ABSTRACT
Common psychiatric responses to disasters include depression, PTSD, generalized anxiety disorder, substance-abuse disorder, and somatization disorder. These symptom complexes may arise because of the various types of trauma experienced, including terror or horror, bereavement, and disruption of lifestyle. Because different types of disaster produce different patterns of trauma, clinical response should address the special characteristics of those affected. Traumatized individuals are typically resistant to seeking treatment, so treatment must be taken to the survivors, at locations within their communities. Most helpful is to train and support mental health workers from the affected communities. Interventions in groups have been found to be effective to promote catharsis, support, and a sense of identification with the group. Special groups to be considered include children, injured victims, people with pre-existing psychiatric histories, and relief workers.
Subject(s)
Disaster Planning/organization & administration , Emergency Services, Psychiatric/organization & administration , Grief , Stress Disorders, Post-Traumatic/prevention & control , Survivors/psychology , Counseling , Humans , Psychotherapy, Brief/methods , Psychotherapy, Group/methods , Stress Disorders, Post-Traumatic/psychology , United StatesABSTRACT
BACKGROUND: Although the chronic use of neuroleptic medications is generally discouraged in patients with bipolar disorder, data on the actual extent of this practice are relatively scarce. METHOD: All bipolar patients receiving treatment at the Connecticut Mental Health Center on September 1, 1994, were identified through a computerized administrative database; the medical record was then examined. Patients were included in the study if (1) the last two recorded diagnoses in the chart were concordant for bipolar disorder and (2) the patient had not been hospitalized in the past year. RESULTS: Of 49 patients meeting review criteria, 33 (67%) met criteria for chronic neuroleptic exposure. The mean +/- SD continuous neuroleptic dosage for these 33 outpatients was 416 +/- 527 mg/day chlorpromazine (CPZ) equivalents. The dosage distribution was skewed, with 17 (52%) receiving < or = 200 mg/day CPZ [corrected] equivalents. CONCLUSION: Chronic neuroleptic administration occurred frequently in our sample of nonhospitalized bipolar outpatients.
Subject(s)
Ambulatory Care/statistics & numerical data , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Adult , Aged , Antidepressive Agents/therapeutic use , Antipsychotic Agents/administration & dosage , Community Mental Health Centers/statistics & numerical data , Connecticut , Drug Therapy, Combination , Drug Utilization , Female , Humans , Lithium/therapeutic use , Male , Medical Records/statistics & numerical data , Middle Aged , Valproic Acid/therapeutic useABSTRACT
Each year, a number of tornados rip through Kentucky, leaving fear, destruction, and human injury in their path. Persons who endure these catastrophes often experience a variety of stress responses. The psychological and medical sequelae include depression, acute and post-traumatic stress disorders, substance abuse, anxiety, and somatization. It is especially important for the Kentucky practitioner to be able to recognize and screen for pathology following a tornado disaster in order to provide leadership in ascertaining treatment for such stress responses.
Subject(s)
Anxiety Disorders/etiology , Depression/etiology , Disasters , Stress Disorders, Post-Traumatic , Substance-Related Disorders/etiology , Animals , Anxiety Disorders/diagnosis , Anxiety Disorders/therapy , Depression/diagnosis , Depression/therapy , Female , Humans , Kentucky , Male , Primary Health Care , Psychiatric Status Rating Scales , Rats , Risk Factors , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/therapy , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapySubject(s)
Antidepressive Agents, Second-Generation/adverse effects , Depressive Disorder/drug therapy , Epilepsies, Myoclonic/chemically induced , Epilepsy, Generalized/chemically induced , Fluoxetine/adverse effects , Receptors, Serotonin/drug effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Trazodone/adverse effects , Adult , Antidepressive Agents, Second-Generation/therapeutic use , Drug Therapy, Combination , Fluoxetine/therapeutic use , Humans , Male , Selective Serotonin Reuptake Inhibitors/therapeutic use , Syndrome , Trazodone/therapeutic useSubject(s)
Delivery of Health Care/organization & administration , Disasters , Hospitals, State , Inpatients/psychology , Adult , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , Female , Hawaii , Humans , Male , Middle Aged , Psychiatric Department, Hospital , Schizophrenia/rehabilitationABSTRACT
Given the frequency of natural disasters in Hawaii, it is important for practitioners to be aware of the numerous resulting psychological responses and risk factors, especially those unique to Hawaii. Practical guidelines are presented for practitioners, both in providing leadership during the disaster and in screening for psychopathology thereafter.
