Clinical and Therapeutic Management of Acute Stress Disorder

Acute stress is an anxiety disorder due to an exposure to a traumatic or stressful event which implies a specific reaction. Clinical features are variable, depending on: type of personality, coping mechanisms, socioeconomic or professional factors, co-morbidities. Therapeutic management involves pharmacotherapy (antidepressants are the most common), psychotherapy or an association between both in selected cases. Keywords: acute stress, anxiety, pharmacotherapy, psychotherap

Is relatively young age within a school year a risk factor for mental health problems and poor school performance? A population-based cross-sectional study of adolescents in Oslo, Norway

BACKGROUND: Several studies have shown that children who are relatively young within a school year are at greater risk for poorer school performance compared with their older peers. One study also reported that relative age within a school year is an independent risk factor for emotional and behavioral problems. The objective of this study was to test the hypothesis that relatively younger adolescents in the multiethnic population of Oslo have poorer school performance and more mental health problems than their relatively older classmates within the same school year. METHODS: This population-based cross-sectional study included all 10(th)-grade pupils enrolled in 2000 and 2001 in the city of Oslo. The participation rate was 88%. Of the 6,752 pupils in the study sample, 25% had a non-Norwegian background. Mental health problems were quantified using the abbreviated versions of Symptom Check List-25 (SCL-10) and the Strength and Difficulties Questionnaire (SDQ). Information on school performances and mental health problems were self-reported. We controlled for confounding factors including parental educational level, social support, gender, and ethnicity. RESULTS: The youngest one-third of pupils had significantly lower average school grades than the middle one-third and oldest one-third of their classmates (p < 0.001). Of the mental health problems identified in the questionnaires, the groups differed only on peer problems; the youngest one-third reported significantly more problems than the middle and oldest groups (p < 0.05). Age within a school year and gender showed significant interactions with total SDQ score, SDQ peer problems score, SDQ pro social score, and SCL-10 score. After stratifying for gender, the peer problem scores differed significantly between age groups only among boys. The SCL-10 score was significant, but only in girls and in the opposite direction to that expected, with the oldest pupils having significantly higher scores than the other two groups (p < 0.05). CONCLUSION: In adolescents from a multicultural city in Norway, relative age within a school year significantly influenced academic performance. In contrast to data from Great Britain, relative age within a school year was not an important risk factor for mental health problems in adolescents in Oslo

A Systematic Review of the Prevalence of Schizophrenia

BACKGROUND: Understanding the prevalence of schizophrenia has important implications for both health service planning and risk factor epidemiology. The aims of this review are to systematically identify and collate studies describing the prevalence of schizophrenia, to summarize the findings of these studies, and to explore selected factors that may influence prevalence estimates. METHODS AND FINDINGS: Studies with original data related to the prevalence of schizophrenia (published 1965–2002) were identified via searching electronic databases, reviewing citations, and writing to authors. These studies were divided into “core” studies, “migrant” studies, and studies based on “other special groups.” Between- and within-study filters were applied in order to identify discrete prevalence estimates. Cumulative plots of prevalence estimates were made and the distributions described when the underlying estimates were sorted according to prevalence type (point, period, lifetime, and lifetime morbid risk). Based on combined prevalence estimates, the influence of selected key variables was examined (sex, urbanicity, migrant status, country economic index, and study quality). A total of 1,721 prevalence estimates from 188 studies were identified. These estimates were drawn from 46 countries, and were based on an estimated 154,140 potentially overlapping prevalent cases. We identified 132 core studies, 15 migrant studies, and 41 studies based on other special groups. The median values per 1,000 persons (10%–90% quantiles) for the distributions for point, period, lifetime, and lifetime morbid risk were 4.6 (1.9–10.0), 3.3 (1.3–8.2), 4.0 (1.6–12.1), and 7.2 (3.1–27.1), respectively. Based on combined prevalence estimates, we found no significant difference (a) between males and females, or (b) between urban, rural, and mixed sites. The prevalence of schizophrenia in migrants was higher compared to native-born individuals: the migrant-to-native-born ratio median (10%–90% quantile) was 1.8 (0.9–6.4). When sites were grouped by economic status, prevalence estimates from “least developed” countries were significantly lower than those from both “emerging” and “developed” sites (p = 0.04). Studies that scored higher on a quality score had significantly higher prevalence estimates (p = 0.02). CONCLUSIONS: There is a wealth of data about the prevalence of schizophrenia. These gradients, and the variability found in prevalence estimate distributions, can provide direction for future hypothesis-driven research

