AIM: To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms.METHODS: Forty patients with liver cirrhosis (LC, with or without low-gr...AIM: To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms.METHODS: Forty patients with liver cirrhosis (LC, with or without low-grade hepatic encephalopathy) were invest-igated using a clinical neuro-psychiatric rating scale based on a comprehensive list of neurological, psychomotor,cognitive, affective, behavioral symptoms, and symptoms of disturbed bioregulation.RESULTS: The analysis revealed that the majority of cirrhotic patients showed, besides characteristic neurological symptoms of hepatic encephalopathy, various psychomotor,affective and bioregulatory symptoms (disturbed sleep and sexual dysfunction). Patients were impaired in the following subscales: sleep and biorhythm disorder (75.0% of patients), Parkinsonoid symptoms (25.0%), affective symptoms (17.5%), and psychomotor retardation (12.5%).The increase of total neuro-psychiatric clinical score was significantly associated with the degree of hepatic enceph-alopathy.CONCLUSION: This study suggests that a substantial number of patients with LC and low-grade hepatic encephalopathy manifest various clinical neuro-psychiatric symptoms. The use of a rating scale, which explores clinical dimensions of hepatic encephalopathy, would improve the management of patients with LC.展开更多
AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rap...AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic encephalopathy.METHODS: A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was investigated.RESULTS: Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy. CONCLUSION: The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.展开更多
Voice hearing, a complex perceptual phenomenon, is reportedly common in the general population yet understudied in nursing. Nurses meet voice hearers from diverse cultures;their understandings influence assessment. Th...Voice hearing, a complex perceptual phenomenon, is reportedly common in the general population yet understudied in nursing. Nurses meet voice hearers from diverse cultures;their understandings influence assessment. The aim was to explore voice hearing in everyday life in a non-patient population, revealing insights for assessing voice hearing. Method: Interview data was transcribed, translated into English and analyzed by qualitative content analysis. Outcome measures are thematic descriptions. Results: Voice hearing over time involved past (about year 2000) and recent (2009) time periods. Four main themes were: “Transitioning from not-being-at home when home alone to being at-home”, “Shifting overtime from frequent, repetitive voice hearing to inferquent intermittent voice hearing overtime”, “Changing from being disempowered to being empowered” and “Progressing from absence of significant others to presence of significant others”. Study Limitations: Interviewing a single participant residing in Scandinavia produced in-depth descriptions consistent with the study’s aim. The participant had no known psychiatric diagnosis and had not received mental health care when recruited and interviewed. However, we cannot be certain that her voice hearing was or was not non-pathological which raises issues concerning truth value of the study. Conclusions: The results reflect life world existential themes of lived time, lived space, lived body and lived human relation, and offers a framework for guiding and challenging nurses’ assessments of voice hearing. Voice hearing can be understood as a bereavement-grief response. Further research is needed in western and non-western cultures and non-patient populations.展开更多
Background Patients with C0VID-19 are at high risk of developing mental health problems;however,the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear.Aims We aime...Background Patients with C0VID-19 are at high risk of developing mental health problems;however,the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear.Aims We aimed to investigate the mental health problems of patients infected with C0VID-19 and to identify the role of psychiatrists in the clinical treatment team during the pandemic.We also share the experience of psychiatric consultations of patients with COVID-19 in Shanghai,China.Methods We analysed data from the psychiatric medical records of 329 patients with COVID-19 in the Shanghai Public Health Clinical Center from 20 January to 8 March 2020.We collected information including sociodemographic characteristics,whether patients received psychiatric consultation,mental health symptoms,psychiatric diagnoses,psychiatric treatments and severity level of COVID-19.Results Psychiatric consultations were received by 84(25.5%)patients with COVID-19.The most common symptoms of mental health problems were sleep disorders(75%),anxiety(58.3%)and depressive symptoms(11.9%).The psychiatric consultation rate was highest in critically ill patients(69.2%),with affective symptoms or disturbed behaviour as their main mental health problems.Psychiatric diagnoses for patients who received consultation included acute stress reaction(39.3%),sleep disorders(33.3%),anxiety(15.5%),depression(7.1%)and delirium(4.8%).In terms of psychiatric treatments,86.9%of patients who received psychiatric consultation were treated with psychotropic medications,including non-benzodiazepine sedative-hypnotic agents(54.8%),antidepressants(26.2%),benzodiazepines(22.6%)and antipsychotics(10.7%).Among the 76 patients who were discharged from the hospital,79%had recovered from mental health problems and were not prescribed any psychotropic medications.The symptoms of the remaining 21%of patients had improved and they were prescribed medications to continue the treatment.Conclusions This is the first study to report psychiatric consultations for patients with COVID-19.Our study indicated that a considerable proportion of patients with COVID-19,especially critically ill cases,experienced mental health problems.Given the remarkable effect of psychiatric treatments,we recommend that psychiatrists be timely and actively involved in the treatment of COVID-19.展开更多
Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach ...Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach of concept analysis was applied.Results:OB was defined as a chronic form of work-related stress.Accurately,it was characterized by emotional exhaustion,depersonalization/cynicism,and reduced personal accomplishment/inefficacy.Antecedents of burnout included(a)demographic characteristics;(b)chronic exposure to work-related stressors;(c)quantitative and qualitative job demands;(d)lack of job resources;and(e)personality traits.Consequences involved(a)individual’s unfavorable quality of life;(b)negative impact on the organization;and(c)poor services quality.Although the Maslach Burnout Inventory(MBI)is perceived as an ideal tool to measure burnout and hence,it is used worldwide,whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed.Conclusions:By proposing a comprehensive definition of the concept,this analysis contributes to recognition of the process of OB of nurses.All nurses are vulnerable to OB.Hence,burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care.It proposes that the prevention of OB would be achieved through team communication training,mindfulness group,education,etc.展开更多
Schizophrenia patients have difficulties in focusing their attention, when distracting information must be ignored. Although it is adaptive in some situations to monitor the background for potentially relevant changes...Schizophrenia patients have difficulties in focusing their attention, when distracting information must be ignored. Although it is adaptive in some situations to monitor the background for potentially relevant changes to a certain degree, voluntary attentional processes seem to be more severely disrupted by distracting information in schizophrenia patients compared to healthy controls. Reorienting processes associated with the detection of potentially relevant information outside the current focus of attention have previously shown to activate a bilateral prefronto-parietal network. The aim of the current study was to investigate whether this network is dysregulated in schizophrenia patients using fMRI during the performance in a combined oddball-incongruence task, in which relevant processing must be shielded from distracting irrelevant salient or conflicting information. During the occurrence of both oddballs and incongruence patients exhibited an increased activation of the intraparietal cortex—a saliency sensitive part of the prefronto-parietal network associated with background-monitoring. As this hyperactivation was accompanied by an increased activation in the dopaminergic midbrain, the results of our study link the finding of a hyperactive salience sensitive cortical region to the finding of the hyperdopaminergic state in schizophrenia, supporting the predominant view of psychosis as a state of aberrant salience.展开更多
Social function deficits are a ubiquitous manifestation of many psychiatric disorders including schizophrenia(Burns,2006;Green et al,2015;Schilbach,2016).Patients with schizophrenia(PSZ)exhibit a variety of abnormalit...Social function deficits are a ubiquitous manifestation of many psychiatric disorders including schizophrenia(Burns,2006;Green et al,2015;Schilbach,2016).Patients with schizophrenia(PSZ)exhibit a variety of abnormalities in social cognition related to social perception,facial emotion recognition,mentalization,and interpersonal coordination(Turetsky et al,2007;Schilbach,2016;Green et al,2019).展开更多
文摘AIM: To evaluate the feasibility of a new clinical rating scale for a standardized assessment of cirrhosis-associated neuro-psychiatric symptoms.METHODS: Forty patients with liver cirrhosis (LC, with or without low-grade hepatic encephalopathy) were invest-igated using a clinical neuro-psychiatric rating scale based on a comprehensive list of neurological, psychomotor,cognitive, affective, behavioral symptoms, and symptoms of disturbed bioregulation.RESULTS: The analysis revealed that the majority of cirrhotic patients showed, besides characteristic neurological symptoms of hepatic encephalopathy, various psychomotor,affective and bioregulatory symptoms (disturbed sleep and sexual dysfunction). Patients were impaired in the following subscales: sleep and biorhythm disorder (75.0% of patients), Parkinsonoid symptoms (25.0%), affective symptoms (17.5%), and psychomotor retardation (12.5%).The increase of total neuro-psychiatric clinical score was significantly associated with the degree of hepatic enceph-alopathy.CONCLUSION: This study suggests that a substantial number of patients with LC and low-grade hepatic encephalopathy manifest various clinical neuro-psychiatric symptoms. The use of a rating scale, which explores clinical dimensions of hepatic encephalopathy, would improve the management of patients with LC.
文摘AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic encephalopathy.METHODS: A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was investigated.RESULTS: Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy. CONCLUSION: The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.
文摘Voice hearing, a complex perceptual phenomenon, is reportedly common in the general population yet understudied in nursing. Nurses meet voice hearers from diverse cultures;their understandings influence assessment. The aim was to explore voice hearing in everyday life in a non-patient population, revealing insights for assessing voice hearing. Method: Interview data was transcribed, translated into English and analyzed by qualitative content analysis. Outcome measures are thematic descriptions. Results: Voice hearing over time involved past (about year 2000) and recent (2009) time periods. Four main themes were: “Transitioning from not-being-at home when home alone to being at-home”, “Shifting overtime from frequent, repetitive voice hearing to inferquent intermittent voice hearing overtime”, “Changing from being disempowered to being empowered” and “Progressing from absence of significant others to presence of significant others”. Study Limitations: Interviewing a single participant residing in Scandinavia produced in-depth descriptions consistent with the study’s aim. The participant had no known psychiatric diagnosis and had not received mental health care when recruited and interviewed. However, we cannot be certain that her voice hearing was or was not non-pathological which raises issues concerning truth value of the study. Conclusions: The results reflect life world existential themes of lived time, lived space, lived body and lived human relation, and offers a framework for guiding and challenging nurses’ assessments of voice hearing. Voice hearing can be understood as a bereavement-grief response. Further research is needed in western and non-western cultures and non-patient populations.
