ABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Aged , Psychopharmacology/trends , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Clinical Trials as Topic , Dementia/epidemiology , Patient Selection , Alzheimer Disease/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Depressive Disorder, Major/therapy , Psychotherapy/statistics & numerical data , Antidepressive Agents/therapeutic use , Patient Compliance , Medication Adherence , Patient Dropouts , Long-Term Care/methods , Cost of Illness , Evaluation of the Efficacy-Effectiveness of Interventions , Biomedical Enhancement , Recurrence , Practice Patterns, Physicians' , Psychotic Disorders/epidemiology , Apathy , Suicidal Ideation , Physician-Patient RelationsABSTRACT
BACKGROUND: Some studies point up the frequent aggressiveness showed by the schizophrenic in-patients. The aim of this research is to know some possible predictors factors of this violence, in order to prevent it. METHOD: A two-year long retrospective study was carried out on acts of physical violence committed by schizophrenic in-patients in a General Hospital. This group was compared with a non-aggressive control group. RESULTS: Twenty-nine (29) patients committed ninety (90) acts of assault. The predictive value for violence has been evaluated using twelve variables (court orders, clinical diagnosis, past history of violence, sex, age, married, single, employment status, profession, cohabitation, previous hospitalizations and recent hospitalization) through Discriminative Analysis of the aggressive group and another control of seventy-two (72) non-aggressive schizophrenic patients. Four significant variables turned out to be predictive of violent behaviour: being clinically diagnosed as residual, having a past history of violence, being unemployed and living alone. CONCLUSIONS: The fact of being diagnosed as residual schizophrenia is always predictive of very aggressive behaviour. Using these four variables, a classification tree for violence prediction in schizophrenic in-patients has been established.
Subject(s)
Aggression , Schizophrenia/diagnosis , Schizophrenia/rehabilitation , Violence/psychology , Adult , Female , Hospitalization , Hospitals, Psychiatric , Humans , Male , Predictive Value of Tests , Retrospective StudiesABSTRACT
Introducción: Diferentes estudios destacan la frecuente agresividad que presentan los pacientes esquizofrénicos hospitalizados. El objetivo de esta investigación es conocer factores predictores de esta violencia, para mejorar su prevención. Metodología: Se realiza un estudio retrospectivo de dos años de duración de los actos de heteroagresividad física cometidos por pacientes esquizofrénicos, ingresados en una Unidad Hospitalaria Psiquiátrica, comparado con un grupo control no agresivo. Resultados: 29 pacientes cometieron 90 actos agresivos. Se evalúa el valor predictivo de agresividad de 12 variables (autorización judicial, tipo clínico, presencia de agresividad previa, sexo, edad, casado, soltero, actividad laboral, convivencia, ingresos anteriores y hospitalización reciente) mediante análisis discriminante del grupo agresivo y de otro control de 72 esquizofrénicos no agresivos. Resultan cuatro variables significativas predictoras de agresividad: tipo clínico residual, presencia de agresividad previa, inexistencia de actividad laboral y vivir solo. Conclusiones: El diagnóstico residual predice siempre el ser muy agresivo. Con las cuatro variables predictoras, se construye un árbol de clasificación pronóstico de agresividad en esquizofrénicos hospitalizados. (AU)
Subject(s)
Adult , Male , Female , Humans , Aggression , Schizophrenia , Violence , Retrospective Studies , Hospitalization , Hospitals, Psychiatric , Predictive Value of TestsABSTRACT
Fundamento: Los pacientes esquizofrénicos no respondedores al tratamiento constituyen un grave problema clínico. Por ello, se desea evaluar la respuesta terapéutica de unas pautas psicofarmacológicas alternativas a los neurolépticos típicos. Método: Una muestra de pacientes esquizofrénicos no respondedores fue asignada aleatoriamente, en diseño doble ciego, a dos grupos terapéuticos: experimental y control. El primero incluía 4 fases: 1) si existen síntomas afectivos asociados: haloperidol y carbamacepina o litio; 2) clozapina; 3) megadosis de haloperidol, y 4) tioridazina y valproato sódico. El grupo control incluía 3 fases: 1) haloperidol; 2) clorpromazina, y 3) clozapina. Se avanza de fase si no hay respuesta terapéutica tras 4 semanas de tratamiento. La evaluación semanal se realizó mediante las siguientes escalas: clínica (BPRS); síntomas positivos (SAPS); síntomas negativos (SANS); ajuste psicosocial (GAF), y efectos secundarios (UKU). Resultados: Diecinueve pacientes han completado al menos una fase del protocolo. Entre los 2 grupos hubo un total de 13 pacientes respondedores: seis con clozapina, tres con haloperidol y cuatro con haloperidol más carbamazepina. El grupo respondedor presentó entre las evaluaciones inicial y final disminuciones medias superiores al 50 por ciento en las escalas BPRS y SAPS (p 40 por ciento en todas las escalas (AU)
