Relationship between affective temperaments and aggression in euthymic patients with bipolar mood disorder and major depressive disorder.

BACKGROUND: So far there is a scarce of studies dealing with the relationship between different aspects of aggressive behaviour and affective temperaments among various mood disorders. The aim of the present study was to explore in a group of patients with affective mood disorders the relationship between affective temperaments and aggression. METHODS: 100 consecutive outpatients in euthymic phase of mood disorders (46 with bipolar disorder-type I, 18 with bipolar disorder-type II and 36 with major depressive disorder) were self-assessed with the Aggression Questionnaire and the short version of Slovenian Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A). RESULTS: The factorial analysis of the TEMPS-A subscales revealed 2 main factors: Factor 1 (prominent cyclothymic profile) consisted of cyclothymic, depressive, irritable, and anxious temperaments and Factor 2 (prominent hyperthymic profile) which was represented by the hyperthymic temperament, and by depressive and anxious temperaments as negative components. Patients with prominent cyclothymic profile got their diagnosis later in their life and had significantly higher mean scores on anger and hostility (non-motor aggressive behaviour) compared with patients with prominent hyperthymic profile. LIMITATIONS: We included patients with different mood disorders, therefore the sample selection may influence temperamental and aggression profiles. We used self-report questionnaires which can elicit sociable desirable answers. CONCLUSION: Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. It seems that distinct temperamental profile could serve as a good diagnostic and prognostic value for non-motor aspects of aggressive behaviour.

Lithium intoxication secondary to unrecognized pontine haemorrhage.

Lithium prophylaxis carries a substantial risk of medical complications, especially in the case of concomitant medical conditions. We describe a patient with unrecognized cerebrovascular haemorrhage, admitted to hospital due to lithium intoxication.

Quality of life and treatment costs in schizophrenic outpatients, treated with depot neuroleptics.

Study aim was 1) to find out the influences on quality of life (QoL) of chronic outpatients with schizophrenia; 2) to calculate Quality Adjusted Life Years (QALY); and 3) to estimate direct 1-year treatment costs. In a 20% sample (100 males, 100 females) of schizophrenic outpatients from the Outpatients Clinic in Ljubljana, Slovenia receiving depot neuroleptics demographic, clinical, and treatment data were collected for the year 1996. The Krawiecka Scale, Global Assessment Scale (GAS), Abnormal Involuntary Movement Scale, Rating Scale for Drug-Induced Akathisia, Rating Scale for Extrapyramidal Side Effects, Quality of Life Scale (QLS), EQ-5D and QALY were used. Multivariate linear regression was used with the QLS score as dependent variable. The patients were on average 44 years old and had been treated for 14 years. The average GAS score was 70. GAS was positively related to the QLS score while the parkinsonism score was inversely correlated with QLS. The patients can expect to live for 10. 20 more QALY on average. The QoL on the EQ-5D scale was 0.73. The annual direct treatment costs amounted to $216,216 in 1996 prices. In well-adjusted chronic patients with schizophrenia the QoL seems to depend mostly on their psychosocial performance and side effects. Although rare, re-hospitalisations accounted for one-half of all treatment expenses.

Olanzapine appears haematologically safe in patients who developed blood dyscrasia on clozapine and risperidone.

We report a 2-year experience with olanzapine treatment (20 mg daily) in a 65-year-old male patient with treatment-resistant paranoid schizophrenia, who had previously developed leucopenia and neutropenia first on clozapine and, subsequently, also on risperidone. Olanzapine seems to be safe in this patient, since no major decreases of haematological parameters were observed. The only exception was a brief decrease of leucocyte and neutrophil (but not erythrocyte or platelet) counts during influenza-like viral infection. However, the control of psychotic symptoms on olanzapine is not as good as on clozapine.

Choosing antipsychotic maintenance therapy--a naturalistic study.

