[Somatic morbidity in the mentally ill]. / Somatische Morbidität bei psychisch Kranken.

In addition to psychosocial impairment, patients with severe mental illness (SMI) are exposed to substantial risks with respect to physical health. Their life expectancy is significantly shortened in the range of 1-2 decades. Against this background common medical comorbidities of this important group of patients are discussed (e.g. cardiovascular, respiratory and metabolic disorders) with a focus on those clinical aspects most relevant for everyday psychiatric practice. Potentials for improvement of curative and preventive health care are outlined. Current scientific and clinical knowledge on somatic health of patients with SMI provides evidence of close interactions between physical and mental health. Meeting the challenge of compromised physical health in this particular group of patients might be a relevant topic for further conceptual development of psychiatry, psychotherapy und psychosomatic medicine.

General medical interventions in patients with dementia treated in a psychogeriatric unit.

Medical records of 50 consecutive psychogeriatric inpatients with moderate or severe dementia were retrospectively analyzed. Comorbid general medical disorders were diagnosed in 88% of the patients (202 disorders; mean: 4.6/patient). At least one general medical intervention was initiated during hospital treatment in 78% of patients (82 interventions in 39 patients with a mean length of stay of 38.8 days). Interventions were most frequently related to respiratory and urinary tract infections, followed by cardiovascular diseases and metabolic disorders, respectively. In conclusion, psychogeriatric patients with advanced dementia are in need of a substantial amount of general medical care.

[Psychiatric disorders in elderly patients caused by disturbed calcium metabolism]. / Ausgeprägte Störungen des Kalziumstoffwechsels als Ursache psychischer Störungen bei Alterspatienten.

We report on three patients admitted to psychiatric hospital due to mental disorder in the context of marked pathology of calcium metabolism: a 69 years old male patient with known major depression developed pronounced deterioration of his mental state with distinct hypercalcemia due to parathyroid adenoma, a 90 years old male patient came to treatment with organic affective und delirious symptomatology caused by severe hypercalcemia due to bronchial carcinoma, and a 79 years old female patient was admitted for mixed depressive and anxiety syndrome with profound hypocalcemia and -magnesaemia originating in malabsorption syndrome due to Crohn's disease. Although all patients had received general medical care previously the relevance of their metabolic disorders with regard to their psychopathology had not been ascertained. In all cases treatment of disturbed electrolyte metabolism resulted in an at least temporary improvement of their psychiatric symptomatology. Our case reports referring to elderly patients with multimorbidity underscore the etiological relevance of disturbed calcium metabolism with regard to a broad spectrum of psychiatric syndromes.

[Transfer of patients between a unit of geriatric psychiatry and general hospitals: a one-year analysis]. / Verlegungen zwischen Gerontopsychiatrie und Allgemeinkrankenhaus: Analyse der Daten eines Jahres.

BACKGROUND AND OBJECTIVE: Patients with psychogeriatric disorders normally are affected by comorbid medical illnesses. In this context the question where to set therapeutic priorities often arises. With regard to that issue frequency of and indications for patient transfer from general hospital to a psychogeriatric unit and vice versa were evaluated in this study. PATIENTS AND METHODS: Retrospective analysis of all admissions during one year in a geriatric psychiatry department of a regional hospital for psychiatry and neurology. RESULTS: 1005 episodes of treatment were analysed: 65.9 % female patients, mean age 76.7 + or - 9.3 years, mean length of stay 37.2 + or - 25.1 days; main diagnoses: organic mental disorders 50.9 %, affective disorders 30.8 %, others 18.3 %. In 330 cases patients were transferred, either from general hospital to the psychogeriatric unit (n = 164) or vice versa (n = 100), or transfer took place back and forth (n = 66). In the overall 166 transfers to general hospitals acute general medical conditions were the most frequent causes (62.7 %), with cardiovascular and respiratory diseases representing the most common diagnoses (24.1 and 13.3 % of all transfers, respectively). CONCLUSION: Although the results presented here originate from one single region and thus cannot be taken as representative for Germany as a whole they indicate a considerable overlap of the clientele of general hospitals and psychogeriatric units. In view of expected demographic changes which presumably will result in a growing proportion of persons with (psycho)geriatric disorders, cooperation between general hospitals, psychogeriatric departments and outpatient treatment has to be intensified with high priority.

[Hallucinogen-induced psychological disorders]. / Halluzinogen-induzierte psychische Störungen.

OBJECTIVE: The purpose of this article is to provide an overview of the current research on hallucinogen induced psychiatric disorders. In addition to LSD and psilocybin hallucinogens of biologic origin are increasingly used by adolescents and young adults. METHODS: Relevant literature and related articles were identified by means of a computerized MEDLINE search including the years 1997 - 2007. As keywords "hallucinogen induced psychosis", "hallucinogen induced flashback", "hallucinogen persisting perception disorder (HPPD)" were used. Finally, 64 journal articles and books out of 103 were included in the review. RESULTS: Acute psychotic syndromes in adolescents are rarely due to intoxications with hallucinogenic drugs. However, clinical relevance of flashback phenomena as post-hallucinogenic psychiatric disorder has to be disputed. Because of the high popularity of biogenic hallucinogens and LSD knowledge of intoxications and resulting psychiatric disorders as well as medical complications and therapeutical approaches are clinically important. Especially intoxications with drugs of herbal origin like tropanalcaloids play an important role in emergency situations.

[An interdisciplinary unit for major psychiatric/somatic comorbidity: concept and 22 years of experience]. / Interdisziplinäre Station für psychisch Kranke mit erheblichen somatischen Komorbiditäten: Konzept und Erfahrungen von 1985-2007.

