Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach.

OBJECTIVES: The study examines the clinical determinants of involuntary psychiatric hospitalization. Specifically, it investigates whether distinct clinical profiles of hospitalized patients can be discerned, what other characteristics they are linked with, and which profiles predict involuntary admission. METHODS: In this cross-sectional multicentre population study, data were collected for 1067 consecutive admissions in all public psychiatric clinics of Thessaloniki, Greece, during 12 months. Through Latent Class Analysis distinct patient clinical profiles were established based on Health of the Nation Outcome Scales ratings. The profiles were then correlated with sociodemographic, other clinical, and treatment-related factors as covariates and admission status as a distal outcome. RESULTS: Three profiles emerged. The "Disorganized Psychotic Symptoms" profile, combining positive psychotic symptomatology and disorganization, included mainly men, with previous involuntary hospitalizations and poor contact with mental health services and adherence to medication, indicating a deteriorating condition and chronic course. Τhe "Active Psychotic Symptoms" profile included younger persons with positive psychotic symptomatology in the context of normal functioning. The "Depressive Symptoms" profile, characterized by depressed mood coupled with nonaccidental self-injury, included mainly older women in regular contact with mental health professionals and treatment. The first two profiles were associated with involuntary admission and the third with voluntary admission. CONCLUSIONS: Identifying patient profiles allows the examination of the combined effect of clinical, sociodemographic, and treatment-related characteristics as risk factors for involuntary hospitalization, moving beyond the variable-centered approach mainly adopted to date. The identification of two profiles associated with involuntary admission necessitates the development of interventions tailored to chronic patients and younger persons suffering from psychosis respectively.

The effect of impaired verbal memory retrieval on autobiographical memory across different life periods in schizophrenia.

OBJECTIVES: Autobiographical memory (AM) involves recollection of personal events and facts about one's life. Αim of the present study was to investigate AM in schizophrenia patients, and, in particular, patients' ability to recall autobiographical memories after controlling for verbal memory and verbal fluency deficits. METHOD: Participants included 40 schizophrenia patients (23 male) and 40 healthy controls (23 male), matched for age, gender, educational level, and premorbid intellectual functioning. Participants' verbal memory (list learning and story recall) and verbal fluency were assessed. AM was evaluated by the Questionnaire of Autobiographical Memory, consisting of the Personal Semantic Memory scale and the Autobiographical Incidents scale. Furthermore, personal incidents' specificity was examined. RESULTS: Schizophrenia patients showed deficits in verbal memory and verbal fluency, as well as in both semantic and episodic AM compared with healthy controls. Deficits were shown in episodic and semantic memories of events and facts dating to three different life periods (childhood, early adulthood and recent life). Regarding specificity of recalled events, patients reported fewer specific autobiographical incidents than controls. After controlling AM deficits for patients' verbal memory and verbal fluency impairment, it was shown that schizophrenia patients recalled fewer memories of autobiographical incidents dating only to recent life, compared with healthy controls. CONCLUSIONS: Schizophrenia patients showed impaired AM after controlling for verbal memory and verbal fluency impairment only in regard with personal episodic memories from recent life. Current findings raise the important issue of cognitive remediation therapy in schizophrenia.

Sexual Response Models: Toward a More Flexible Pattern of Women's Sexuality.

INTRODUCTION: Recent research suggests that none of the current theoretical models can sufficiently describe women's sexual response, because several factors and situations can influence this. AIM: To explore individual variations of a sexual model that describes women's sexual responses and to assess the association of endorsement of that model with sexual dysfunctions and reasons to engage in sexual activity. METHODS: A sample of 157 randomly selected hospital employees completed self-administered questionnaires. MAIN OUTCOME MEASURES: Two models were developed: one merged the Master and Johnson model with the Kaplan model (linear) and the other was the Basson model (circular). Sexual function was evaluated by the Female Sexual Function Index and the Brief Sexual Symptom Checklist for Women. The Reasons for Having Sex Questionnaire was administered to investigate the reasons for which women have sex. RESULTS: Women reported that their current sexual experiences were at times consistent with the linear and circular models (66.9%), only the linear model (27%), only the circular model (5.4%), and neither model (0.7%). When the groups were reconfigured to the group that endorsed more than 5 of 10 sexual experiences, 64.3% of women endorsed the linear model, 20.4% chose the linear and circular models, 14.6% chose the circular model, and 0.7% selected neither. The Female Sexual Function Index, demographic factors, having sex for insecurity reasons, and sexual satisfaction correlated with the endorsement of a sexual response model. When these factors were entered in a stepwise logistic regression analysis, only the Female Sexual Function Index and having sex for insecurity reasons maintained a significant association with the sexual response model. CONCLUSION: The present study emphasizes the heterogeneity of female sexuality, with most of the sample reporting alternating between the linear and circular models. Sexual dysfunctions and having sex for insecurity reasons were associated with the Basson model.

