An increasing number of studies have suggested that increased physical activity is associated with less mental illness.However,the relationship between exercise and psychotic experiences(PEs)is still unknown.The purpo...An increasing number of studies have suggested that increased physical activity is associated with less mental illness.However,the relationship between exercise and psychotic experiences(PEs)is still unknown.The purpose of this study was to explore the relationship between exercise and PEs in college students in the United States.Data from the Health Mind Survey(2020–2021 round)were analyzed.Respondents included 137,916 college students who were asked about exercise and PEs(lifetime psychotic experiences,delusions,and hallucinations).A multivariate logistic regression analysis was used to investigate the relationship between exercise and PEs while controlling for demographic characteristics.There was a significant correlation between exercise and PEs among college students.Compared to students who exercised less than one hour per week,students who exercisedfive or more hours per week had fewer lifetime psychotic experiences.This samefinding obtained for both male and female college students.Thefindings from the present study indicate that exercising forfive or more hours each week is most correlated with decreased PEs among college students.However,experimental studies are required to extend and confirm ourfindings and determine the causality of this relationship.展开更多
AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.METHODS: Standardized semi-structured interview of 150 family members of psy...AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.METHODS: Standardized semi-structured interview of 150 family members of psychotic patients receiving full time treatment. This study on associative stigma in family members of psychotic patients was part of a larger research program on the burden of the family, using "Interview for the Burden of the Family" and the chapters stigma, treatment and attribution from the "Family interview Schedule". The respondents were relatives, one per patient, either partner or parent. The patients had been diagnosed with schizophrenia or schizo-affective disorder. All contacts with patients and relatives were in Dutch. Relatives were deemed suitable to participate in this research if they saw the patient at least once a week. Recruitment took place in a standardized way: after obtaining the patient's consent, the relatives were approached to participate. The results were analyzed using SPSS Version 18.0. RESULTS: The prevalence of associative stigma in this sample is 86%. Feelings of depression in the majority of family members are prominent. Twenty-one point three percent experienced guilt more or less frequent, while shame was less pronounced. Also, 18.6% of allrespondents indicated that they tried to hide the illness of their family member for others regularly or more. Three six point seven percent really kept secret about it in certain circumstances and 29.3% made efforts to explain what the situation or psychiatric condition of their family member really is like. Factors with marked significance towards higher associative stigma are a worsened relationship between the patient and the family member, conduct problems to family members, the patients' residence in a residential care setting, and hereditary attributional factors like genetic hereditability and character. The level of associative stigma has significantly been predicted by the burden of aggressive disruptions to family housemates of the psychotic patient.CONCLUSION: Family members of psychotic patients in Flanders experience higher associative stigma compared to previous international research. Disruptive behavior by the patient towards in-housing family members is the most accurate predictor of higher associative stigma.展开更多
With the advent of technological advancements and the widespread Internet connectivity during the last couple of decades,social media platforms(such as Facebook,Twitter,and Instagram)have consumed a large proportion o...With the advent of technological advancements and the widespread Internet connectivity during the last couple of decades,social media platforms(such as Facebook,Twitter,and Instagram)have consumed a large proportion of time in our daily lives.People tend to stay alive on their social media with recent updates,as it has become the primary source of interactionwithin social circles.Although social media platforms offer several remarkable features but are simultaneously prone to various critical vulnerabilities.Recent studies have revealed a strong correlation between the usage of social media and associated mental health issues consequently leading to depression,anxiety,suicide commitment,and mental disorder,particularly in the young adults who have excessively spent time on socialmedia which necessitates a thorough psychological analysis of all these platforms.This study aims to exploit machine learning techniques for the classification of psychotic issues based on Facebook status updates.In this paper,we start with depression detection in the first instance and then expand on analyzing six other