Subject(s)
Adolescent , Adult , Female , Male , Middle Aged , Humans , Psychopharmacology/methods , Schizophrenia/complications , Schizophrenia/diagnosis , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/pharmacokinetics , Antipsychotic Agents/metabolism , Drug Resistance, Microbial , Clozapine/administration & dosage , Risperidone/administration & dosage , Chlorpromazine/administration & dosage , Haloperidol/administration & dosage , Triazines/administration & dosage , Prospective Studies , Clinical Protocols , Clozapine/administration & dosageABSTRACT
INTRODUCTION: A total of 235 patients with diagnoses of Alzheimer's dementia together with psychotic and/or affective symptomatology, as well as behavioral disturbances was included in an open label postmarketing surveillance study. The study objectives were to asses: 1) risperidone efficiency in psychotic and affective symptomatology and behavioral disturbances; 2) risperidone influence in the patient's performance, 3) dosage range at which efficiency is observed; and 4) safety in this group of patients. Patients were observed during a six month period. Risperidone was used at a mean dosage of 1.23 +/- 0.86 mg daily (range: 0.5-4.5 mg daily). MATERIAL AND METHODS: Risperidone was assessed by the Clinical Global Impression (CGI), Geriatric Depression Scale (GDS), Neuropsychiatric Inventory (NPI), Clinical Deterioration Rating (CDR), UKU subscale for neurological side effects and spontaneous reports. Patients were evaluated at baseline, 15 days and months 1, 2, 4 and 6. Sixteen patients (6.8%) were excluded from the statistical analysis due to protocol violation. Fifty four patients (24.7%) dropped out. RESULTS: Risperidone produced a significant improvement in the mean total scores of CGI, NPI, GDS (patient's satisfaction, hope.) and CDR (judgment and problem solving, community affairs, hobbies.) scales. Extrapyramidal symptoms improved from day 15 onwards in patients who had received antipsychotic treatment previously; in naive treated patients these symptoms did not change during the study period. CONCLUSIONS: Risperidone was well tolerated. Only 6 (2. 7%) discontinued treatment due to adverse events. Ninety seven percent of the patients did not suffer any adverse event; the resting 2.7% suffered one or more side effects: sedation (1.4%), constipation (0.5%) and vomiting (0.5%) among others.
Subject(s)
Alzheimer Disease/psychology , Antipsychotic Agents/adverse effects , Mental Disorders/drug therapy , Mental Disorders/etiology , Mood Disorders/drug therapy , Mood Disorders/etiology , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , Risperidone/adverse effects , Basal Ganglia Diseases/chemically induced , Basal Ganglia Diseases/diagnosis , Dose-Response Relationship, Drug , Humans , Severity of Illness Index , Treatment OutcomeABSTRACT
The SIDAM--a new instrument for the symptomatic diagnosis and measurement of dementia according to DSM-III-R and ICD-10--is described. It comprises a brief structured clinical interview, a range of cognitive tests (e.g. including the Mini-Mental State (Folstein et al. 1975)) which constitute a short neuropsychological battery and a section for clinical judgement and third party information. All items rely on DSM-III-R and ICD-10 algorithms. The SIDAM has a high overall test-retest reliability which equally holds true on the diagnostic, criterion and item level. It is a brief (average of 28 min), practical and easily scored diagnostic instrument, which reliably separates subjects with DSM-III-R and ICD-10 dementia from those without such a disorder. Good congruence was found between SIDAM diagnoses and corresponding ICD-9 expert diagnoses. Furthermore, the SIDAM-Score (SISCO) allows a detailed measurement of even low levels of cognitive impairment and provides quantification of severity grading of cognitive dysfunction.
