This article focuses on a psychiatric morbidity in critical illness survivors, posttraumatic stress disorder (PTSD). We present a case in the second person, because it is helpful to imagine what ...being critically ill can be like from the perspective of a patient without medical training. One-fifth of critical illness survivors have clinically relevant PTSD symptoms in the year after intensive care, and markers of risk include prior psychiatric illness, benzodiazepine administration in the intensive care unit (ICU), and early post-ICU memories of frightening, nightmare-like experiences during intensive care. ICU diaries are a low-tech, low-cost interventions that can supplement psychiatric care.
This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder ...(OCD), to inform TTM classification.
We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders.
TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4).
TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
•Trichotillomania was classified as an impulse control disorder, is now classified as obsessive-compulsive disorder related•Characterizing the strength of comorbid relations is one of several approaches to classify psychiatric conditions•The current study investigates the strength of relationships between TTM and other DSM-IV Axis I conditions•TTM was most strongly associated with OCD and other conditions previously conceptualized as impulse control disorders•TTM could also classified as a condition involving impaired impulse control/appetitive behavior, or as a grooming disorder
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Critical illness survivors frequently have substantial psychiatric morbidity, including posttraumatic stress, depression, and anxiety symptoms. Prior psychiatric illness is a potent predictor of ...postcritical illness psychiatric morbidity. Early emotional distress and memories of frightening psychotic and nightmarish intensive care unit (ICU) experiences are risk factors for longer term psychiatric morbidity. ICU diaries may be effective in decreasing psychiatric morbidity after critical illness, though these and other interventions deserve further study.
Recent studies have shown an association between proactive psychiatric consultation on medical units and shorter length of stay. The aim of this study was to assess the impact of implementing a ...proactive psychiatric consult service on general medical units in an urban teaching hospital on length of stay and qualitative measurement of satisfaction of adequacy of psychiatric services.
Bivariate and multivariate analyses of demographic, clinical and outcome data were performed comparing patients seen by the proactive psychiatric consult team, patients seen contemporaneously on other general medical units by a traditional, reactive consult team and patients seen the prior year on the proactive intervention units by the reactive consult team. Length of stay was the primary outcome examined. Regression modeling was performed to assess further the relationship of length of stay with the three groups. Nursing and physician staff were queried before and after intervention regarding satisfaction with psychiatric resources on the intervention units.
Patients seen by the proactive team had shorter length of stay than those seen by contemporaneous reactive consult team (p = 0.005) or the prior year by the reactive team on the intervention units (p = 0.005). There was no significant difference between the latter two groups. Time to consult was also shorter for patients seen through the proactive model than the reactive model on other units at the same time (0.01) or the preceding year (<0.001). Nursing and physician satisfaction with psychiatric help increased significantly in three of four measures.
Proactive psychiatric consultation in our study correlated with shorter time to consult, shorter length of stay, and improved staff satisfaction compared to a reactive consult model.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background Lyme disease, a tick-borne illness transmitted to humans, has become increasingly recognized. Objective Given the myriad neurovegetative and neuropsychiatric symptoms that can be ...associated with Lyme disease, we sought to review the epidemiology, evaluation, and treatment of the disorder. Methods A case vignette that highlights manifestations of the condition and dilemmas associated with its treatment is presented. Conclusions Knowledge about its symptoms, its abnormal laboratory tests, and its course can help to guide the timely and appropriate management of this spirochetal infection.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Patients with medically unexplained symptoms often experience significant distress and impaired functioning; such symptoms may lead to a diagnosis of a somatic symptom and related disorder. ...Psychiatrists who work in oncology settings are likely to evaluate patients with somatic symptom and related disorders because these conditions are common. By contrast, conversion disorder often involves a loss or change in sensory or motor function that suggests a physical disorder, but lacks evidence of a medical or neurological condition. Those with factitious illness and malingering deliberately fabricate or feign symptoms to occupy the sick role (primary gain) or to obtain material reward (secondary gain), such as disability payments. Treatment includes ruling out medical emergencies, offering psychiatric assistance, setting clear boundaries, thoroughly documenting the assessment and treatment, and managing countertransference reactions elicited by the patient.
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