psychotic issues(e.g.,depression,anxiety,psychopathic deviate,hypochondria,unrealistic,and hypomania)commonly found in adults due to extreme use of social media networks.To classify the psychotic issues with the user’s mental state,we have employed different Machine Learning(ML)classifiers i.e.,Random Forest(RF),Support Vector Machine(SVM),Naïve Bayes(NB),and K-Nearest Neighbor(KNN).The used ML models are trained and tested by using different combinations of features selection techniques.To observe themost suitable classifiers for psychotic issue classification,a cost-benefit function(sometimes termed as‘Suitability’)has been used which combines the accuracy of the model with its execution time.The experimental evidence argues that RF outperforms its competitor classifiers with the unigram feature set.展开更多
Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative...Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.展开更多
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of rese...BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.展开更多
BACKGROUND The subsequent waves of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)pandemic have represented a dramatic health emergency characterized by significant consequences on mental health.Diachr...BACKGROUND The subsequent waves of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)pandemic have represented a dramatic health emergency characterized by significant consequences on mental health.Diachronic variations in the incidence rates of acute relapse of psychiatric disorders may represent significant"sentinel events"for assessing the mental health response to an unprecedented stressful event.AIM To investigate the variation in psychiatric hospitalization rates and differences in sociodemographic and clinical-psychopathological peculiarities at Bologna"Maggiore"General Hospital Psychiatric Ward(GHPW)between the first two waves SARS-CoV-2 pandemic and the same periods of the previous 3 years.The secondary purpose of the study was to suggest a diachronic response pathway to stress by reporting additional literature data on coping strategies.METHODS This observational and retrospective study collected information on admission to the GHPW at the"Maggiore"Hospital in Bologna in the index periods defined as follows:the first period between February 24,2020 and April 30,2020(first epidemic wave)and the second period between October 8,2020,and January 7,2021(second pandemic wave).Absolute numbers and proportion of admitted patients,their sociodemographic and clinical-psychopathological characteristics were compared with the same parameters recorded in the two same periods of the previous 3 years.No strict inclusion or exclusion criteria were provided in the data collection to collect information on all patients requiring acute psychiatric hospitalization.RESULTS During the first wave,there was a significant reduction in hospitalization rates,although there was a simultaneous increase in compulsory hospitalizations and the acute relapse of schizophrenia spectrum and other psychotic disorders.During the second wave,hospitalization rates reached those recorded during the same period of the previous 3 years,mainly due to the rise of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressor-related disorders and suicidal behaviors.CONCLUSION The coping strategies adopted during the first wave of the SARS-CoV-2 pandemic protected the vulnerable population from the general risk of clinical-psychopathological acute relapse,even if they increased the susceptibility to run into schizophrenia spectrum and other psychotic disorder relapses.In the medium-long term(as in the second pandemic wave),the same strategies do not play protective roles against the stress associated with the pandemic and social restriction measures.Indeed,during the second wave of the SARS-CoV-2 pandemic,an increase in total hospitalization rate,suicidal behaviors and the incidence rate of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressorrelated disorders was observed.展开更多
Screening patients for psychotic features can pose a problem when using verbal based tests. Establishment of validity of non-verbal psychotic screening scale can enhance diagnostic specificity and address challenges a...Screening patients for psychotic features can pose a problem when using verbal based tests. Establishment of validity of non-verbal psychotic screening scale can enhance diagnostic specificity and address challenges associated with verbal based tests. The goal of this study is to check whether Bender Visual Motor Gestalt Test-II will serve as a diagnostic specific tool for distinguishing between psychotic patients and healthy population. A total of 40 participants 22 males and 18 females were employed in the study. They were made of 10 patients diagnosed with schizophrenia, another 10 with depressions associated with psychotic features, 10 with substance/medication induced disorders and 10 healthy adults as the control. Their ages ranged from 20 - 65 with a mean age of 35.70 and standard deviation of 6.04. The healthy control group was staff of the hospital that was comparable to the patients in terms of age, gender and studies. All participants available who met the inclusive criteria who were willing to participate were selected. The instruments were (BVMGT-II) and (WHODAS 2.0). The design of the study was between group designs and One Way ANOVA was employed for data analysis. The findings of the study showed that BVMGT-II discriminated between patients with psychotic disorder and healthy population. It is recommended that BVMGT-II should be employed as screening instrument by the clinical/neuropsychologists in clinical psychological assessment for distinguishing psychotic patients from healthy population.展开更多