A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology

BACKGROUND: Understanding variations in the incidence of schizophrenia is a crucial step in unravelling the aetiology of this group of disorders. The aims of this review are to systematically identify studies related to the incidence of schizophrenia, to describe the key features of these studies, and to explore the distribution of rates derived from these studies. METHODS: Studies with original data related to the incidence of schizophrenia (published 1965–2001) were identified via searching electronic databases, reviewing citations and writing to authors. These studies were divided into core studies, migrant studies, cohort studies and studies based on Other Special Groups. Between- and within-study filters were applied in order to identify discrete rates. Cumulative plots of these rates were made and these distributions were compared when the underlying rates were sorted according to sex, urbanicity, migrant status and various methodological features. RESULTS: We identified 100 core studies, 24 migrant studies, 23 cohort studies and 14 studies based on Other Special Groups. These studies, which were drawn from 33 countries, generated a total of 1,458 rates. Based on discrete core data for persons (55 studies and 170 rates), the distribution of rates was asymmetric and had a median value (10%–90% quantile) of 15.2 (7.7–43.0) per 100,000. The distribution of rates was significantly higher in males compared to females; the male/female rate ratio median (10%–90% quantile) was 1.40 (0.9–2.4). Those studies conducted in urban versus mixed urban-rural catchment areas generated significantly higher rate distributions. The distribution of rates in migrants was significantly higher compared to native-born; the migrant/native-born rate ratio median (10%–90% quantile) was 4.6 (1.0–12.8). Apart from the finding that older studies reported higher rates, other study features were not associated with significantly different rate distributions (e.g. overall quality, methods related to case finding, diagnostic confirmation and criteria, the use of age-standardization and age range). CONCLUSIONS: There is a wealth of data available on the incidence of schizophrenia. The width and skew of the rate distribution, and the significant impact of sex, urbanicity and migrant status on these distributions, indicate substantial variations in the incidence of schizophrenia

EVALUAREA CLINICĂ ŞI STRATEGII TERAPEUTICE UTILE IN COMPORTAMENTUL VIOLENT

Aggressive behavior represents a symptom, a clinical predominant syndrome and in many cases it may be associated with psychomotor agitation. In the clinical assessment of violent behavior, particular attention will be paid to matters affecting the patient's past or present situation, such as aggressive ideas, plans and acts of violence careless driving, acts of vandalism, family history of violence. In order to administer therapy in aggressive or violent cases, infringement and seclusion techniques are sometimes necessary. Keywords: aggressive behavior, violence risk, pharmacological managementComportamentul agresiv reprezintă un sindrom predominant clinic, un simptom care se poate asocia cu agitaţie psihomotorie. &Icirc;n evaluarea clinică a comportamentului violent se acordă o atenţie deosebită factorilor care afectează situaţia actuală sau istoricul anterior, precum ideile agresive, planurile, actele de violenţă, actele de vandalism, istoricul familial de violenţă. Administrarea terapiei &icirc;n cazurile violente sau agresive necesită uneori contenţie.&nbsp;Cuvinte cheie: comportament agresiv, risc de violenta, management farmacologi

NOUTATI ASUPRA MANAGEMENTULUI TERAPEUTIC AL TULBURARII OBSESIV COMPULSIVE

The purpose of this article is to inform the reader on an evidence based medical treatment algorithm in order to be used in patients with obsessive-compulsive disorder (OCD). Relevant studies were identified through a comprehensive review and were classified according to the type of patients being investigated, the quality of the study design and function of invasiveness, availability and complexity of therapeutic approach. When ineffective first-line therapeutic trials (such as selective serotonin reuptake inhibitors [SSRIs] and venlafaxină) or the cognitive-behavioral therapy, they should be followed by other therapeutic approaches, such as clomipramine, adding antipsychotics or pindolol, or the use of high doses of SSRIs. These therapeutic strategies should be useful for most patients with OCD. Additional approaches include intravenous clomipramine, oral morphine, " heroic drug strategies" deep brain stimulation and functional neurosurgery. Independent studies are urgently needed to help identify the most promising therapeutic sequences for treatment of OCD.Scopul acestui articol este de a informa cititorul asupra unui algoritm terapeutic medicamentos bazat pe evidente, in scopul de a fi utilizat la pacientii cu tulburare obsesiv-compulsiva (TOC). Studiile relevante au fost identificate printr-o revizuire cuprinzatoare si au fost clasificate in functie de tipul de pacienti cercetati, de calitatea design-ului studiului si in functie de invazivitatea, disponibilitatea si complexitatea abordarii terapeutice. Atunci cand sunt ineficiente, incercarile terapeutice de prima linie (cum ar fi inhibitorii selectivi ai recaptarii serotoninei [SSRI] si venlafaxina) sau terapia cognitiv-comportamentala ar trebui sa fie urmate de alte abordari terapeutice, precum: clomipramina, adaugarea de antipsihotice sau pindolol, sau folosirea unor doze crescute de SSRI. Aceste strategii terapeutice ar trebui sa fie de folos majoritatii pacientilor cu TOC. Abordari suplimentare includ: clomipramina intravenos, morfina pe cale orala, "strategii medicamentoase eroice", stimularea profunda a creierului si neurochirurgia functionala. Studii independente sunt urgent necesare pentru a ajuta la identificarea celor mai promitatoare secvente terapeutice pentru tratamentul TOC

