Psychiatric manifestations of HIV disease

Background: The appearance of AIDS on the medical and social scene in the early 1980 has been followed by worldwide spread of the disease and escalating numbers of persons affected. the first case was detected in 1984. For the first time in a worldwide epidemic, it has been necessary to try to change fundamental aspects of the human behavior by education and the dissemination of knowledge about psychiatric manifestations. Aim: To find out the psychiatric manifestations of HIV disease. Methods & Materials: 37 patients and 20 controls were taken up for evaluation of psychopathology. It’s a prospective study. Sociodemographic proforma, Socioeconomic Scale, Trail making A & B tests, color cancellation test, Raven's progressive matrices, Wechsler scale for memory, Linguistic fluency test were used. Results: Persons with HIV were having psychiatric manifestations like, Adjustment disorders, Depression, suicide, schizophrenia, Mild cognitive impairment to Dementia were noted among HIV and associated illnesses. Conclusion: Proper treatment adherence, counselling, follow up will improve the patient’s wellbeing.

Psychiatric Morbidity in Cancer Patients

Introduction: Psychiatric disorders are most prevalent (adjustment disorder- 13-42%, depression- 41-47% and generalized anxiety disorders upto 15%) in cancer patients. Some of initial responses like shock and denial, fear of disease and anxiousness about familial responsibilities are also common. Study aimed to investigate psychiatric morbidity in cancer patients. Material and Methods: The study was conducted at the cancer research centre of a large tertiary care hospital. Hamilton Rating Scale for Depression and Beck Anxiety Inventory were administered to the 200 cancer patients and 200 normal healthy relatives of patients. It was followed by a formal psychiatric interview based on the International Classification of Diseases-10 (ICD-10). The patients were studied before commencement of treatment to know the effect of cancer on psychological status of cancer patients. Results: The study revealed that a significant number of cancer patients (74%) suffered from psychiatric diagnostic entity (Adjustment disorder in 32%, Depression in 32% and Anxiety disorder in (10%) and other morbidities (suicidal ideations in 32%, Fear of disease and anxious about their familial responsibilities in 12% and Denial defense mechanism in 6%). Gastro-intestinal cancer patients suffered more from depression and other psychiatric disorders. Evaluation by Hamilton Rating Scale for Depression and Beck Anxiety Inventory also revealed more and statistically significant (P value= 0.000 and 0.011, respectively) psychiatric disorders and morbidities among cancer patients. Conclusions: The patients who were old, male, married, less educated and from lower socioeconomic status (SES) suffered more. However, female patients suffered more from adjustment disorder and more middle aged men had fear of disease and were anxious

Association between empathic ability and job adjustment disorder of pediatric nurses / 现代临床护理

Objective To survey the current situation and explore the association between empathic ability and job adjustment disorder of pediatric nurses. Methods The Jefferson scale of empathy health professionals and job adjustment disorder scale were used for the survey among 189 pediatric nurses. Pearson correlation analysis was used to explore the association between empathic ability and job adjustment disorder of pediatric nurses. Results The total score of empathic ability of pediatric nurses was (76.32 ±5.03), the score of their job adjustment disorder was (23.69 ±6.03). Their empathic ability and its dimensions were significantly negatively related with job adjustment disorder (P ＜0.01). Conclusions The empathic ability of pediatric nurses was at a medium to low level, job adjustment disorder was at a medium to high level. The higher level of pediatric nurses' empathic ability, the lower level of job adjustment disorder is. Hospital staff should take measures to improve pediatric nurses' empathic ability, and the pediatric nurses themselves should also actively cultivate their own perception, and improve the empathic ability so as to better acclimatize themselves to pediatric nursing job and reduce the degree of job adjustment disorder.

Burden of Psychiatric Disorders among Pediatric and Young Adults with Inflammatory Bowel Disease: A Population-Based Analysis / 대한소아소화기영양학회지

PURPOSE: There is increasing prevalence of psychiatric disorders among inflammatory bowel Disease (IBD) population. Further, presence of psychiatric disorders has been shown as an independent predictor of quality of life among patients with IBD. We intended to explore the prevalence of various psychiatric disorders among pediatric and young adult population with IBD as a population-based analysis. METHODS: We did a retrospective case control analysis using a deidentified cloud-based database including health care data across 26 health care networks comprising of more than 360 hospitals across USA. Data collected across different hospitals were classified and stored according to Systematized Nomenclature of Medicine-Clinical Terms. We preidentified 10 psychiatric disorders and the queried the database for the presence of at least one of the ten psychiatric disorders among IBD patients between 5 and 24 years of age and compared with controls. RESULTS: Total of 11,316,450 patients in the age group between 5 and 24 years and the number of patients with a diagnosis of IBD, Crohn's disease or ulcerative colitis were 58,020. The prevalence of psychiatric disorders was 21.6% among IBD mainly comprising of depression and anxiety disorder. Multiple logistic regression analysis showed, IBD is 5 times more likely associated with psychiatric disorders than controls, p<0.001). We showed a steady increasing trend in the incidence of psychiatric disorders among IBD patients (2% in 2006 to 15% in 2017). CONCLUSION: Largest population-based analysis demonstrated an increased prevalence of psychiatric disorders among IBD patients. Our study emphasizes the need for psychological and mental health services to be incorporated as a part of the routine IBD clinic.