Mood disorders/psychosis have been associated with dysfunctions in the default mode network(DMN).However,the relative contributions of DMN regions to state and trait disturbances in pediatric bipolar disorder(PBD)rema...Mood disorders/psychosis have been associated with dysfunctions in the default mode network(DMN).However,the relative contributions of DMN regions to state and trait disturbances in pediatric bipolar disorder(PBD)remain unclear.The aim of this study was to investigate the possible mechanisms of PBD through brain imaging and explore the influence of psychotic symptoms on functional alterations in PBD patients.Twenty-nine psychotic and 26 non-psychotic PBD patients,as well as 19 age-and sex-matched healthy controls underwent a restingstate functional MRI scan and the data were analyzed by independent component analysis.The DMN component from the fMRI data was extracted for each participant.Spearman's rank correlation analysis was performed between aberrant connectivity and clinical measurements.The results demonstrated that psychotic PBD was characterized by aberrant DMN connectivity in the anterior cingulate cortex/medial prefrontal cortex,bilateral caudate nucleus,bilateral angular gyri,and left middle temporal gyrus,while non-psychotic PBD was not,suggesting further impairment with the development of psychosis.In summary,we demonstrated unique impairment in DMN functional connectivity in the psychotic PBD group.These specific neuroanatomical abnormalities may shed light on the underlying pathophysiology and presentation of PBD.展开更多
Recently, two researches by Doucet et al. and Collin et al. used functional neuroimaging as a tool to improve the management of schizophrenia and other psychotic disorders [1, 2]. We would like to highlight several is...Recently, two researches by Doucet et al. and Collin et al. used functional neuroimaging as a tool to improve the management of schizophrenia and other psychotic disorders [1, 2]. We would like to highlight several issues in relation to cardiopulmonary comorbidity, radiomics and machine learning, and therapeutic regimens, along with their clinical implications.展开更多
BACKGROUND Cerebrotendinous xanthomatosis(CTX)is a rare autosomal recessive lipid-storage disorder caused by mutations in CYP27A1.Psychiatric manifestations in CTX are rare and nonspecific,and they often lead to consi...BACKGROUND Cerebrotendinous xanthomatosis(CTX)is a rare autosomal recessive lipid-storage disorder caused by mutations in CYP27A1.Psychiatric manifestations in CTX are rare and nonspecific,and they often lead to considerable diagnostic and treatment delay.CASE SUMMARY A 33-year-old female patient admitted to the psychiatric ward for presentation of delusions,hallucinations,and behavioral disturbance is reported.The patient presented with cholestasis,cataract,Achilles tendon xanthoma,and cerebellar signs in adulthood and with intellectual disability and learning difficulties in childhood.After the characteristic CTX findings on imaging were obtained,a pathological examination of the Achilles tendon xanthoma was refined.Replacement therapy was then initiated after the diagnosis was clarified by genetic analysis.During hospitalization in the psychiatric ward,the nonspecific psychiatric manifestations of the patient posed difficulty in diagnosis.After the patient’s history of CTX was identified,the patient was diagnosed with organic schizophrenia-like disorder,and psychotic symptoms were controlled by replacement therapy combined with antipsychotic medication.CONCLUSION Psychiatrists should be aware of CTX,its psychiatric manifestations,and clinical features and avoid misdiagnosis of CTX for timely intervention.展开更多
BACKGROUND Alzheimer’s disease(AD)is among the most prevalent forms of dementia in the world and neuropathological studies suggest similar high prevalence of mixed(AD+vascular)dementias.Approximately 25%-50%of indivi...BACKGROUND Alzheimer’s disease(AD)is among the most prevalent forms of dementia in the world and neuropathological studies suggest similar high prevalence of mixed(AD+vascular)dementias.Approximately 25%-50%of individuals with AD develop psychosis sometime during their illness.The presence of psychosis in AD worsens outcomes.Currently there are no United States Food and Drug Administration(FDA)approved medications for the treatment of psychosis in AD.Pimavanserin,a novel atypical antipsychotic medication,was approved by the FDA for the treatment of hallucinations and delusions associated with Parkinson disease psychosis and is currently in clinical trials for the treatment of psychosis in AD.AIM To evaluate the