TULBURĂRILE DE SOMN ÎN PATOLOGIA PSIHIATRICĂ

  A healthy sleep is needed to restore the daily vitality, to consolidate the memory, to support the immunity and thus to ensure a proper functioning of the body and mind. Untreated, sleep disorders increase the risk of cardiac disorders, may contribute to memory impairment and depression. Sleep disorders in psychiatric pathology exist as an independent nosological entity but have also an interactive relationship of comorbidity with other psychiatric pathologies. The knowledge of this interactive relationship can increase the consistency and the uniformity of the sleep disorders approach among mental health professionals.   Key words: sleep disorders, comorbidity  Un somn sănătos este necesar pentru restaurarea vitalității zilnice, pentru a consolida memoria, pentru a susține imunitatea și a asigura, astfel, o bună funcționare. Netratate, tulburările de somn cresc riscul afecțiunilor cardiace, pot contribui la tulburări de memorie, depresie. Tulburările de somn există &icirc;n patologia psihiatrică ca entitate nosologică de sine stătătoare, dar și &icirc;ntr-o relație interactivă și bidirecțională de comorbiditate cu alte patologii psihiatrice. Scopul cunoașterii acestei relații interactive este creșterea consistenței și uniformității abordării tulburărilor de somn printre profesioniștii sănătății mintale. &nbsp; Cuvinte cheie: tulburări de somn, comorbiditate &nbsp

CONSIDERAŢII TEORETICE ASUPRA REACŢIILOR DE ADAPTARE ÎN PSIHIATRIA DE DEZASTRU

Understanding disaster psychiatry involved changing several paradigms: • The first major change involves the focus of care on those that have not yet changes of illness• In disaster situations, the diagnosis of a mental disorder arises carefully after preliminary examination.• In the acute phase psychiatrist has a duty to make psycho-education and encourage natural recovery, spontaneous rather than treat.• In terms of disaster, the physician should treat the person on site.Studies of psychiatric disorders resulting from disasters belong to a broader range of research on stress. Developed theories propose the following model: external needs (represented by the traumatic event that is the primary stressor) require a response that is based on internal or external resources. Loss or reduction of these resources, either specific (social, financial) or symbolic (beliefs, expectations) are considered as secondary stressors and can have severe impact on recovery. The incidence of PTSD and functional impairment in the general population following a disaster is significantly lower than that evidenced in the directly exposed population.CONCLUSION. Disaster psychiatry, a newer but very important branch of psychiatry has a decisive role in prevention, response and psychic recovery of people in a disaster case. It is a new way of working in psychiatry, often held to the spot of a traumatic event and which requires multiple approaches - short and long term approaches, in order to eliminate any negative consequences on the human psychicKeywords: Disaster psychiatry, stress, posttraumatic stress disorder (PTSD)&Icirc;nţelegerea psihiatriei de dezastru a implicat schimbarea mai multor paradigme:&bull;Prima schimbare majoră implică concentrarea atenţiei pe &icirc;ngrijirea celor la care nu s-au produs &icirc;ncă modificările de boală&bull;&Icirc;n situaţiile unui dezastru, diagnosticul unei tulburari psihice se pune cu mare atenţie, după examinări prealabile.&bull;&Icirc;n faza acută psihiatrul are datoria să facă psihoeducatie şi să favorizeze recuperarea naturală, spontană mai degrabă dec&acirc;t să trateze.&bull;&Icirc;n condiţiile unui dezastru, medicul trebuie să trateze persoana la locul respectiv. Studiile efectuate asupra tulburărilor psihiatrice apărute &icirc;n urma unor dezastre, aparţin unei sfere mai largi a cercetării asupra stresului. Teoriile elaborate propun următorul model: nevoile externe (reprezentate de evenimentul traumatic ce constutuie factorul de stres primar) impun un răspuns care se bazează pe resurse interne sau externe. Pierderea sau diminuarea acestor resurse, fie concrete (sociale, financiare), fie simbolice (credinţe, aşteptări), se constituie drept factori de stres secundari şi pot avea impact sever asupra recuperării Incidenţa tulburărilor de stres posttraumatic şi a deteriorărilor funcţionale la nivelul populaţiei generale &icirc;n urma unui dezastru este semnificativ mai mică dec&acirc;t cea evidenţiată &icirc;n r&acirc;ndul populaţiei expuse &icirc;n mod direct.CONCLUZIE. Psihiatria de dezastru, ramură mai nouă dar foarte importantă a pshiatriei are un rol determinant &icirc;n prevenirea, răspunsul şi recuperarea psihică a persoanelor &icirc;n cazul unui dezastru. Constituie un nou mod de lucru &icirc;n cadrul psihiatriei , desfăşurat de multe ori la faţa locului unui eveniment traumatizanti care presupune mai multe abordări &ndash; pe termen scurt şi pe termen lung pentru eliminarea tuturor consecinţelor negative asupra psihicului uman.Cuvinte cheie : psihiatrie de dezastru, stress, tulburare de stress posttraumati

