Clinical Practice and Epidemiology in Mental Health最新文献

Background: Aggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult.

Objective: To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland.

Methods: We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R) and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days.

Results: A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10-1.78) for physical attacks and 1.83 (1.70-1.97) for all aggressive incidents (including purely verbal aggression). The mean severity was 8.80 +/- 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (>/= 9 pts.). 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6-2.9), longer length of stay (OR 2.7; 2.0-3.8), and a diagnosis of schizophrenia (ICH-10 F2) (OR 2.1; 1.5-2.9) was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission.

Conclusion: Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the study design we consider the incidence rates as robust and representative for acute wards in German speaking Switzerland, and thus useful as reference for comparative and interventional research. Implications for clinical practice include the recommendation to extend the systematic risk assessment beyond the first days after admission. The study confirms the necessity to differentiate between types of aggressive behaviour when reporting and comparing incidence-data.

Background: The authors tested the hypothesis that depression is a possible factor influencing the course of cancer by reviewing prospective epidemiological studies and calculating summary relative risks.

Methods: Studies were identified by computerized searches of Medline, Embase and PsycINFO. as well as manual searches of reference lists of selected publications. Inclusion criteria were cohort design, population-based sample, structured measurement of depression and outcome of cancer known for depressed and non-depressed subjects

Results: Thirteen eligible studies were identified. Based on eight studies with complete crude data on overall cancer, our summary relative risk (95% confidence interval) was 1.19 (1.06-1.32). After adjustment for confounders we pooled a summary relative risk of 1.12 (0.99-1.26).No significant association was found between depression and subsequent breast cancer risk, based on seven heterogeneous studies, with or without adjustment for possible confounders. Subgroup analysis of studies with a follow-up of ten years or more, however, resulted in a statistically significant summary relative risk of 2.50 (1.06-5.91).No significant associations were found for lung, colon or prostate cancer.

Conclusion: This review suggests a tendency towards a small and marginally significant association between depression and subsequent overall cancer risk and towards a stronger increase of breast cancer risk emerging many years after a previous depression.

Background: Long-stay hospitalization is often a consequence of insufficient care structures. This article examines the characteristics and care conditions of long-stay hospitalization (LSH) in an urban area in Germany.

Methods: Extensive data of patients in the urban catchment area of the Medical School of Hannover, capital of Lower Saxony, were evaluated during a 10 years period.

Results and conclusion: Community psychiatric efforts certainly help to reduce long-stay hospitalization, but cannot fully prevent it. Reference figures are given for comparable urbanized areas: consequently 500 chronically mentally ill persons per 100.000 inhabitants must be expected, 20% of which must be considered as long stay hospitalized according to a given definition. We estimate 250 places per 100.000 inhabitants to be required for institutionalised outpatient care, further 30 places for day clinic and full-time in-patient treatment and 40 places for residential home treatment. We suggest these results as a guidance for psychiatric planning in comparable communities.

Background: Depressive episodes in elderly patients with cerebrovascular damage are characterized by poor responses to standard antidepressants. Recent reports have suggested that the atypical antipsychotic, quetiapine may have antidepressant properties and, in mice, may prevents memory impairment and hippocampus neurodegeneration induced by global cerebral ischemia.

Objective: To evaluate the efficacy of combination therapy with quetiapine in depressed elderly patients with cerebrovascular damage.

Methods: An open-label, 6-month follow-up study of patients with major depressive disorder (DSM-IV) and cerebral abnormalities (assessed by MRI) without severe cognitive impairment. Patients who had not responded to standard antidepressants (months of treatment 6.5 +/- 7.2) additionally received quetiapine (300 +/- 111 mg/d). Patients were evaluated at baseline (t0) and Months 1, 3, and 6 (t1, t3, t6) using the Clinical Global Impressions Scale for Severity (CGI-S) and the Hamilton Depression Rating Scale (HAM-D).