existing literature regarding the use of pimavanserin for treating psychosis among individuals with AD.METHODS A literature review of clinical studies of pimavanserin treatment for psychosis in individuals with AD was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Trials were identified by systematically searching PubMed,MEDLINE,EMBASE,Cochrane Central Register of Controlled Trials,Web of Science,and Scopus through October 2019.The 5-point Jadad scoring system was used to assess the methodologic quality of the randomized placebo-controlled trials.RESULTS A total of 499 citations were retrieved and pooled in EndNote and de-duplicated to 258 citations.This set was uploaded to Covidence for screening.Two separate screeners(Srinivasan S and Tampi RR)evaluated the titles,abstracts,and full text of eligible articles.Of the identified 258 abstracts,98 articles underwent full text review and 2 publications from 1 randomized controlled trial(RCT)were included in the final analysis.The quality of evidence was assessed to be of good methodologic quality,scoring 4 out of 5 using the 5-point Jadad questionnaire with the Jadad Scoring calculation.This systematic review found only one RCT that evaluated the use of pimavanserin for the treatment of psychosis among individuals with AD.This phase 2 trial resulted in two publications,the second of which was a subgroup analysis from the original study.The evidence from these two publications showed that pimavanserin improves psychotic symptoms among individuals with AD when compared to placebo at week 6.CONCLUSION Pimavanserin may be a pharmacologic consideration for the treatment for psychosis in AD.Additional RCTs are needed to assess the evidence of effectiveness before pimavanserin is considered a standard treatment.展开更多
Patients with schizophrenia(SCZ)are at high risk of cardiovascular disease(CVD)due to an inherited predisposition,a sedentary life style and the use of antipsychotic medications.Several approaches have been taken to m...Patients with schizophrenia(SCZ)are at high risk of cardiovascular disease(CVD)due to an inherited predisposition,a sedentary life style and the use of antipsychotic medications.Several approaches have been taken to minimize this risk but results continue to be unsatisfactory.A potential alternative is prescribing selective serotonin reuptake inhibitors(SSRIs).SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression.We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ.A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ.Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine.Two of those studies found improvements with fluvoxamine.Of the other two reports,one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol,low-density lipoprotein and triglyceride.The second report suggests that when SSRIs are combined with antipsychotics,the metabolic impact depends on the antipsychotic prescribed.While there are promising results,no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ.Further studies are needed to resolve this matter.展开更多
AIM To provide an updated of recent findings about efficacy of cognitive-behavior therapy(CBT) in reduction of command hallucinations.METHODS Pub Med/MEDLINE,Cochrane Library,the Cumulative Index to Nursing and Allied...AIM To provide an updated of recent findings about efficacy of cognitive-behavior therapy(CBT) in reduction of command hallucinations.METHODS Pub Med/MEDLINE,Cochrane Library,the Cumulative Index to Nursing and Allied Health Literature,PsycI NFO,Clinical Trial.gov searches were performed using the keywords "hallucinations","behavioural therapy" and " cognitive therapy" in order to identify relevant articles published during the years of 2011 to 2016.No language limits were used.Studies conducted within control group,reviews,editorials,were excluded.Data on efficacy,acceptability and tolerability were extracted by three authors independently.Disagreements were resolved in a consensus meeting or by another reviewer.RESULTS A total of eight articles were eligible for inclusion.Two are randomized clinical trials(RCTs) and six are observational studies.The two RCTs included showed a greater efficacy of CBT compared to standard care on auditory hallucinations(AHs).Nevertheless,they considered different CBT models,particularly Treatment of Resistant Command Hallucinations and Cognitive Therapy for Command Hallucinations.As regards non RCT-studies,all papers included showed reduction on frequency and severity of AHs and distress related to them.However,the lack of content details within non-RCTs studies decreased their comparability.In terms of predictive variables,our findings show that negative symptoms at baseline appeared to be the strongest predictor of the treatment efficacy.Indeed,negative symptoms showed a significant negative correlation on outcome.CONCLUSION Although more conclusive studies are still needed,we found some preliminary evidence for the efficacy of CBT in the treatment of command hallucinations.展开更多
基金supported by: HunanProvincial Department of Education Research InnovationGeneral Project: Research on The Strategy of ImprovingCollege Students’ Health Literacy under the Background ofHealthy China (CX20211027).