Managementul terapeutic al sindromului catatonic

Catatonic states occur in the context of a wide variety of both psychiatric and medical conditions. Since 1992 benzodiazepines represent a first-line treatment in catatonia, because they offer several advantages: a wide margin of safety, a rapid response, and they are easily administered. Other treatments include atypical antipsychotics, antiglutamatergic drugs, lithium. Lorazepam and other GABA-A promoters (benzodiazepines, zolpidem) increase GABA activity as their mechanism of action.Starile catatonice apar în diverse afectiuni psihiatrice sau medicale. Benzodiazepinele reprezinta prima linie de tratament în catatonie din începând 1992, datorita unei serii de avantaje: profil de siguranta bun, raspuns rapid, usor de administrat. Alte tipuri de tratatment includ antipsihotice atipice, agenti antiglutaminergici, litiu, Lorazepam si alti stimulanti GABA-A (benzodiazepine, zolpidem) actioneaza prin cresterea activitatii GABA ergice

Considerații asupra eficacității terapiei cu valdoxan în tulburările depresive și anxioase

Anxiety and depression are some of the most common psychiatric comorbidities, and at the same time the psychiatric disorders with the highest prevalence in the general population (between 30 % and 50 % of adults diagnosed with major depressive disorder associate an anxiety disorder spectrum, and about 50 % of patients diagnosed with an anxiety disorder also meet the diagnostic criteria for depressive disorder ).Only a few therapeutic strategies address both the anxiety and depressive disorders and the existing ones are far from being satisfactory due to the latency of onset of action, poor tolerability and the potential for addiction phenomena.Although part of the latest psychotropic class, Agomelatine has demonstrated efficacy on depressive symptoms and associated sleep disorders.Increasingly numerous recent studies demonstrate  the anxiolytic effect of Agomelatine, both on depressive disorders associated with anxiety disorders and on anxiety symptoms ( generalized anxiety disorder). Keywords:Valdoxan, depressive, anxiety disordersAnxietatea și depresia reprezintă unele dintre cele mai frecvente comorbidități psihiatrice și &icirc;n același timp tulburările psihiatrice cu prevalența cea mai mare &icirc;n populația generală (&icirc;ntre 30% și 50% dintre adulții diagnosticați cu tulburare depresivă majoră asociază și o tulburare din spectrul anxietății și aproximativ 50% din pacienții diagnosticați cu o tulburare anxioasă &icirc;ntrunesc și criteriile de diagnostic pentru tulburarea depresivă).Doar c&acirc;teva strategii terapeutice se adresează at&acirc;t tulburărilor depresive, c&acirc;t și celor anxioase, iar cele existente sunt departe de a fi satisfăcătoare din cauza latenței debutului acțiunii, tolerabilității deficitare și posibilității de apariție a fenomenelor de dependență.Deși făc&acirc;nd parte din clasa celor mai noi psihotrope, agomelatina și-a demonstrat deja eficacitatea asupra simptomatologiei depresive ;i a tulburărilor de somn asociate.Studii recente din ce &icirc;n ce mai numeroase demonstrează, &icirc;nsă, și efectul anxiolitic al agomelatinei at&acirc;t &icirc;n tulburările depresive asociate cu simptome anxioase, c&acirc;t și &icirc;n tulburări anxioase (tulburarea de anxietate generalizată).&nbsp;Cuvinte cheie: Valdoxan, depresie, anxietat