Rhabdomyolysis after lamotrigine overdose: a case report and review of the literature.

BACKGROUND: Lamotrigine is an effective anticonvulsant drug that has also been demonstrated to be effective in the treatment of bipolar disorder. We report a case of rhabdomyolysis after intentional overdose in a woman aged 48. CASE PRESENTATION: A 48-year-old female presented to the emergency department after an acute ingestion of 6 g of lamotrigine. The patient suffered from bipolar disorder, and she was taking lamotrigine and olanzapine. At that point, she had a major depressive episode, and she wanted to commit suicide. Activated charcoal was administered in the emergency department. Her vital signs were still normal, and she entered the Medical clinic, where she had been there for 2 days in a good condition. The hematological and biochemical results were normal. On the fourth day, the levels of creatine phosphokinase (CPK) showed remarkable increase (2500 IU/ml). Fluid and bicarbonate intravenous administration was performed, and CPK levels returned to normal after 3 days. CONCLUSION: The majority of patients exposed to lamotrigine in overdose experienced no toxic clinical effects. The most common clinical effects are drowsiness and lethargy, vomiting, nausea, ataxia, dizziness/vertigo, and tachycardia. In this case report, the patient was alert and did not have any serious complications, except for mild rhabdomyolysis, which was the main consequence of lamotrigine overdose.

Development and validation of the Greek severe impairment battery (SIB).

BACKGROUND: Most neuropsychological batteries, especially those most often used, are unsuitable for the assessment of patients with severe dementia. The Severe Impairment Battery (SIB) was developed for the evaluation of preserved cognitive functions in these patients. The aim of this study was to formulate a Greek version of the SIB and to conduct a first assessment of its use of patients with mild, moderate, or severe Alzheimer's disease (AD), compared to the Mini-Mental State Examination (MMSE). METHODS: A convenience sample of 42 dementia patients according to DSM-IV-TR criteria and 23 healthy participants was selected. Patients were assessed twice using a Greek translation of the SIB and the Greek version of MMSE. Patients were divided into three severity groups based on grouped by Clinical Dementia Rating (CDR) score and the SIB and MMSE scores were compared. RESULTS: The validity of the SIB was confirmed by evaluating the correlation coefficients between the SIB and Greek-MMSE, grouped by CDR, which were found to be significant. Cronbach's α for the total SIB score and each subscale score showed high significance, and the item-total correlation for each subscale was also acceptable. The test-retest correlation for the total SIB score and subscale scores were significant. The total SIB score and subscale scores were examined according to CDR. CONCLUSION: The Greek SIB is reliable and valid in differentiating patients with moderate or severe dementia, whereas MMSE loses sensitivity due to a floor and ceiling effect.

No differences between drug naive and drug experienced unipolar depressed patients in terms of neurobiological testing: a cross sectional study.

Successful antidepressant treatment has been associated with concomitant changes in brain function, consolidated as long as treatment is continued and remission is preserved. The present study aimed at assessing the impact of prior antidepressant treatment on brain function in currently depressed but unmedicated individuals by investigating for any differences between antidepressant-naïve vs. antidepressant-experienced subjects. Fifty right-handed patients (22 medication-naïve vs. 28 medication-experienced), suffering from major depression participated in the study. They all underwent a standardised clinical interview and psychometric assessment combined with neurobiological tests (brain SPECT, Dexamethasone Suppression Test, Dexfenfluramine Challenge Test, electro-oculogram, flash-electroretinogram and flash-visual evoked potentials and pattern-reversal visual evoked potentials). No significant differences between medication-naïve and medication-experienced depressed subjects were found in terms of the neurobiological markers assessed, after controlling for age, sex, age at onset, number of depressive episodes, depression subtype (melancholic, atypical or undifferentiated) and severity of current episode. Unmedicated currently depressed patients, no matter their previous exposure to antidepressants, show similar changes in brain function. This does not necessarily mean that antidepressants do not have a long term effect on brain physiology, since not all patients relapse. However, it seems that those patients who relapse after stopping medication, seem to 'regress' to an 'as if never medicated' state, with regard to brain function. These findings might suggest that continuous maintenance treatment with antidepressants is essential for patients at high risk to relapse. Alternatively, they might suggest that our methodology assesses only a shallow and mainly state part of the pathophysiology of depression.