文摘An increasing number of studies have suggested that increased physical activity is associated with less mental illness.However,the relationship between exercise and psychotic experiences(PEs)is still unknown.The purpose of this study was to explore the relationship between exercise and PEs in college students in the United States.Data from the Health Mind Survey(2020–2021 round)were analyzed.Respondents included 137,916 college students who were asked about exercise and PEs(lifetime psychotic experiences,delusions,and hallucinations).A multivariate logistic regression analysis was used to investigate the relationship between exercise and PEs while controlling for demographic characteristics.There was a significant correlation between exercise and PEs among college students.Compared to students who exercised less than one hour per week,students who exercisedfive or more hours per week had fewer lifetime psychotic experiences.This samefinding obtained for both male and female college students.Thefindings from the present study indicate that exercising forfive or more hours each week is most correlated with decreased PEs among college students.However,experimental studies are required to extend and confirm ourfindings and determine the causality of this relationship.
文摘AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.METHODS: Standardized semi-structured interview of 150 family members of psychotic patients receiving full time treatment. This study on associative stigma in family members of psychotic patients was part of a larger research program on the burden of the family, using "Interview for the Burden of the Family" and the chapters stigma, treatment and attribution from the "Family interview Schedule". The respondents were relatives, one per patient, either partner or parent. The patients had been diagnosed with schizophrenia or schizo-affective disorder. All contacts with patients and relatives were in Dutch. Relatives were deemed suitable to participate in this research if they saw the patient at least once a week. Recruitment took place in a standardized way: after obtaining the patient's consent, the relatives were approached to participate. The results were analyzed using SPSS Version 18.0. RESULTS: The prevalence of associative stigma in this sample is 86%. Feelings of depression in the majority of family members are prominent. Twenty-one point three percent experienced guilt more or less frequent, while shame was less pronounced. Also, 18.6% of allrespondents indicated that they tried to hide the illness of their family member for others regularly or more. Three six point seven percent really kept secret about it in certain circumstances and 29.3% made efforts to explain what the situation or psychiatric condition of their family member really is like. Factors with marked significance towards higher associative stigma are a worsened relationship between the patient and the family member, conduct problems to family members, the patients' residence in a residential care setting, and hereditary attributional factors like genetic hereditability and character. The level of associative stigma has significantly been predicted by the burden of aggressive disruptions to family housemates of the psychotic patient.CONCLUSION: Family members of psychotic patients in Flanders experience higher associative stigma compared to previous international research. Disruptive behavior by the patient towards in-housing family members is the most accurate predictor of higher associative stigma.
