Transfers to psychiatry through the consultation-liaison psychiatry service: 11 years of experience

BACKGROUND: There are only a few reports on issues related to patient transfer from medical and surgical departments to the psychiatric ward by the consultation-liaison psychiatry service, although it is a common practice. Here, we present a study assessing the factors that influence such transfers. METHOD: We examined the demographic and clinical backgrounds of a group of patients transferred from internal medicine and surgery to the psychiatric ward over an 11-year period. A comparison was made of this data with data obtained from a group of non-transferred patients, also seen by the same consultation-liaison psychiatry service. RESULTS: According to our findings, the typical transferred patient, either female or male, is single, divorced or widowed, lives alone, belongs to a lower socioeconomic class, presents initially with (on the whole) a disturbed and disruptive behaviour, has had a recent suicide attempt with persistent suicidal ideas, suffers from a mood disorder (mainly depressive and dysthymic disorders), has a prior psychiatric history as well as a prior psychiatric inpatient treatment, and a positive diagnosis on axis II of the five axis system used for mental health diagnosis. CONCLUSION: The transfer of a patient to the psychiatric ward is a decision depending on multiple factors. Medical diagnoses do not seem to play a major role in the transfer to the psychiatric ward. From the psychiatric diagnosis, depressive and dysthymic disorders are the most common in the transferred population, whilst the transfer is influenced by social factors regarding the patient, the patient's behaviour, the conditions in the ward she/he is treated in and any recent occurrence(s) that increase the anxiety of the staff

The Alcohol Use Disorders Identification Test (AUDIT): reliability and validity of the Greek version

<p>Abstract</p> <p>Background</p> <p>Problems associated with alcohol abuse are recognised by the World Health Organization as a major health issue, which according to most recent estimations is responsible for 1.4% of the total world burden of morbidity and has been proven to increase mortality risk by 50%. Because of the size and severity of the problem, early detection is very important. This requires easy to use and specific tools. One of these is the Alcohol Use Disorders Identification Test (AUDIT).</p> <p>Aim</p> <p>This study aims to standardise the questionnaire in a Greek population.</p> <p>Methods</p> <p>AUDIT was translated and back-translated from its original language by two English-speaking psychiatrists. The tool contains 10 questions. A score ≥ 11 is an indication of serious abuse/dependence. In the study, 218 subjects took part: 128 were males and 90 females. The average age was 40.71 years (± 11.34). From the 218 individuals, 109 (75 male, 34 female) fulfilled the criteria for alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and presented requesting admission; 109 subjects (53 male, 56 female) were healthy controls.</p> <p>Results</p> <p>Internal reliability (Cronbach α) was 0.80 for the controls and 0.80 for the alcohol-dependent individuals. Controls had significantly lower average scores (t test <it>P </it>< 0.001) when compared to the alcoholics. The questionnaire's sensitivity for scores >8 was 0.98 and its specificity was 0.94 for the same score. For the alcohol-dependent sample 3% scored as false negatives and from the control group 1.8% scored false positives. In the alcohol-dependent sample there was no difference between males and females in their average scores (t test <it>P </it>> 0.05).</p> <p>Conclusion</p> <p>The Greek version of AUDIT has increased internal reliability and validity. It detects 97% of the alcohol-dependent individuals and has a high sensitivity and specificity. AUDIT is easy to use, quick and reliable and can be very useful in detection alcohol problems in sensitive populations.</p

Hospital Anxiety and Depression Scale (HADS): validation in a Greek general hospital sample

<p>Abstract</p> <p>Background</p> <p>The Hospital Anxiety and Depression Scale (HADS) has been used in several languages to assess anxiety and depression in general hospital patients with good results.</p> <p>Methods</p> <p>The HADS was administered to 521 participants (275 controls and 246 inpatients and outpatients of the Internal Medicine and Surgical Departments in 'Attikon' General Hospital in Athens). The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were used as 'gold standards' for depression and anxiety respectively.</p> <p>Results</p> <p>The HADS presented high internal consistency; Cronbach's α cofficient was 0.884 (0.829 for anxiety and 0.840 for depression) and stability (test-retest intraclass correlation coefficient 0.944). Factor analysis showed a two-factor structure. The HADS showed high concurrent validity; the correlations of the scale and its subscales with the BDI and the STAI were high (0.722 – 0.749).</p> <p>Conclusion</p> <p>The Greek version of HADS showed good psychometric properties and could serve as a useful tool for clinicians to assess anxiety and depression in general hospital patients.</p