Subject(s)
Disasters , Stress, Psychological , Disaster Planning , Hawaii , Humans , Stress, Psychological/etiology , Stress, Psychological/prevention & controlABSTRACT
Diurnal weight gain was found to be abnormal among 44 of 77 institutionalized chronically psychotic patients. All patients were weighed and urine samples obtained weekly for 3 weeks at 7 A.M. and 4 P.M. Diurnal weight gain was normalized as a percentage by subtracting the 7 A.M. weight from the 4 P.M. weight, multiplying the difference by 100, and then dividing the result by the 7 A.M. weight. Normalized diurnal weight gain (NDWG) was 2.504 +/- 1.266% for the 44 study patients with abnormal findings, .631 +/- .405% for the 16 acutely psychotic controls, and .511 +/- .351% for 29 normals. Urine excretion was related (r = .476, p = .001) to NDWG in the subgroup of study patients with abnormal NDWG, consistent with the observation that their fluid intake exceeded fluid excretion in the afternoon.
Subject(s)
Drinking/physiology , Psychotic Disorders/physiopathology , Water-Electrolyte Balance/physiology , Weight Gain/physiology , Adult , Circadian Rhythm/physiology , Female , Hospitalization , Humans , Hypothalamus/physiopathology , Male , Middle Aged , Psychotic Disorders/psychologyABSTRACT
We found diurnal weight gain to be abnormal among 41 institutionalized patients with manic-depressive spectrum disorders. They were weighed at 7 AM and 4 PM weekly for three weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 AM weight from the 4 PM weight, multiplying the difference by 100, and then dividing the result by the 7 AM weight. NDWG was 2.216 +/- 1.513 percent for the study population, .631 +/- .405 percent for 16 young, newly admitted controls, and .511 +/- .351 percent for 29 normals. Abnormal NDWG may be an additional feature of manic-depressive spectrum disorders.
Subject(s)
Bipolar Disorder/physiopathology , Body Weight , Circadian Rhythm/physiology , Adult , Bipolar Disorder/drug therapy , Blood Pressure , Chlorpromazine/therapeutic use , Female , Humans , MaleABSTRACT
Seven patients (6 men and 1 woman, mean age 39.1 +/- SD 6.9 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent serial determinations of serum sodium (SOD), plasma atrial natriuretic peptide (ANP), and urinary osmolality (UOSM) at 7 AM and 4 PM. There was a diurnal increase in ANP (7 AM 17.9 +/- 5.1 pg/ml and 4 PM 27.7 +/- 9.0 pg/ml, p = 0.02), a diurnal decrease in serum sodium (7 AM 141.1 +/- 1.7 mEq/l, 4 PM 129.9 +/- 3.2 mEq/l, p less than 0.0001) and no diurnal change in UOSM. The diurnal increase in ANP in the the PIP syndrome contrasts to the diurnal decrease in ANP reported in normal subjects. Our data, while preliminary, suggest that patients with the PIP syndrome have increased intravascular volume leading to ANP secretion, natriuresis, and hyponatremia.
Subject(s)
Circadian Rhythm , Hyponatremia/physiopathology , Psychotic Disorders/physiopathology , Thirst/physiology , Adult , Atrial Natriuretic Factor/blood , Female , Humans , Hyponatremia/metabolism , Male , Middle Aged , Osmolar Concentration , Psychotic Disorders/metabolism , Sodium/blood , Syndrome , Urine/chemistryABSTRACT
We found abnormal diurnal weight gain among 25% of acutely psychotic patients with schizophrenia and 68% of chronically psychotic patients with schizophrenia. They were weighed at 7:00 AM and 4:00 PM weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7:00 AM weight from the 4:00 PM weight, multiplying the difference by 100, and dividing the result by the 7:00 AM weight, NDWG was 0.93% +/- 0.89% for the 36 acutely psychotic patients and 2.2% +/- 1.5% for the 68 chronically psychotic patients (F = 25.297, p less than 0.0001). Drugs did not explain this difference. Our data, though preliminary, suggest that water dysregulation, as manifested by abnormal diurnal weight gain, develops in schizophrenia as patients progress into Arieti's third stage of this disorder. A longitudinal study design, rather than our cross-sectional one, would be necessary to assess developmental changes in schizophrenia.
Subject(s)
Schizophrenia/physiopathology , Schizophrenic Psychology , Water Intoxication/physiopathology , Water-Electrolyte Balance/physiology , Adult , Chronic Disease , Circadian Rhythm/physiology , Humans , Male , Psychiatric Department, Hospital , Weight Gain/physiologyABSTRACT
Fourteen patients receiving multiple antipsychotic drugs in a state mental hospital long-term unit comprised the study sample. They completed a 1-year clinical trial to reduce such drugs to a single antipsychotic agent. Six of the 14 patients were successfully converted to a single antipsychotic drug without clinical deterioration. Eight patients showed marked psychiatric decompensation when converted to single antipsychotic therapy. Factors that may have contributed to this difference are discussed.