文摘With the advent of technological advancements and the widespread Internet connectivity during the last couple of decades,social media platforms(such as Facebook,Twitter,and Instagram)have consumed a large proportion of time in our daily lives.People tend to stay alive on their social media with recent updates,as it has become the primary source of interactionwithin social circles.Although social media platforms offer several remarkable features but are simultaneously prone to various critical vulnerabilities.Recent studies have revealed a strong correlation between the usage of social media and associated mental health issues consequently leading to depression,anxiety,suicide commitment,and mental disorder,particularly in the young adults who have excessively spent time on socialmedia which necessitates a thorough psychological analysis of all these platforms.This study aims to exploit machine learning techniques for the classification of psychotic issues based on Facebook status updates.In this paper,we start with depression detection in the first instance and then expand on analyzing six other psychotic issues(e.g.,depression,anxiety,psychopathic deviate,hypochondria,unrealistic,and hypomania)commonly found in adults due to extreme use of social media networks.To classify the psychotic issues with the user’s mental state,we have employed different Machine Learning(ML)classifiers i.e.,Random Forest(RF),Support Vector Machine(SVM),Naïve Bayes(NB),and K-Nearest Neighbor(KNN).The used ML models are trained and tested by using different combinations of features selection techniques.To observe themost suitable classifiers for psychotic issue classification,a cost-benefit function(sometimes termed as‘Suitability’)has been used which combines the accuracy of the model with its execution time.The experimental evidence argues that RF outperforms its competitor classifiers with the unigram feature set.
文摘Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.
文摘BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.
文摘BACKGROUND The subsequent waves of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)pandemic have represented a dramatic health emergency characterized by significant consequences on mental health.Diachronic variations in the incidence rates of acute relapse of psychiatric disorders may represent significant"sentinel events"for assessing the mental health response to an unprecedented stressful event.AIM To investigate the variation in psychiatric hospitalization rates and differences in sociodemographic and clinical-psychopathological peculiarities at Bologna"Maggiore"General Hospital Psychiatric Ward(GHPW)between the first two waves SARS-CoV-2 pandemic and the same periods of the previous 3 years.The secondary purpose of the study was to suggest a diachronic response pathway to stress by reporting additional literature data on coping strategies.METHODS This observational and retrospective study collected information on admission to the GHPW at the"Maggiore"Hospital in Bologna in the index periods defined as follows:the first period between February 24,2020 and April 30,2020(first epidemic wave)and the second period between October 8,2020,and January 7,2021(second pandemic wave).Absolute numbers and proportion of admitted patients,their sociodemographic and clinical-psychopathological characteristics were compared with the same parameters recorded in the two same periods of the previous 3 years.No strict inclusion or exclusion criteria were provided in the data collection to collect information on all patients requiring acute psychiatric hospitalization.RESULTS During the first wave,there was a significant reduction in hospitalization rates,although there was a simultaneous increase in compulsory hospitalizations and the acute relapse of schizophrenia spectrum and other psychotic disorders.During the second wave,hospitalization rates reached those recorded during the same period of the previous 3 years,mainly due to the rise of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressor-related disorders and suicidal behaviors.CONCLUSION The coping strategies adopted during the first wave of the SARS-CoV-2 pandemic protected the vulnerable population from the general risk of clinical-psychopathological acute relapse,even if they increased the susceptibility to run into schizophrenia spectrum and other psychotic disorder relapses.In the medium-long term(as in the second pandemic wave),the same strategies do not play protective roles against the stress associated with the pandemic and social restriction measures.Indeed,during the second wave of the SARS-CoV-2 pandemic,an increase in total hospitalization rate,suicidal behaviors and the incidence rate of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressorrelated disorders was observed.
文摘Screening patients for psychotic features can pose a problem when using verbal based tests. Establishment of validity of non-verbal psychotic screening scale can enhance diagnostic specificity and address challenges associated with verbal based tests. The goal of this study is to check whether Bender Visual Motor Gestalt Test-II will serve as a diagnostic specific tool for distinguishing between psychotic patients and healthy population. A total of 40 participants 22 males and 18 females were employed in the study. They were made of 10 patients diagnosed with schizophrenia, another 10 with depressions associated with psychotic features, 10 with substance/medication induced disorders and 10 healthy adults as the control. Their ages ranged from 20 - 65 with a mean age of 35.70 and standard deviation of 6.04. The healthy control group was staff of the hospital that was comparable to the patients in terms of age, gender and studies. All participants available who met the inclusive criteria who were willing to participate were selected. The instruments were (BVMGT-II) and (WHODAS 2.0). The design of the study was between group designs and One Way ANOVA was employed for data analysis. The findings of the study showed that BVMGT-II discriminated between patients with psychotic disorder and healthy population. It is recommended that BVMGT-II should be employed as screening instrument by the clinical/neuropsychologists in clinical psychological assessment for distinguishing psychotic patients from healthy population.