Results: Nine patients were included in the study, with a mean age of 72.8 +/- 9.4 years. CGI-S scores decreased from baseline to Month 6: 5.8 +/- 0.7 (t0), 5.4 +/- 0.7 (t1), 5.0 +/- 0.8 (t3), and 4.5 +/- 1.0 (t6), with a significant improvement at 6 months compared with baseline (P = 0.006). A significant improvement over the 6-month period was also observed with HAM-D scores (t0 = 27.2 +/- 4.0, t6 = 14.8 +/- 3.8, P < 0.001).

Conclusion: In this study, quetiapine was efficacious as combination therapy in depressed elderly patients with cerebrovascular damage. The promising results from this study warrant confirmation in large, randomized, double-blind, placebo-controlled studies.

Background: Age-related cataract is the major cause of blindness in humans throughout the world. The majority of previous studies of cataract in Down's syndrome (which usually results from trisomy 21) have reported that the prevalence of this ocular abnormality is higher for a given age range than in the general population. The objective of the present study was to study the prevalence of cataract in a well-defined population of adults with Down's syndrome.

Methods: An in-patient population of 68 adults (35 males and 33 females) with Down's syndrome, aged between 28.9 and 83.3 years, underwent ophthalmological examination for the presence of cataracts.

Results: Overall, the prevalence of cataract was 16.2%, with no significant difference in the prevalence between males (17.1%) and females (15.2%). In those aged between 45 and 64 years, the prevalence was 16.7%, rising in those aged between 65 and 75 years to 28.6%.

Conclusion: Compared with the general population, the prevalence of cataract in Down's syndrome was raised in those aged 45 to 64, but not in those aged 65 to 75 years; the latter might be a function of the relatively small number of patients in this age group. The increased prevalence of cataract found in those in the 45- to 64-year-old age group may be the result of increased levels of the copper- and zinc-containing superoxide dismutase enzyme (CuZnSOD), in turn resulting from the location of the associated five exons of SOD1 on chromosome 21. These elevated levels of superoxide dismutase may give rise to increased levels of reactive species, including hydrogen peroxide and hydroxyl radicals, which may increase the risk of cataractogenesis. It is suggested that nutritional supplementation with antioxidants may therefore help reduce the prevalence of cataract in Down's syndrome.

Background: This case report highlights the diagnostic and assessment difficulties faced by mental health professionals when dealing with a Deaf client.

Case presentation: We used mobile phone text facility to monitor and liaise with the client while in the community. We focused on the affect and signing amplitude/intensity of the client to make a diagnosis of bipolar disorder, prescribed valproate semisodium, and noticed an improvement in two months.

Conclusion: This is an example of some areas of good practice when assessing a Deaf client with mental health problems.

The Edinburgh Postnatal Depression Scale (EPDS) is the instrument most used worldwide for screening of Post-Partum Depression (PPD). The SRQ20 questionnaire has been largely used for screening of minor psychiatric disorders. This study aimed to compare the accuracy of the two instruments in screening for PPD. At the third-month follow-up home visit to infants of the 2004 Pelotas Birth Cohort, Southern Brazil, a sub-sample of 378 mothers was selected. Among other questions, EPDS and SRQ20 were applied by trained fieldworkers. Up to 15 days later, a mental health professional re-interviewed the mother (the gold standard interview). Sensitivity and specificity of each cutoff point were calculated for EPDS and SRQ20 and the results were plotted at a ROC curve. The areas under both curves were compared. Highest sensitivity and specificity cutoff were observed for EPDS >/= 10 (sensitivity 82.7%, 95%CI 74.0 - 89.4; specificity 65.3%, 95%CI 59.4 - 71.0) and for SRQ20 >/= 6 (sensitivity 70.5%, 95%CI 60.8 - 79.0%; specificity 75.5%, 95%CI 70.0 - 80.5%). Shape of ROC curves and areas under both curves were virtually identical (respectively, 0.8401 +/- 0.02 for EPDS and 0.8402 +/- 0.02 for SRQ20; p = 0.9). In conclusion SRQ20 showed to be as valid as EPDS as a screening tool for PPD at third month after delivery.

