emotional outbursts. The social deficits seen in autism spectrum disorders are in part caused by the difficulty these individuals have with modulating their own anger and interpreting their own emotions and those of people around them. Individuals with autism spectrum disorders tend to learn and process visual information more effectively than auditory information. Thus, visual supports can help individuals with autism spectrum disorders process information more effectively. This article discusses the use of one particular visual support, an "emotions thermometer," in helping instruct individuals with autism spectrum disorders on recognizing and modulating their own emotions. The article also discusses anger management techniques that can be utilized once individuals have begun to recognize more subtle signs of irritability within themselves.

We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.

This paper reviews studies bearing on the validity of the bereavement exclusion for the diagnosis of major depression. It concludes that the exclusion is not supported by the best available data, and the authors propose revisions for Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition.

Objective. To assess the ability of mental health professionals to use the 4-item Negative Symptom Assessment instrument, derived from the Negative Symptom Assessment-16, to rapidly determine the severity of negative symptoms of schizophrenia.Design. Open participation.Setting. Medical education conferences.Participants. Attendees at two international psychiatry conferences.Measurements. Participants read a brief set of the 4-item Negative Symptom Assessment instructions and viewed a videotape of a patient with schizophrenia. Using the 1 to 6 4-item Negative Symptom Assessment severity rating scale, they rated four negative symptom items and the overall global negative symptoms. These ratings were compared with a consensus rating determination using frequency distributions and Chi-square tests for the proportion of participant ratings that were within one point of the expert rating.Results. More than 400 medical professionals (293 physicians, 50% with a European practice, and 55% who reported past utilization of schizophrenia ratings scales) participated. Between 82.1 and 91.1 percent of the 4-items and the global rating determinations by the participants were within one rating point of the consensus expert ratings. The differences between the percentage of participant rating scores that were within one point versus the percentage that were greater than one point different from those by the consensus experts was significant (p<0.0001). Participants rating of negative symptoms using the 4-item Negative Symptom Assessment did not generally differ among the geographic regions of practice, the professional credentialing, or their familiarity with the use of schizophrenia symptom rating instruments.Conclusion. These findings suggest that clinicians from a variety of geographic practices can, after brief training, use the 4-item Negative Symptom Assessment effectively to rapidly assess negative symptoms in patients with schizophrenia.

In this article, we provide information on patient-reported side effects from a cross-section of real-world patients. Specifically, data on side effects were tabulated for patients taking at least one of the following atypical antipsychotic medications: aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone. Approximately 54 percent of the 353 respondents reported having experienced a side effect as a result of taking an atypical antipsychotic medication. Most common side effects mentioned included the following: weight gain/hunger, tiredness/lethargy, and lack of coordination/muscle problems, such as tenderness, twitches, and tremors. Of those experiencing a side effect, less than 25 percent reported this side effect to their physician.

Up to one-third of community participants report being perpetrators of road rage, indicating that various forms of road rage are relatively commonplace. However, only two percent or less of incidents culminate in serious damage to persons or vehicles. The most common offenders appear to be young and male. A number of factors may contribute to road rage, including environmental factors (e.g., greater number of miles driven per day, traffic density), nonspecific psychological factors (e.g., displaced aggression, attribution of blame to others), and bona fide Axis I and II disorders. The most common Axis I disorders appear to be related to alcohol and substance misuse, whereas possible Axis II disorders include borderline and antisocial personality disorders. Being aware of these contributory factors to road rage may improve general clinical awareness of the nature and treatment of perpetrators.

Gait reflects all levels of nervous system function. In psychiatry, gait disturbances reflecting cortical and subcortical dysfunction are often seen. Observing spontaneous gait, sometimes augmented by a few brief tests, can be highly informative. The authors briefly review the neuroanatomy of gait, review gait abnormalities seen in psychiatric and neurologic disorders, and describe the assessment of gait.

Disturbances in sleep are empirically associated with a number of different psychiatric disorders. In this pilot study, we examined whether four general queries about mental healthcare utilization ("Have you ever been seen by a psychiatrist?," "Have you ever been hospitalized in a psychiatric hospital?," "Have you ever been in counseling?," and "Have you ever been on medication for your nerves?") would evidence correlations with various aspects of sleep disturbance as measured by the Pittsburgh Sleep Quality Index. In a cross-sectional sample of convenience, we surveyed 75 internal medicine outpatients. We asked participants about the four preceding mental healthcare variables as well as sleep experiences using the Pittsburgh Sleep Quality Index. Prior to statistical analyses, we assigned one point to each mental healthcare utilization variable endorsed and developed a composite score (0-4). In analyses, while the mental-healthcare-utilization composite score was not related to overall sleep quality (i.e., the Global Pittsburgh Sleep Quality Index Score), it was statistically significantly related to the Pittsburgh Sleep Quality Index component of Sleep Disturbance (p<.01). This suggests that while individuals with greater mental healthcare utilization do not evidence differences in overall sleep quality compared to those with low utilization, they do report more disturbances in sleep.

Excessive tanning appears to be evident in about one quarter of regular sunbathers. Susceptible individuals are likely to be young Caucasians from Western societies. Despite ongoing education by the media to the public about the risks of excessive exposure to ultraviolet radiation and the availability of potent sunscreens, there seems to be a concurrent proliferation of tanning facilities. What might be potential psychological explanations for excessive or pathological tanning? Psychopathological explanations may exist on both Axes I and II and include substance use, obsessive-compulsive, body dysmorphic, and borderline personality disorders. While there is no known treatment for pathological sunbathing, we discuss several treatment interventions from the literature that have been successfully used for the general public.