Una mirada crítica sobre la reacción situacional en la atención primaria de salud / A critical glance on the situational reaction in primary health care

La enfermedad situacional es una categoría nosográfica poco analizada en la bibliografía médica. En este artículo se abordan aspectos importantes relacionados con su valor clasificatorio y práctico, así como la importancia que reviste en el plan de formación del médico general integral, debido a las potencialidades de desarrollo en la comunidad. Además, se enfatiza en las posibilidades prácticas de aplicar los procedimientos psicoterapéuticos de apoyo, que son oportunos y facilitadores para evitar la sobresaturación de la demanda asistencial secundaria, resultante del envío o remisión

The situational disease is a nosographic category little analyzed in the medical literature. In this work important aspects related to its classificatory and practical value are approached, as well as the importance that it has in the training plan of the comprehensive general doctor, due to the development potentialities in the community. It is also emphasized on the practical possibilities of implementing the support psychotherapeutic procedures that are opportune and facilitators to avoid the overflood of secondary assistance demand, resulting from referral.

Case formulation report of cognitive behavior therapy for adjustment disorder: A case study / 中国心理卫生杂志

This study discussed how to make a cognitive behavioral therapy-orientated case formulation for the client who was diagnosed as adjustment disorder,and also the importance of the role of case formulation in guiding the whole counseling process.Four months before the client asked for psychological help,he gradually showed symptoms of depression,insomnia,work inefficiency and being suspicious of self-capacity because of the promotion and the change of supportive system.We did the psychological counseling aiming at his cognitive,emotional and behavioral problems.In addition,the Beck Depression Inventory (BDI),Beck Anxiety Inventory (BAI) and Subjective Units of Distress Scale (SUDs) were used to evaluate his emotional condition before,after and during the counseling.Results demonstrated that the client's emotional,cognitive and social functions were significantly improved,achieving the expected goals.In conclusion,the cognitive behavioral therapy-orientated case formulation for adjustment disorder could effectively guide the counseling practice.

<b>A Case of Involuntary Movements Treated with Yokukansankashakuyakukoboku</b> / 日本東洋医学雑誌

We report the case of a 17-year-old male who had involuntary movements treated with yokukansankashakuyakukoboku. He had first recognized the involuntary movement 6 years previously. His symptom could not be alleviated with neurological and psychological treatments, and he visited our clinic for treatment with Kampo medicine. His symptom gradually alleviated with yokukansankashakuyakukoboku. The ancient physician Sekki (薛已) created yokukansan in China's Ming Dynasty. Yokukansan and its various add-on combinations were used in the Edo Era of Japan. Keisetsu Ohtsuka then created yokukansankashakuyakukoboku, which is however now rarely used because there is no extract drug in Japan. There are markedly nervous patients however, who can be treated with this formula. Thus, the authors feel that more research needs to be done on the differences between yokukansan and yokukansankashakuyakukoboku.

Distinguishing Quantitative Electroencephalogram Findings between Adjustment Disorder and Major Depressive Disorder

OBJECTIVE: Adjustment disorder (ADJ) is a common diagnosis. However, it is difficult to distinguish ADJ from other major Axis I disorders, such as major depressive disorder (MDD). The aim of this study was to determine the distinguishing neurophysiological characteristics between ADJ and MDD using quantitative analysis of an electroencephalogram (QEEG). METHODS: The study included 30 patients with ADJ and 51 patients with MDD. Resting (eye closed) vigilance controlled EEG recordings were assessed at 19 electrode sites according to the international 10/20 system. QEEG absolute power and coherence were calculated for the delta, theta, alpha and beta bandwidths. RESULTS: Absolute powers of alpha and high beta bands, particularly at the frontocentral area, differed between MDD and ADJ group (p<0.05). Interhemispheric coherence values for the delta and beta bands were lower in the ADJ group than in the MDD group (p<0.05). Intrahemispheric coherence values for the alpha band were also lower in the ADJ group (p<0.05). CONCLUSION: The differences in QEEG power and coherence in our investigation suggest that underlying pathophysiologic mechanisms may be different between ADJ and MDD.

Estresores psicosociales y depresión mayor recurrente / Psychosocial stressors and major recurrent depression