基金supported by National Natural Science Foundation of China (81171291, 81371531, 81571344, 81871344)the Natural Science Foundation of Jiangsu Province, China (BK20161109)+2 种基金the Key Program for Guangming Lu (BWS11J063, and 10z026)the Natural Science Foundation of the Higher Education Institutions of Jiangsu Province, China (18KJB190003)the Postdoctoral Science Foundation of China (2014M552700)
文摘Mood disorders/psychosis have been associated with dysfunctions in the default mode network(DMN).However,the relative contributions of DMN regions to state and trait disturbances in pediatric bipolar disorder(PBD)remain unclear.The aim of this study was to investigate the possible mechanisms of PBD through brain imaging and explore the influence of psychotic symptoms on functional alterations in PBD patients.Twenty-nine psychotic and 26 non-psychotic PBD patients,as well as 19 age-and sex-matched healthy controls underwent a restingstate functional MRI scan and the data were analyzed by independent component analysis.The DMN component from the fMRI data was extracted for each participant.Spearman's rank correlation analysis was performed between aberrant connectivity and clinical measurements.The results demonstrated that psychotic PBD was characterized by aberrant DMN connectivity in the anterior cingulate cortex/medial prefrontal cortex,bilateral caudate nucleus,bilateral angular gyri,and left middle temporal gyrus,while non-psychotic PBD was not,suggesting further impairment with the development of psychosis.In summary,we demonstrated unique impairment in DMN functional connectivity in the psychotic PBD group.These specific neuroanatomical abnormalities may shed light on the underlying pathophysiology and presentation of PBD.
基金supported by grants from the National Natural Science Foundation of China (81801675)the Military Medical Major Program during the Thirteenth Five-Year Plan Period of China (AWS17J012)
文摘Recently, two researches by Doucet et al. and Collin et al. used functional neuroimaging as a tool to improve the management of schizophrenia and other psychotic disorders [1, 2]. We would like to highlight several issues in relation to cardiopulmonary comorbidity, radiomics and machine learning, and therapeutic regimens, along with their clinical implications.
基金National Natural Science Foundation of China,No.82172061the Key Research and Development Plan in Jiangsu,No.BE2022677and the 16th Batch of Six Talent Peak Projects in Jiangsu,No.WSN-166.
文摘BACKGROUND Cerebrotendinous xanthomatosis(CTX)is a rare autosomal recessive lipid-storage disorder caused by mutations in CYP27A1.Psychiatric manifestations in CTX are rare and nonspecific,and they often lead to considerable diagnostic and treatment delay.CASE SUMMARY A 33-year-old female patient admitted to the psychiatric ward for presentation of delusions,hallucinations,and behavioral disturbance is reported.The patient presented with cholestasis,cataract,Achilles tendon xanthoma,and cerebellar signs in adulthood and with intellectual disability and learning difficulties in childhood.After the characteristic CTX findings on imaging were obtained,a pathological examination of the Achilles tendon xanthoma was refined.Replacement therapy was then initiated after the diagnosis was clarified by genetic analysis.During hospitalization in the psychiatric ward,the nonspecific psychiatric manifestations of the patient posed difficulty in diagnosis.After the patient’s history of CTX was identified,the patient was diagnosed with organic schizophrenia-like disorder,and psychotic symptoms were controlled by replacement therapy combined with antipsychotic medication.CONCLUSION Psychiatrists should be aware of CTX,its psychiatric manifestations,and clinical features and avoid misdiagnosis of CTX for timely intervention.