基金This work was supported by Shanghai Clinical Research Center for Mental Health,Shanghai,China(SCRC-MH(19MC1911100)).
文摘Background Patients with C0VID-19 are at high risk of developing mental health problems;however,the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear.Aims We aimed to investigate the mental health problems of patients infected with C0VID-19 and to identify the role of psychiatrists in the clinical treatment team during the pandemic.We also share the experience of psychiatric consultations of patients with COVID-19 in Shanghai,China.Methods We analysed data from the psychiatric medical records of 329 patients with COVID-19 in the Shanghai Public Health Clinical Center from 20 January to 8 March 2020.We collected information including sociodemographic characteristics,whether patients received psychiatric consultation,mental health symptoms,psychiatric diagnoses,psychiatric treatments and severity level of COVID-19.Results Psychiatric consultations were received by 84(25.5%)patients with COVID-19.The most common symptoms of mental health problems were sleep disorders(75%),anxiety(58.3%)and depressive symptoms(11.9%).The psychiatric consultation rate was highest in critically ill patients(69.2%),with affective symptoms or disturbed behaviour as their main mental health problems.Psychiatric diagnoses for patients who received consultation included acute stress reaction(39.3%),sleep disorders(33.3%),anxiety(15.5%),depression(7.1%)and delirium(4.8%).In terms of psychiatric treatments,86.9%of patients who received psychiatric consultation were treated with psychotropic medications,including non-benzodiazepine sedative-hypnotic agents(54.8%),antidepressants(26.2%),benzodiazepines(22.6%)and antipsychotics(10.7%).Among the 76 patients who were discharged from the hospital,79%had recovered from mental health problems and were not prescribed any psychotropic medications.The symptoms of the remaining 21%of patients had improved and they were prescribed medications to continue the treatment.Conclusions This is the first study to report psychiatric consultations for patients with COVID-19.Our study indicated that a considerable proportion of patients with COVID-19,especially critically ill cases,experienced mental health problems.Given the remarkable effect of psychiatric treatments,we recommend that psychiatrists be timely and actively involved in the treatment of COVID-19.
基金This project was supported by Medical Research Fund of Guangdong Province(No.A2018440).
文摘Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach of concept analysis was applied.Results:OB was defined as a chronic form of work-related stress.Accurately,it was characterized by emotional exhaustion,depersonalization/cynicism,and reduced personal accomplishment/inefficacy.Antecedents of burnout included(a)demographic characteristics;(b)chronic exposure to work-related stressors;(c)quantitative and qualitative job demands;(d)lack of job resources;and(e)personality traits.Consequences involved(a)individual’s unfavorable quality of life;(b)negative impact on the organization;and(c)poor services quality.Although the Maslach Burnout Inventory(MBI)is perceived as an ideal tool to measure burnout and hence,it is used worldwide,whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed.Conclusions:By proposing a comprehensive definition of the concept,this analysis contributes to recognition of the process of OB of nurses.All nurses are vulnerable to OB.Hence,burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care.It proposes that the prevention of OB would be achieved through team communication training,mindfulness group,education,etc.
文摘Schizophrenia patients have difficulties in focusing their attention, when distracting information must be ignored. Although it is adaptive in some situations to monitor the background for potentially relevant changes to a certain degree, voluntary attentional processes seem to be more severely disrupted by distracting information in schizophrenia patients compared to healthy controls. Reorienting processes associated with the detection of potentially relevant information outside the current focus of attention have previously shown to activate a bilateral prefronto-parietal network. The aim of the current study was to investigate whether this network is dysregulated in schizophrenia patients using fMRI during the performance in a combined oddball-incongruence task, in which relevant processing must be shielded from distracting irrelevant salient or conflicting information. During the occurrence of both oddballs and incongruence patients exhibited an increased activation of the intraparietal cortex—a saliency sensitive part of the prefronto-parietal network associated with background-monitoring. As this hyperactivation was accompanied by an increased activation in the dopaminergic midbrain, the results of our study link the finding of a hyperactive salience sensitive cortical region to the finding of the hyperdopaminergic state in schizophrenia, supporting the predominant view of psychosis as a state of aberrant salience.
基金Support was provided by the National Natural Science Foundation of China (Nos.62207025 to Y.P.and 82201658 to J.C.)the Humanities and Social Sciences Research Project from the Ministry of Education of China (No.22YJC190017 to Y.P.)+1 种基金the STI2030-Major Projects (No.2022ZD0214000 to J.C.)the National Key R&D Program of China (No.2021YFC2502200 to J.C.).
文摘Social function deficits are a ubiquitous manifestation of many psychiatric disorders including schizophrenia(Burns,2006;Green et al,2015;Schilbach,2016).Patients with schizophrenia(PSZ)exhibit a variety of abnormalities in social cognition related to social perception,facial emotion recognition,mentalization,and interpersonal coordination(Turetsky et al,2007;Schilbach,2016;Green et al,2019).