Familial comorbidity of bipolar disorder and multiple sclerosis: genetic susceptibility, coexistence or causal relationship?

Our purpose in undertaking the present study was to examine the hypotheses proposed for explaining the frequent comorbidity of bipolar disorder and multiple sclerosis. One hypothesis posits that, when there is comorbidity, MS plays a causal role in psychiatric manifestations. Another suggests that both disorders have a common underlying physiological process that increases the likelihood of their co-occurrence. We examined two adult siblings with comorbidity and their relatives, including three generations of family members with psychiatric morbidity. We found an extensive multigenerational history of bipolar disorder in this family. This history would seem to support the hypothesis of a common underlying brain process (potentially genetically-based) to explain the comorbidity of BD and MS, but cannot clarify whether this comorbidity implies a relationship between the two disorders or merely reflects parallel processes of brain deterioration. We cannot, however, rule out the possibility of a subclinical MS-related process leading to the early manifestation of BD, with MS appearing much later in time, or even a third, undetermined factor, leading to familial comorbidity. Although we have insufficient information to support either hypothesis definitively, we present the familial cases as a springboard for a discussion of dilemmas related to teasing apart MS and BD comorbidity. Further observation of the clinical course of the younger family members, who have not yet shown any neurological signs, over the next few years may elucidate the current picture further.

Factors affecting hospital length of stay: is substance use disorder one of them? A study in a Greek public psychiatric hospital.

Comorbidity of psychiatric disorder and substance use disorder (SUD) is very common. Clinical experience says that comorbidity increases inpatient length of stay. We aimed to discover which factors affect length of stay for inpatients at a psychiatric department in a specialized mental hospital in a Greek urban area, and specifically whether SUD is one of them. All patients admitted over a 12-month period were given the CAGE questionnaire and that part of the EUROPASI questionnaire dealing with substance use. This was followed by a diagnostic interview to establish the final diagnosis in accordance with the DSM-IV criteria. Following this, the patients' characteristics in conjunction with their average length of stay were all evaluated statistically. A total of 313 patients were assessed. Present substance use disorder was identified in 102 individuals (32.6%). The principal substances involved in addiction or abuse were alcohol, cannabis, benzodiazepines, and opiates. Patients differed as to their cooperation with the medication regime. On the other hand, there was no statistical difference regarding the number of hospitalisations. Psychopathology was not found to play a direct role, as no one diagnosis correlated with length of stay. The factors found to affect length of stay in this psychiatric department were the length of time they had been mentally ill and cooperation in taking medication. It appears that SUD is not one of the factors affecting length of stay.

Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases.

BACKGROUND: Microvascular free tissue transfer has become a significant factor in the reconstruction of head and neck cancer patients. Various donor sites are available to enable anatomical and functional repair of a defect. METHODS: All free vascularized tissue transfers performed during the period from March 1982 to September 2000 were retrieved from this hospital's database and analysed with regard to the surgical defect, chosen donor site and complications. RESULTS: During the 18-year period a total of 1,164 patients with head and neck cancer were treated in this institution. A total of 500 free-flap reconstructions were performed for 479 patients. In the majority of patients (n = 451) reconstruction was indicated following ablative tumour surgery. With regard to donor site selection, the first choice of free jejunum was used in 181 patients, followed by the radial forearm flap in 140 patients. Among the 500 free-flap reconstructions, a total flap loss rate of 6% was observed. Patient age (p = 0.004) and tobacco use (p = 0.043) were significant risk factors for complications overall, whereas patient age (p = 0.021) and operating time (p = 0.043) were significantly correlated with local complications. CONCLUSION: Immediate repair of head and neck defects using free tissue transfer is a successful and reliable method and is becoming the gold standard at many institutions. The complication rate is low once experience with these techniques has been acquired.