Subject(s)
Alzheimer Disease/diagnosis , Dementia, Multi-Infarct/diagnosis , Dementia/diagnosis , Interview, Psychological , Mental Status Schedule/statistics & numerical data , Neuropsychological Tests/statistics & numerical data , Psychiatric Status Rating Scales/statistics & numerical data , Aged , Aged, 80 and over , Alzheimer Disease/classification , Alzheimer Disease/psychology , Dementia/classification , Dementia/psychology , Dementia, Multi-Infarct/classification , Dementia, Multi-Infarct/psychology , Diagnosis, Differential , Female , Humans , Male , Mental Recall , Middle Aged , Personality Disorders/classification , Personality Disorders/diagnosis , Personality Disorders/psychology , Psychometrics/statistics & numerical data , Reproducibility of ResultsABSTRACT
The SIDAM, a new clinical structured interview for the diagnosis and measure of dementia according to DSM-III-R and ICD-10, is described. This instrument comprises a clinical overview, several cognitive tests, including the Mini-Mental State, and a section for clinical judgement and information coming from others. Every item relies on DSM-11-R and ICD-10 algorithms. The SIDAM has a hight test-retest reliability on the clinical diagnosis and the different diagnostic criteria. It is a brief (28 minutes), practical screening instrument. Good congruence is found between SIDEM, DSM-III-R and ICD-10, and the corresponding ICD-9 expert diagnosis. Furthermore the SIDAM Total Score (SISCO), allows a good measurement of low level of cognitive impairments and provides quantification of severity of cognitive disorders. The SIDAM has been translated and adapted into Spanish.
Subject(s)
Alzheimer Disease/diagnosis , Dementia, Multi-Infarct/diagnosis , Dementia/diagnosis , Psychiatric Status Rating Scales , Aged , Female , Humans , Male , Predictive Value of TestsABSTRACT
The malignant neuroleptic syndrome (MNS) is an idiosyncratic reaction to neuroleptic drugs. Although it was described in the sixties, it is still a poorly known condition. Controversy still exists about its conceptual frame, and its true incidence is still unknown. We have evaluated 9 cases of MNS seen in a 37 month period. There were 5 females, with a mean age of 50 years. Haloperidol, either single or in association, was the most commonly implicated drug. The estimated frequency of MNS in our population at risk was 1.5%. Eight patients had complications and 5 died from them (55%). We discuss the pathogenetic mechanisms, the conceptual characterization and the current diagnostic criteria. We evaluate the causes of the high mortality in our series. We think that a higher suspicion index of this condition would be desirable, and we recommend early treatment with vigorous supportive measures and drug therapy. We think that prospective studies are required to assess the true incidence of MNS.
Subject(s)
Neuroleptic Malignant Syndrome , Adult , Aged , Female , Humans , Male , Middle Aged , Neuroleptic Malignant Syndrome/complications , Neuroleptic Malignant Syndrome/diagnosis , Neuroleptic Malignant Syndrome/epidemiology , Neuroleptic Malignant Syndrome/etiology , Neuroleptic Malignant Syndrome/mortality , Psychiatry , Spain/epidemiologyABSTRACT
Four cases of resistant Schizophrenia treated with valproate association with different neuroleptic drugs (thioridazine in three cases and loxapine in one) are presented. After a mean period of three months with this treatment, clinical improvement, consisting in a reduction of positive symptoms, as measured by the BPRS, and a normalization of hostile/disruptive behavior, was observed, and hospital discharge was possible. Reduction of symptoms was still present after a follow-up of 4 to 24 months. As valproate is a drug with gabaergic properties, a GABA involvement in the pathogenesis of schizophrenia is discussed. The association of valproate to neuroleptic drugs should be considered in the treatment of resistant Schizophrenia.