文摘BACKGROUND Alzheimer’s disease(AD)is among the most prevalent forms of dementia in the world and neuropathological studies suggest similar high prevalence of mixed(AD+vascular)dementias.Approximately 25%-50%of individuals with AD develop psychosis sometime during their illness.The presence of psychosis in AD worsens outcomes.Currently there are no United States Food and Drug Administration(FDA)approved medications for the treatment of psychosis in AD.Pimavanserin,a novel atypical antipsychotic medication,was approved by the FDA for the treatment of hallucinations and delusions associated with Parkinson disease psychosis and is currently in clinical trials for the treatment of psychosis in AD.AIM To evaluate the existing literature regarding the use of pimavanserin for treating psychosis among individuals with AD.METHODS A literature review of clinical studies of pimavanserin treatment for psychosis in individuals with AD was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Trials were identified by systematically searching PubMed,MEDLINE,EMBASE,Cochrane Central Register of Controlled Trials,Web of Science,and Scopus through October 2019.The 5-point Jadad scoring system was used to assess the methodologic quality of the randomized placebo-controlled trials.RESULTS A total of 499 citations were retrieved and pooled in EndNote and de-duplicated to 258 citations.This set was uploaded to Covidence for screening.Two separate screeners(Srinivasan S and Tampi RR)evaluated the titles,abstracts,and full text of eligible articles.Of the identified 258 abstracts,98 articles underwent full text review and 2 publications from 1 randomized controlled trial(RCT)were included in the final analysis.The quality of evidence was assessed to be of good methodologic quality,scoring 4 out of 5 using the 5-point Jadad questionnaire with the Jadad Scoring calculation.This systematic review found only one RCT that evaluated the use of pimavanserin for the treatment of psychosis among individuals with AD.This phase 2 trial resulted in two publications,the second of which was a subgroup analysis from the original study.The evidence from these two publications showed that pimavanserin improves psychotic symptoms among individuals with AD when compared to placebo at week 6.CONCLUSION Pimavanserin may be a pharmacologic consideration for the treatment for psychosis in AD.Additional RCTs are needed to assess the evidence of effectiveness before pimavanserin is considered a standard treatment.
文摘Patients with schizophrenia(SCZ)are at high risk of cardiovascular disease(CVD)due to an inherited predisposition,a sedentary life style and the use of antipsychotic medications.Several approaches have been taken to minimize this risk but results continue to be unsatisfactory.A potential alternative is prescribing selective serotonin reuptake inhibitors(SSRIs).SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression.We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ.A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ.Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine.Two of those studies found improvements with fluvoxamine.Of the other two reports,one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol,low-density lipoprotein and triglyceride.The second report suggests that when SSRIs are combined with antipsychotics,the metabolic impact depends on the antipsychotic prescribed.While there are promising results,no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ.Further studies are needed to resolve this matter.
文摘AIM To provide an updated of recent findings about efficacy of cognitive-behavior therapy(CBT) in reduction of command hallucinations.METHODS Pub Med/MEDLINE,Cochrane Library,the Cumulative Index to Nursing and Allied Health Literature,PsycI NFO,Clinical Trial.gov searches were performed using the keywords "hallucinations","behavioural therapy" and " cognitive therapy" in order to identify relevant articles published during the years of 2011 to 2016.No language limits were used.Studies conducted within control group,reviews,editorials,were excluded.Data on efficacy,acceptability and tolerability were extracted by three authors independently.Disagreements were resolved in a consensus meeting or by another reviewer.RESULTS A total of eight articles were eligible for inclusion.Two are randomized clinical trials(RCTs) and six are observational studies.The two RCTs included showed a greater efficacy of CBT compared to standard care on auditory hallucinations(AHs).Nevertheless,they considered different CBT models,particularly Treatment of Resistant Command Hallucinations and Cognitive Therapy for Command Hallucinations.As regards non RCT-studies,all papers included showed reduction on frequency and severity of AHs and distress related to them.However,the lack of content details within non-RCTs studies decreased their comparability.In terms of predictive variables,our findings show that negative symptoms at baseline appeared to be the strongest predictor of the treatment efficacy.Indeed,negative symptoms showed a significant negative correlation on outcome.CONCLUSION Although more conclusive studies are still needed,we found some preliminary evidence for the efficacy of CBT in the treatment of command hallucinations.