En este trabajo se examinan los estresores psicosociales y la depresión recurrente a través de la revisión de la literatura básica en la materia. Se define el estrés y se clasifica desde diferentes perspectivas. El estrés es una causa de tensión y exigencia o mecanismo de adaptación.El estrés y la presentación del primer episodio depresivo están directamente relacionados, sin embargo cuando se presentan recurrencias el estrés significativo pierde fuerza dentro de los factores que lo desencadenan. Los estresores, especialmente los psicosociales, están relacionados con la presentación de recurrencias. Entre estos se destacan estresores internos y externos, por sucesos vitales, estrés de rol y las contrariedades cotidianas, la alta exigencia y el perfeccionismo. El no cumplimiento de metas es otro factor provocador de crisis en la transición del ciclo vital. El neuroticismo y el perfeccionismo, como actitudes disfuncionales provocan aislamiento y falta de soporte social. Los esquemas cognitivos disfuncionales conducen a un procesamiento erróneo de la información. La depresión es una pauta de relación que no permite encontrar formas adaptativas de enfrentar la vida y conducir las relaciones interpersonales. Aunque hay nuevas visiones que la consideran como un esfuerzo adaptativo. La comorbilidad puede hacer recurrir la depresión. Se ha sugerido que patrones maladaptativos cognitivos, en particular en interacción con estresores, podrían llevar a pobres resultados en el tratamiento de sujetos con trastorno depresivo mayor en comorbilidad con trastornos de personalidad. Estos, independientemente del estado de la depresión, han sido asociados con elevadas actitudes disfuncionales.

This paper examines psychosocial stressors and recurrent depression through a review of the basic literature on the subject. Stress is defined and classified from different perspectives. Stress is a cause of tension and demand or an adaptive mechanism. Stress and the presentation of the first episode of depression are directly related, however when recurrences are present significant stress loses strength among the factors that trigger it. Stressors, especially the psychosocial, are related to recurrences. Chief among these are internal and external stressors, and life events, role stress and annoyances of daily living, high demands and perfectionism. Failure to accomplish goals is another factor provoking crisis in the life cycle transition. Neuroticism and perfectionism, and dysfunctional attitudes lead to isolation and lack of social support. Dysfunctional cognitive schemes lead to erroneous information processing. Depression is a pattern of relationship failing to find adaptive ways of coping with life and conduct relationships, although there are new visions that consider it as an adaptive effort. Comorbidity can lead the recurrence of depression. It has been suggested that maladaptive cognitive patterns, in particular in interaction with stressors, could lead to poor results in the treatment of patients with major depressive disorder comorbidity with personality disorder. These, regardless of the state of depression have been associated with high dysfunctional attitudes.

Intervención psiquiátrica en programa de trasplantes / Psychiatric intervention in a transplantation program

En los últimos años la Psiquiatría de Enlace e Interconsulta ha experimentado un salto cualitativo, acercándose al espacio común del resto de las especialidades médicas: el hospital general. La participación de psiquiatras en programas clínicos específicos como las unidades de trasplantes de órganos sólidos tiene fundamentaciones técnicas precisas dada la correlación entre síntomas psíquicos y las características clínicas específicas de las enfermedades médicas que requieren de este procedimiento. Cada vez hay una mayor preocupación en los clínicos y cirujanos en relación a los factores psíquicos que obstaculizan la adherencia a los tratamientos e indicaciones médicas tanto antes como después de efectuado el trasplante. La población de pacientes pre y post-trasplantados exhiben elevadas tasas de cuadros psiquiátricos específicos que ameritan un tratamiento coordinado multidisciplinario. El objetivo de este trabajo es mostrar la experiencia inicial que estamos desarrollando en la Unidad de Trasplantes de Clínica Las Condes.

In recent years consultation-liaison psychiatry has experienced a quantum leap closer to the common space of the other medical specialties: the general hospital. The participation in clinical programs such as the units of solid organ transplants have required technical arguments given the correlation between psychiatric symptoms and the clinical features of specific medical illness that require this procedure. During the last time, there have been and increasingly concern among clinicians and surgeons in regard to the psychological factors that affect the adherence to treatment and medical advice before and after transplant. The population concerning pre and post transplantation issues, exhibits significant rates of specifics psychiatric disorders which require evaluation and drug treatment specialist coordination. The aim of this paper is to show the initial experience we have developed in the transplant unit of Clínica Las Condes, concerning psychiatric and psychosocial issues.

Consultation-liaison psychiatry in Maharaj Nakorn Chiang Mai Hospital

Objective: The aim of this study was to evaluate common problems in consultation-liaison psychiatry, characteristics of consulted patients, and medical and psychiatric diagnoses of the patients in Maharaj Nakorn Chiang Mai Hospital. Methods: We performed a retrospective descriptive study from June 2005 to August 2006. All participants were medically ill inpatients who consulted for psychiatric problems. The authors reviewed the demographic data such as age, sex, ward, systemic disease, medical disease, psychiatric provisional diagnosis and psychiatric diagnosis. Results: Four hundreds patients were consulted for psychiatric evaluation, 0.82 % of all general hospital inpatients, 235 (58.8 %) males and 165 (41.2 %) females. The modal age group was between 20 - 49 years old (58.8 %) mostly referred by the department of internal medicine and surgery. At discharge, common diagnoses were adjustment disorder (35.0 %), delirium (32.5 %), substance-related disorders (17.0 %), depressive disorders (13.3 %), and psychotic disorders (4.3 %). Sensitivity rates for diagnosis of these psychiatric disorders were 12.1%, 50.8%, 75 %, 43.4% and 64.7% respectively. Conclusion: Patients with high suicidal risk, in particular adjustment and depressive disorders are common in consultation-liaison psychiatry. Attention should also be given to patients with high risks of aggression, disruption, or disorganization, such as delirium, substance abuse, and psychotic disorders.