Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo

<p>Abstract</p> <p>Background</p> <p>Patients admitted to a psychiatric hospital with suicidal behavior (SB) are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan.</p> <p>Method</p> <p>155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II) and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined.</p> <p>Results</p> <p>The common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD). SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range) of the total number of SBs in the lifetime history was 7 (1-141). Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified.</p> <p>Conclusions</p> <p>Features of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission and frequent SB repetition in the lifetime history. Gender and age appeared to have an influence on SB method selection and SB-preceding processes. The findings have important implications for assessment and treatment of psychiatric suicidal patients.</p

Public Health Reports ; v. 76, no. 12, December 1961 : cover

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Depressive symptomatology among university students in Denizli, Turkey: prevalence and sociodemographic correlates.

AIM: To determine overall and subgroup prevalence of depressive symptomatology among university students in Denizli, Turkey during the 1999-2000 academic year, and to investigate whether sociodemographic factors were associated with depressive symptoms in university students. METHODS: A stratified probability sample of 504 Turkish university students (296 male, 208 female) was used in a cross-sectional study. Data were obtained by self-administered questionnaire, including questions on sociodemographic characteristics and problem areas. The revised Beck Depression Inventory (BDI) was used to determine depressive symptoms of the participants. BDI scores 17 or higher were categorized as depressive for logistic regression analysis. Student t-test and linear regression were used for continuous data analysis. RESULTS: Out of all participants, 26.2% had a BDI score 17 or higher. The prevalence of depressive symptoms increased to 32.1% among older students, 34.7% among students with low socioeconomic status, 31.2% among seniors, and 62.9% among students with poor school performance. The odds ratio of depressive symptoms was 1.84 (95% confidence interval [CI], 1.03-3.28) in students with low socioeconomic status and 7.34 (95% CI, 3.36-16.1) in students with poor school performance in the multivariate logistic model. The participants identified several problem areas: lack of social activities and shortage of facilities on the campus (69.0%), poor quality of the educational system (54.8%), economic problems (49.3%), disappointment with the university (43.2%), and friendship problems (25.9%). CONCLUSIONS: Considering the high frequency of depressive symptoms among Turkish university students, a student counseling service offering mental health assistance is necessary. This service should especially find the way to reach out to poor students and students with poor school performance

Attention Deficit Hyperactivity Disorder

Objective: Attention deficit hyperactivity disorder (ADHD) and bipolar disorder are frequently comorbid diagnoses. Aim of this study was to compare the neurological soft signs in patients with bipolar disorder and in patients with comorbid ADHD to those in control subjects. This study helps us to understand the impact of ADHD on the soft neurological signs in bipolar disorder in adults.Methods: Sixty euthymic patients diagnosed with bipolar I disorder and 33 healthy control subjects were enrolled in the study. The Wender Utah Rating Scale, Adult ADHD Rating Scale and The Structured Clinical Interview for DSM-IV Disorders were administered to the participants. The subjects were classified into three study groups, namely, bipolar patients with comorbid ADHD (n=13), bipolar patients without comorbid ADHD (n=47) and controls. We performed the Neurological Evaluation Scale in the three groups.Results: Comorbid ADHD group showed poor performance on complex motor tasks such as fist-ring test and fist-edge-palm test, while bipolar group showed poor performance on Ozeretski test. Comorbid ADHD patients performed poorly on graphestesia, stereognosis and primitive reflexes.Conclusion: Abnormalities of repetitive motor performance and primitive reflexes observed in comorbid ADHD patients support the hypothesis that ADHD involves a deficit in fronto-striatal-thalamic neurocircuits. In contrast, impaired sequential motor performance in BP subjects shows deficits in dorsolateral prefrontal cortex. These results show that the pathophysiology of bipolar disorder and ADHD may be related to different areas, and comorbid ADHD may increase the severity of the soft neurological signs. (Archives of Neuropsychiatry 2011; 48: 107-13

Mega-dose lorazepam addiction and withdrawal symptoms

The fact that health policies in developing countries make it easier to access drugs (controlled substances), might result in addiction and dependence problems despite initial treatment purposes for drug intake. Benzodiazepines are drugs that have been widely prescribed and have been classified as controlled drugs. In this clinical case report, a patient is described who began to use lorazepam, developed tolerance and dependence to mega-dose of drug because of easy access to drug. The patient has used lorazepam approximately for six months as he gradually increased dose up to 220 mg/day. His efforts to drop the drug was unsuccessful and subsequently he applied to emergency service because of disturbing withdrawal symptoms. He showed initial withdrawal symptoms of severe restlessness, hyperpnea, sweating, headache, anxiety, and irritability which were succesfully controlled in the second day. Seizure or any other life threatening adverse effect were not observed during treatment. The health policies in developing countries should be arranged strictly to control availability and access to controlled drugs even by prescribed patients in order to avoid development of addiction in such cases

Update on HPV vaccination coverage in the US

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I disorder: a preliminary study