CHARACTERISTICS OF SUICIDE VICTIMS WHO HAD VERBALLY COMMUNICATED SUICIDAL FEELINGS TO THEIR FAMILY MEMBERS

Background: Verbal expression of suicidal feelings has rarely been investigated in the literature, particularly regarding individuals who died by suicide. Subjects and methods: We retrospectively collected data on the suicide cases of the period November 2007-October 2009 from the Athens Greater Area and completed psychological autopsy questionnaires after phone interviews with their family members. The specific question was: “Has your relative expressed to you his/her deep suffering or the intention to end his/her life at any time during the six months prior to the suicide?” Results: Data were collected for 248 individuals who died by suicide out of a total of 335. 121 of them (48.8%) had verbally communicated their intention to die -or their profound suffering- to their family members. Suicide communicators were older (p<0.001), less educated (p=0.04), more frequently divorced or separated and less often single (p<0.01) than non-communicators. They had more often positive psychiatric history (p=0.004) and were less physically well (p=0.005), in comparison to noncommunicators. Differences regarding sex, nationality, previous attempts, suicide note-leaving, completed suicide method and hospitalization either for physical illness or psychiatric disorder the year prior to the suicide were not statistically significant among the two groups. Considered that we interviewed only one relative for every case, the actual number of suicide communicators would be probably higher; the suicidal feelings could have been disclosed to another relative instead. Conclusions: This is the first time that a similar study was carried out in Greece. We found that approximately half of the individuals who died by suicide in our sample had been (verbal) suicide communicators. The latter seem to present distinct characteristics. These findings, coupled with the observation that the relatives are keen observers of the suicidal feelings of their loved ones, could provide new insights to future suicide prevention efforts

The key role of daytime sleepiness in cognitive functioning of adults with attention deficit hyperactivity disorder

Background: Adults with attention deficit hyperactivity disorder (ADHD) frequently suffer from sleep problems and report high levels of daytime sleepiness compared to neurotypical controls, which has detrimental effect on quality of life. Methods: We evaluated daytime sleepiness in adults with ADHD compared to neurotypical controls using an observer-rated sleepiness protocol during the Sustained Attention Response Task as well as electroencephalogram (EEG) slowing, a quantitative electroencephalographic measure collected during a short period of wakeful rest. Results: We found that adults with ADHD were significantly sleepier than neurotypical controls during the cognitive task and that this on-task sleepiness contributed to cognitive performance deficits usually attributed to symptoms of ADHD. EEG slowing predicted severity of ADHD symptoms and diagnostic status, and was also related to daytime sleepiness. Frontal EEG slowing as well as increased frontal delta were especially prominent in adults with ADHD. We have validated and adapted an objective observer-rated measure for assessing on-task sleepiness that will contribute to future sleep research in psychology and psychiatry. Conclusions: These findings indicate that the cognitive performance deficits routinely attributed to ADHD and often conceptualized as cognitive endophenotypes of ADHD are largely due to on-task sleepiness and not exclusively due to ADHD symptom severity. Daytime sleepiness plays a major role in cognitive functioning of adults with ADHD

Porencephaly and psychosis: a case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Malformations of the cerebral cortex are often associated with developmental delay and psychoses. Porencephaly is a rare congenital disorder of central nervous system involving a cyst or a cavity filled with cerebrospinal fluid, in brain's parenchyma.</p> <p>Case presentation</p> <p>We present a 25 years old woman with her first psychotic episode. She also suffers from porencephaly in the frontotemporal lobes region. It is emphasized that the two consistently abnormal brain regions in schizophrenia research had significant damage in this patient since birth. There is a total of only five cases of schizencephaly or porencephaly associated with psychosis in the scientific literature. Their clinical characteristics as well as the imaging results are described.</p> <p>Conclusion</p> <p>It is unclear if porencephaly and psychosis concur by chance or are causally related. The area where the porencephalic cysts appear seems to be of relevance. This case highlights the need for further research.</p

Extrapyramidal side effects and suicidal ideation under fluoxetine treatment: a case report

<p>Abstract</p> <p>Background</p> <p>We present the case of a 52-year-old woman with depression who developed extrapyramidal symptoms (mainly parkinsonism) and suicidal ideation while on fluoxetine.</p> <p>Methods</p> <p>The patient underwent neurological and neuroimaging examination.</p> <p>Results</p> <p>The patient's neurological and neuroimaging examinations were normal and there was no other cause of extrapyramidal symptoms. The patient showed remission of the aforementioned symptomatology when fluoxetine was discontinued.</p> <p>Conclusions</p> <p>This case shows that fluoxetine can be associated with extrapyramidal symptoms, and this may have an aggravating affect on clinical depression progress and the emergence of suicidal ideation.</p