Objective: To assess the long-term response to add-on quetiapine therapy in patients with bipolar I disorder who were not adequately responding to standard medications.

Methods: Outpatients with bipolar I disorder (DSM-IV-TR) responding inadequately to standard treatment were observed before and after the addition of quetiapine. Symptom severity was evaluated using the Clinical Global Impressions scale for Bipolar Disorder (CGI-BP) each month. Relapses included hospitalization, treatment in a day hospital or clinic, scores >/= 1 point higher than previous CGI-BP scores and/or upward titration of quetiapine or other medications.

Results: Sixty-one patients (age range of 18-68 years) were observed prospectively for an average of 7.5 months (range 3-18 months) prior to addition of quetiapine and subsequently followed for an average of 15.7 months (range 6-42 months). The final mean quetiapine dose was 537.1 +/- 91.7 mg/d. Prior to quetiapine addition, an annual relapse rate of 2.09 episodes was recorded, relating to 0.94 depressive and 1.15 manic or mixed episodes. Following quetiapine addition, annual relapse rates were reduced to 0.61 episodes, representing 0.14 depressive and 0.46 manic or mixed episodes. Compared with the period of add-on quetiapine treatment, the relative risk of relapse prior to quetiapine therapy was 3.4 for all episodes (chi2 = 24.8, P < 0.001), 6.7 for depressive episodes (chi2 = 24.7, P < 0.001), and 2.5 for manic or mixed episodes (chi2 = 9.0, P < 0.05).

Conclusion: This naturalistic follow-up study provides preliminary evidence for the efficacy of long-term add-on quetiapine treatment in the prevention of relapses of manic or mixed and depressive episodes of bipolar I disorder, and particularly in the prevention of depressive episodes.

Background: Processing personal data for research purposes and the requirement of anonymity has been the subject of recent debate. We aimed to determine the proportion of individuals who present to emergency departments with non-fatal suicidal behavior where an NHS number has been successfully traced and to investigate the characteristics of patients associated with non-capture.

Method: This was a descriptive study of people attending after self-harm using allocation of NHS numbers as main outcome measurement. Data from the Multicentre Monitoring of Self-Harm Project from 3 centres in England were used to identify consecutive patients (N = 3000) who were treated in six emergency departments in Oxford, Manchester and Leeds in 2004 and 2005 following self-harm.

Results: NHS number was available between 55-73% of individuals across centres. Characteristics associated with non-recording of NHS number in more than one centre included those from ethnic minority groups (Oxford: chi-squared statistic = 13.6, df = 3, p = 0.004; Manchester: chi-squared statistic = 13.6, df = 3, p

Conclusion: Basing research studies on NHS number as the unique identifier, as suggested by the Data Protection Act 1998 and the Patient Information Advisory Group, would exclude some of the most vulnerable groups for further self-harm or suicide. This bias may also affect other research registers.

Objective: To describe: a) a self-report questionnaire of 34 item, developed by a Family Association of Psychiatric Patients in collaboration with two psychiatrists to evaluate by key-relative in a clinical practice the perceived quality of mental health services, the needs and family burden; b) the methodology of validation.

Methods: It has been studied (a) the Face Validity by two focus groups of 10 relatives for each group, (b) the concurrent validity of family burden items comparing the ABC with QPF, a widely used questionnaire, in 6 Italian mental health centres on a sample of key-relatives, (c) the discriminant validity comparing three different samples of key-relatives of patients with psychiatric illness, Alzheimer or cancer. The internal consistency of items for assessing relatives' opinions on the quality of care has been evaluated by Chronbach' s alpha. The test-retest has been evaluated on a sample of 20 key-relatives.

Results: The results indicate a fairly good performance of the questionnaire in this preliminary but almost complete phase of validation. The time to fill in it has been estimated in a 7 minutes average.

Conclusion: It is possible by this self-report questionnaire to evaluate in a clinical routine setting and in a very short time three important problems for relatives and professionals: opinions and needs of relatives, and objective and subjective family burden of severe mental illness.