Antipsychotic maintenance treatment is essential for preventing relapses of schizophrenia, but the variety of available antipsychotics may complicate the choice of drug. The aim of our naturalistic one-year follow-up study was to find out the factors predicting the choice of antipsychotics in discharged patients with schizophrenia or schizoaffective disorder and the predictors of one-year rehospitalization. The patients were receiving oral or depot classical antipsychotics or atypical agents clozapine or risperidone. Symptoms were assessed with Present State Examination. Included were 447 patients (202 males and 245 females) with a mean age of 39.1 years and 5.9 previous hospitalizations. The majority of patients (n = 322) were receiving depot antipsychotics and 43 were prescribed atypical agents. Two predictive models were built using the logistic regression analysis. Previously prescribed depot antipsychotics were positively related to further depot use, while patients who left the hospital against medical advice and those with slowness of speech at admission were less likely to receive depot drugs. On the other hand, previously used atypical antipsychotics and longer hospitalization predicted further use of atypical agents while patients discharged to community care facilities or nursing homes and those with more frequent previous hospitalizations were less likely to receive atypical agents. The Cox survival analysis showed the following one-year rehospitalization risk factors: diagnosis of schizoaffective disorder, frequent previous hospitalizations, inappropriate behavior, and oral classical antipsychotics versus depot or atypical agents. This study may yield some insight into the decision-making process in everyday clinical work regarding the choice of antipsychotic maintenance medication and its influence on rehospitalization rate.

The knowledge of inpatients with schizophrenia on their medication at hospital discharge.

Purpose-To examine the knowledge of schizophrenic in patients regarding their medication.Methods-Fifty male and 50 female patients with schizophrenia were interviewed before discharge from the University Psychiatric Hospital in Ljubljana, Slovenia. Socio-demographic and clinical data were collected and the Global Assessment Scale (GAS) was used. Patients were asked to give the name, purpose and adverse effects of their prescribed drugs.Results-The mean age of the patients was 40.0 years and they had, on average, 6.9 admissions. Their mean GAS score was 58.5, indicating moderately impaired everyday functioning. The majority of patients were prescribed two to four psychotropic drugs. Most patients (87.0%) could name the antipsychotic, 77.0% knew the purpose of their medication and 65.0% knew its side-effects. The same was true for the name (90.3%) and purpose (77.0%) of the anticholinergic, but its side-effects were less well known (28.9%). The name of the hypnotic was known to 76.5% patients, the purpose to 90.6% and its side-effects to 34.4%. Only 58% of patients had ever requested information on their medication. The majority of patients received information from package inserts (35%) or from psychiatrists (29%). Most patients (55%) were satisfied with the information.Conclusions-The information on medication among patients is insufficient. Clinicians should regularly offer and repeat relevant information. Copyright (c) 2000 John Wiley & Sons, Ltd.

Predictors of suicide in psychiatric hospital.

OBJECTIVE: About 5% of all suicides occur in psychiatric hospitals. The aim of this study was to look for potential characteristics common to patients who committed suicide in psychiatric hospital. METHOD: All patients who committed suicide in University Psychiatric Hospital in Ljubljana, Slovenia, in the period 1984-1993 were included. The suicidal patients (SP) with schizophrenia (SCH) and affective psychoses (AP) were compared to an age-, sex- and diagnosis-matched control group. Data from files and (in control patients) patient interviews were gathered. Multivariate logistic regression analysis was used. RESULTS: A total of 79 patients (34 males and 45 females) committed suicide. The majority of them had SCH (n = 36) and AP (n = 23). The predictors of suicide among patients with AP and SCH were depression and lack of insight and, in addition in patients with SCH, past suicidal behaviour and poor relationships with family members. CONCLUSION: This study provides the clinician with information on risk factors for in-patient suicide.

Age at onset of schizophrenia and neuroleptic dosage.

BACKGROUND: Lower age at onset of schizophrenia has been traditionally associated with poorer response to treatment and less favourable prognosis. The aim of the study was to find out whether age at onset of schizophrenia is related to the dosage of typical neuroleptics in outpatients. METHOD: Age at onset was defined as age at first seeking of psychiatric help. Demographic, social and disease-related characteristics were studied in a group of 200 stable outpatients with schizophrenia (100 males and 100 females). Psychopathological symptoms were assessed with the Krawiecka Scale. Neuroleptic dosage was converted to milligrams of chlorpromazine equivalents and logarithmically transformed to obtain normal distribution. RESULTS: Onset of schizophrenia occurred earlier in males than in females. The average dosage was 251.7 (SD 303.9) mg chlorpromazine equivalents. In a multivariate linear regression model, lower age at onset and higher sum of symptoms were related to the drug dosage. CONCLUSION: The results confirm the findings of other authors that patients with lower age at onset are less responsive to typical neuroleptics. Some of the patients with early onset would be more appropriately treated with atypical neuroleptics, which may have better therapeutic efficacy.