In this article we describe in detail a specialised facility geared toward caring for patients presenting with major psychiatric and somatic comorbidity. Located in a psychiatric hospital, an important feature of the treatment offered in this unit is that psychiatric/psychotherapeutic and somatic care are provided by the same team members. Working in this unit places high demands on the medical team, which must be competent in both fields, especially during emergency situations. Due to the severity of the patients' symptomatology, the unit requires more staff than regular psychiatric wards. Frequent psychiatric diagnoses necessitating the transfer of patients to this ward include delirium associated with internal/neurologic disorders or occurring postoperatively, and affective syndromes and dementia due to general medical conditions. Somatic disorders frequently requiring treatment in this ward include acute cardiovascular syndromes, liver or renal failure, infections, and conditions arising postoperatively or following trauma.

[How much general medical competency does a psychiatrist need?]. / Wie viel allgemeinmedizinische Kompetenz benötigen Psychiater?

Due to manifold interactions between physical and mental health, there exist close interactions between psychiatric care and that from other medical fields. In this regard, points of general medical practice are discussed as they relate to psychiatric care. The frequency of somatic comorbidities in patients with mental disorders and a rising proportion of elderly patients are strong arguments for inclusion of general medical elements in psychiatric and psychotherapeutic training.

Effects of improved glycaemic control maintained for 3 months on cognitive function in patients with Type 2 diabetes.

BACKGROUND AND AIM: In a previous study we failed to find beneficial short-term effects of improved glycaemic control on cognitive functioning in patients with Type 2 diabetes mellitus. A subgroup of the entire sample was tested again to examine the effect of longer-lasting improvement of metabolic control on cognitive functioning. METHODS: The cognitive performance of 26 patients with Type 2 diabetes was assessed at baseline and 3 months after discharge. Thirteen controls were tested at the similar time-points. Attention/concentration, psychomotor speed, verbal fluency, verbal memory and depressive symptoms were assessed. Improved glycaemic control was generally achieved with insulin therapy (20/26). RESULTS: At baseline, there was a trend for diabetic patients to perform worse than controls. Both groups improved significantly over 3 months in several measures. However, diabetic patients did not improve more than controls. CONCLUSIONS: In individuals with long-standing Type 2 diabetes, previous reports of improved cognitive capacity following restoration and maintenance of near-normoglycaemia were not confirmed. This might relate to the type of anti-diabetic therapy.

Short-term effects of improved glycemic control on cognitive function in patients with type 2 diabetes.

BACKGROUND: According to numerous studies, type 2 diabetes is associated with mild cognitive dysfunction, and there is some evidence suggesting favorable effects of improved metabolic control on the mental capability of elderly diabetic patients. OBJECTIVE: To compare patients with type 2 diabetes to normal controls with respect to cognitive performance and to investigate the consequences of glycemic adjustment. METHODS: 53 patients with type 2 diabetes, most of them in secondary failure on oral antidiabetic drugs, but free from conditions which may cause brain dysfunction, were included (mean age 58.8 +/- 6.1 years, duration of disease 12.0 +/- 6.4 years). They were examined prior to (t1), and following (t2) glycemic adjustment with a time interval of approximately 2 weeks. 29 non-diabetic controls, comparable with regard to age, gender, education and verbal intelligence were examined twice with a corresponding time interval. Cognitive performance was assessed by well-standardized tests with a focus on attention/concentration, psychomotor speed, verbal fluency and verbal memory; mood status by two self-rating scales. Restoration of glycemic control included insulin treatment in the majority of patients (46/53). RESULTS: Diabetic subjects scored significantly lower in all cognitive tests used, while they did not differ from controls in mood status. From t1 to t2 they improved in those tests measuring attention/concentration, and psychomotor speed. With regard to similar changes in controls, we interpret these improvements as practice effects rather than the consequence of altered metabolic control. CONCLUSION: In a sample of patients with long-standing type 2 diabetes we could not confirm previous reports of improved cognitive capacity with restoration of glycemic control. Further studies on the effects of changes in control of blood glucose on cognitive performance in type 2 diabetes should be conducted with special regard to drugs used to lower blood glucose.

Thyroid function test abnormalities in newly admitted psychiatric patients residing in an iodine-deficient area: patterns and clinical significance.

OBJECTIVE: The prevalence of abnormal in-vitro thyroid function tests in psychiatric in-patients may be as high as 24%. Thus far, however, there is only limited data addressing the underlying causes of these abnormal test results, i.e. how often they can be attributed to genuine thyroid disease. METHOD: We conducted an observational study of all in-patients admitted to our institution during 1 calendar year running analyses of total thyroxin (T4), free thyroxin index (FTI) and thyroid-stimulating hormone (TSH). Patients with abnormal test results were classified according to an algorithm which had been established previously. RESULTS: In 243 of 880 patients with in-vitro thyroid function analysis, at least one concentration of either T4, FTI or TSH was found to be outside the reference range. Work-up according to the algorithm was completed in 848 patients; alterations were classified as representing thyroid dysfunction in 100 (41% of patients with abnormal test results), non-specific findings in 92 (38%), influence of ingested drugs in 18 (7%) and of severe physical disease in 1 (0.4%). As measures of T4 and/or FTI provided no essential information in 854 patients (97% of tested), we found that in most cases the determination of TSH alone was sufficient for demonstrating normal thyroid function. CONCLUSION: In 27.6% of newly admitted patients living in an iodine-deficient area, at least one abnormal result in either T4, FTI or TSH values was found. Genuine thyroid disease was found in slightly less than half the patients with an abnormal value.