Objective: Attention-deficit hyperactivity disorder (ADHD) is a disorder that typically first appears in childhood and has the main symptoms of inattention, overactivity, and impulsivity. Attention-deficit hyperactivity disorder and bipolar disorder are frequently comorbid and overlapping diagnoses. Although there is data describing the overlap of ADHD and bipolar disorder in childhood and youth, little is known about the comorbidity of these disorders in adulthood. In this study, our aim was to investigate comorbidity of attention deficit hyperactivity disorder in bipolar disorder and to compare several socio-demographic and clinical variables of bipolar patients with and without comorbid ADHD.Method: Sixty patients diagnosed with euthymic bipolar I disorder were enrolled in the study. Patients with bipolar disorder were observed in the outpatient setting during at least two months to ensure the existence of euthymia before the study procedures were conducted. Socio-demographic data form, Hamilton Depression, Young Mania, Wender Utah and Adult ADHD Rating Scales, and the Structured Clinical Interview for DSM-IV were applied to the participants. Socio-demographic data included variables such as age, gender, educational status, episode number, and the type of present treatment. Between group comparisons were made by using Mann-Whitney U test and Chi-square test.Results: The comorbidity rate of ADHD in our study sample with bipolar I disorder was 21.7%. There were no significant differences between with and without comorbid ADHD groups in terms of their age, gender, and educational level. Comorbid ADHD patients were smoking more cigarettes than those without comorbid ADHD. In addition, the number of their total episodes and manic episodes were relatively higher in the comorbid ADHD group.Conclusions: The results suggest that ADHD is a common comorbidity in adult bipolar patients. The existence of high rates of comorbidity leads to important diagnostic and therapeutic complications. Further study is needed to clarify the impact of ADHD on clinical outcomes of adult bipolar patients and to provide guidelines for therapeutic approaches

efficiencies in patients with schizophrenia and schizoaffective disorder

Schizophrenia and schizoaffective disorder are chronic and debilitating psychiatric disorders. The present study was designed to determine DNA damage in patients with schizophrenia and schizoaffective disorder to assess the roles of oxidative metabolism and DNA repair mechanisms in this process, to assess the contribution of drugs, and thus to demonstrate the differences between schizophrenia and schizoaffective disorder. Thirty schizophrenia and 30 schizoaffective disorder patients, each having at least five years of disease history, aged between 18 and 60 years with no physical or neurological diseases, and 30 healthy volunteers participated in the study. Psychometric scales were applied, and 5 ml of blood was taken from all participants. The DNA damage was measured in lymphocytes by the comet assay method; the total oxidative parameters by ELISA; OGG1 and NEIL1 gene expressions by real-time PCR: and the role of drugs by in vitro assays. The most important finding in this study was that patients with schizophrenia had significantly greater DNA damage than schizoaffective disorder patients and the controls. This study also provides evidence of high oxidative stress statuses and inadequate DNA repair capacities in patients with schizophrenia. Moreover, psychotropic drugs did not induce any DNA damage to the lymphocytes according to in vitro analyses. The use of clozapine and adequate repair processes of the patients were the decisive factors in the prevention of DNA damage. The results of this study provide a reexamination of schizoaffective disorder within the schizophrenia spectrum and indicate that schizoaffective disorder may be considered a different diagnostic category. (C) 2018 Elsevier B.V. All rights reserved

Shift Work and Women

Background: Shift workers face many physical, mental and social problems due to the disruption in the synchronization of their circadian rhythms, unusual working hours, exemption from social life as well as the negative impacts of such work. The purpose of the present study was to assess the different impacts of shift work on sleep, mental and social status among female textile workers in Denizli, Turkey.Methods: The study was carried out in 2012 at two different textile factories in Denizli-Turkey. A total of 799 workers took part in the study: 661 were shift workers and 138 were non-shift workers. Daytime sleepiness and quality of sleep were evaluated respectively via the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Polysomnographic examinations and psychiatric interviews were conducted on seven shift workers and 11 non-shift workers who exhibited daytime sleepiness.Results: The prevalence of daytime sleepiness was 20% and the rate of poor sleep quality was 61.5% among non-shift workers, while the rates were 15.4% and 83.5%, respectively among shift workers. It was observed that working shifts does not have an impact on daytime sleepiness, but is related to a 4.92-fold risk of poor sleep quality. In addition, risk of daytime sleepiness was 3.41 times higher in the presence of a mentally/physically disabled person in the family, 3.36 times higher if the person has an extra job, 3.15 times higher if the person suffered/suffers from a previous/current psychiatric disorder, and 1.17 times higher if the daily house work load of the individual is high.Conclusions: Working shifts disturbs sleep quality independent of many factors known to effect sleep. A history of previous or present psychiatric disorders increases the risk of daytime sleepiness.C1 [Ugurlu, Tugce Toker; Ozdel, Osman] Pamukkale Univ, Fac Med, Dept Psychiat, Denizli, Turkey.[Ugurlu, Erhan; Dursunoglu, Nese] Pamukkale Univ, Fac Med, Dept Pulmonol, Denizli, Turkey

An evaluation of the differences in DNA damage in lymphocytes and repair efficiencies in patients with schizophrenia and schizoaffective disorder.

Schizophrenia and schizoaffective disorder are chronic and debilitating psychiatric disorders. The present study was designed to determine DNA damage in patients with schizophrenia and schizoaffective disorder to assess the roles of oxidative metabolism and DNA repair mechanisms in this process, to assess the contribution of drugs, and thus to demonstrate the differences between schizophrenia and schizoaffective disorder. Thirty schizophrenia and 30 schizoaffective disorder patients, each having at least five years of disease history, aged between 18 and 60 years with no physical or neurological diseases, and 30 healthy volunteers participated in the study. Psychometric scales were applied, and 5 ml of blood was taken from all participants. The DNA damage was measured in lymphocytes by the comet assay method; the total oxidative parameters by ELISA; OGG1 and NEIL1 gene expressions by real-time PCR; and the role of drugs by in vitro assays. The most important finding in this study was that patients with schizophrenia had significantly greater DNA damage than schizoaffective disorder patients and the controls. This study also provides evidence of high oxidative stress statuses and inadequate DNA repair capacities in patients with schizophrenia. Moreover, psychotropic drugs did not induce any DNA damage to the lymphocytes according to in vitro analyses. The use of clozapine and adequate repair processes of the patients were the decisive factors in the prevention of DNA damage. The results of this study provide a reexamination of schizoaffective disorder within the schizophrenia spectrum and indicate that schizoaffective disorder may be considered a different diagnostic category