Subject(s)
Antipsychotic Agents/therapeutic use , Psychotic Disorders/drug therapy , Adult , Chronic Disease , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Humans , Male , Psychotic Disorders/psychologyABSTRACT
We found diurnal weight gain to be abnormal among 39 chronic schizophrenic patients. The patients were weighed and urine samples obtained weekly for three weeks at 7 a.m. and 4 p.m. We normalized the dirunal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.075 +/- 1.331% for the 38 study patients, .631 +/- .405% for 16 acutely psychotic controls and .511 +/- .351% for 29 normals. Seventy-seven percent of the study patients had abnormal NDWG values and 62% were polyuric. NDWG related to urine volume (n = 39, r = .356, p = .026) with the variability in urine excretion explaining 13% of the variability in NDWG. We discuss factors that may have contributed to our findings.
Subject(s)
Circadian Rhythm , Schizophrenia/physiopathology , Schizophrenic Psychology , Urodynamics , Water Intoxication/physiopathology , Weight Gain , Adult , Chronic Disease , Drinking , Female , Humans , Male , Middle Aged , Pituitary Gland, Posterior/physiopathology , Polyuria/physiopathology , Reference Values , Risk FactorsABSTRACT
We studied 20 geriatric and 87 nongeriatric chronically psychotic male inpatients, 16 acutely psychotic male control subjects, and 14 male normal subjects. The subjects were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was .509% +/- .337%, 2.209% +/- 1.529%, .631% +/- .405%, and .533% +/- .410%, among the geriatric men, nongeriatric men, control subjects, and normal subjects respectively. Differences in diagnoses and drugs did not explain these findings. We hypothesize that abnormal diurnal weight gain may be a risk factor for premature death among chronically psychotic inpatients.
Subject(s)
Psychotic Disorders/physiopathology , Weight Gain , Adult , Aged , Antipsychotic Agents/administration & dosage , Blood Pressure , Carbamazepine/administration & dosage , Chronic Disease , Circadian Rhythm , Humans , Lithium/administration & dosage , Male , Pulse , Risk Factors , Water Intoxication/physiopathologyABSTRACT
We compared the diurnal weight gain of 46 patients with mental retardation to that of 21 patients with organic mental syndromes. They were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and dividing the result by the 7 a.m. weight. Normalized diurnal weight gain was abnormal among one fourth of patients with mental retardation and two thirds of those with organic mental syndromes. Differences in age, sex, baseline weight, antipsychotic drugs, lithium, carbamazepine, blood pressure, and pulse did not explain our results. We believe that our findings provide additional evidence to separate patients with mental retardation from those with psychosis.
Subject(s)
Circadian Rhythm , Intellectual Disability/physiopathology , Weight Gain , Adult , Blood Pressure , Female , Humans , Male , Middle Aged , Sodium Chloride/blood , Water Intoxication/therapy , Weight Gain/drug effectsABSTRACT
We found diurnal weight gain to be abnormal among 28 institutionalized chronically psychotic patients. They were weighed daily for 15 days at 7 a.m. and 4 p.m. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.8 +/- 1.3% for the 28 study patients, 0.631 +/- 0.405% for 16 acutely psychotic controls, and 0.511 +/- 0.351% for 29 normals. Ninety-three per cent of the study sample had NDWG values above the upper limit of normal. Sex, diagnosis, smoking, baseline weight, blood pressure, and pulse did not explain these observations. NDWG related (N = 28, r = 0.552, P = 0.002) to antipsychotic drug dose. The implications of our findings are discussed.
Subject(s)
Circadian Rhythm , Psychotic Disorders/physiopathology , Weight Gain , Adult , Affective Disorders, Psychotic/physiopathology , Blood Pressure/drug effects , Chlorpromazine/therapeutic use , Circadian Rhythm/drug effects , Drinking Behavior/physiology , Female , Humans , Male , Neurocognitive Disorders/physiopathology , Personality Disorders/physiopathology , Schizophrenia/physiopathology , Smoking/physiopathology , Water-Electrolyte Balance/drug effects , Weight Gain/drug effectsABSTRACT
We found diurnal weight gain to be abnormal among 93 chronically psychotic patients, most of whom had schizophrenia. They were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and dividing the result by the 7 a.m. weight. NDWG was 1.7 +/- 1.0 percent for the study sample, 0.6 +/- 0.4 percent for 16 acutely psychotic controls, and 0.5 +/- 0.4 percent for 29 normals. More than 60 percent of the study sample had abnormal NDWG values. NDWG related to antipsychotic drug dose (r = 0.290, p = 0.005) with variability in drug dose accounting for 8 percent of the variability in NDWG. This report provides yet another piece of evidence that disordered water balance is common in chronic psychiatric patients. The etiology is unknown, but it may relate to subtle brain abnormalities in the regulation of fluid intake and excretion.
