The multifactorial origin of violent behaviors generates the need to use prediction tools adapted to different contexts, patient profiles and types of aggression. The main objective of this work was ...to design an instrument to detect the risk of violence and aggression quickly and effectively in patients with mental disorder in psychiatric intensive care units.
The sample consisted of 722 admissions of 629 patients from the psychiatric intensive care units. Violent incidents were recorded using the Overt Aggression Scale (OAS). A new scale has been designed and its psychometric properties have been evaluated.
The Scale for the Evaluation of Risk of Aggressiveness (ERA) includes static and dynamic risk factors, has an AUC=0.854, a sensitivity of 82%, a specificity of 73%, a positive predictive value of 62% and a negative predictive value of 88% when the cut-off point of ¾ is used to determine the risk of violent or aggressive behavior.
The ERA has proven to be a valid and reliable instrument to forecast the risk of aggressiveness in patients admitted to an acute care unit of psychiatry. It also allows monitoring and updating this risk during the patient's stay in the psychiatric intensive care unit.
A positron emission tomography (PET) study has suggested that dopamine transporter density of the caudate/putamen is reduced in methamphetamine users. The authors measured nucleus accumbens and ...prefrontal cortex density, in addition to caudate/putamen density, in methamphetamine users and assessed the relation of these measures to the subjects' clinical characteristics.
PET and 2-beta-carbomethoxy-3beta-(4-(11)C fluorophenyl)tropane, a dopamine transporter ligand, were used to measure dopamine transporter density in 11 male methamphetamine users and nine male comparison subjects who did not use methamphetamine. Psychiatric symptoms in methamphetamine users were evaluated by using the Brief Psychiatric Rating Scale and applying a craving score.
The dopamine transporter density in all three of the regions observed was significantly lower in the methamphetamine users than the comparison subjects. The severity of psychiatric symptoms was significantly correlated with the duration of methamphetamine use. The dopamine transporter reduction in the caudate/putamen and nucleus accumbens was significantly associated with the duration of methamphetamine use and closely related to the severity of persistent psychiatric symptoms.
These findings suggest that longer use of methamphetamine may cause more severe psychiatric symptoms and greater reduction of dopamine transporter density in the brain. They also show that the dopamine transporter reduction may be long-lasting, even if methamphetamine use ceases. Further, persistent psychiatric symptoms in methamphetamine users, including psychotic symptoms, may be attributable to the reduction of dopamine transporter density.
Driving under the influence of cannabis (DUIC) has become a growing concern. Studies investigating the impact of DUIC on traffic safety have shown evidence that, during the acute period of cannabis ...intoxication, cannabis diminishes driving faculties and is associated with an elevated risk of collision. However, DUIC drivers seem to exhibit a general reckless driving style that may contribute to an over-estimation of DUIC-related collisions among this group. In this study, we investigated DUIC drivers with respect to self-reported dangerous driving habits (e.g., risky driving, aggressive driving and negative emotional driving), behaviours observed in a driving simulator, psychological predictors and crash involvement. Results suggest that DUIC is associated with self-reported and observed risky driving and negative emotional driving. We also found that sensation seeking and impulsivity are independent psychological predictors of DUIC. Finally, a trend suggests that self-reported DUIC is associated with an increased risk of being involved in a car accident, after controlling for dangerous driving and demographic variables. Implications for interventions are discussed.
In order to optimize the treatment in wards for patients with dementia, we investigated predictors of the length of stay in the ward for patients with dementia. A prospective analysis of 72 patients ...with dementia was conducted in two wards for patients with dementia. Severity of dementia was assessed by the Clinical Dementia Rating, basic activities of daily living were evaluated using the Physical Self-Maintenance Scale, and severity of behavioral and psychological symptoms of dementia and caregiver distress were determined with the Nursing Home version of the Neuropsychiatric Inventory. Stepwise regression analysis was used to identify predictors of the length of stay. Fewer patients were discharged to home compared to those discharged to institutions or transferred to a different hospital or ward. The mean length of stay was 92.0 days. Clinical Dementia Rating and total distress scale score on the Nursing Home version of the Neuropsychiatric Inventory were significant independent predictors of the length of stay. The total Nursing Home version of the Neuropsychiatric Inventory score and total distress scale score on the Nursing Home version of the Neuropsychiatric Inventory were significantly improved through treatment. Our results suggest that treatment in the wards for patients with dementia is effective for improvement of behavioral and psychological symptoms of dementia. However, some patients could not be discharged to their home despite improvement of behavioral and psychological symptoms of dementia, and this may be related to caregiver burden at admission.
Recovery is understood as living a life with hope, purpose, autonomy, productivity, and community engagement despite a mental illness. The aim of this study was to provide further information on the ...psychometric properties of the Person-in-Recovery and Provider versions of the Revised Recovery Self-Assessment (RSA-R), a widely used measure of recovery orientation. Data from 654 individuals were analyzed, 519 of whom were treatment providers (63.6% female), while 135 were inpatients (10.4% female) of a Canadian tertiary-level psychiatric hospital. Confirmatory and exploratory techniques were used to investigate the factor structure of both versions of the instrument. Results of the confirmatory factor analyses showed that none of the four theoretically plausible models fit the data well. Principal component analyses could not replicate the structure obtained by the scale developers either and instead resulted in a five-component solution for the Provider and a four-component solution for the Person-in-Recovery version. When considering the results of a parallel analysis, the number of components to retain dropped to two for the Provider version and one for the Person-in-Recovery version. We can conclude that the RSA-R requires further revision to become a psychometrically sound instrument for assessing recovery-oriented practices in an inpatient mental health-care setting.
Rationale
Ketamine induces effects resembling both positive and negative psychotic symptoms of schizophrenia. These are thought to arise through its action as an uncompetitive antagonist of the
N
...-methyl-
D
-aspartate (NMDA) receptor.
Objectives
We used
123
ICNS-1261 to study ketamine binding to NMDA receptors in healthy human controls in vivo and its relationship to positive and negative psychotic symptom induction.
Materials and methods
Ten healthy controls underwent two single-photon emission tomography scans with
123
ICNS-1261. On each occasion, they received a bolus infusion of either ketamine or saline. The Brief Psychiatric Rating Scale (BPRS) was administered at the end of each scan. Predefined regions of interest were used to estimate change in volume of distribution of
123
ICNS-1261 following ketamine administration. Two normalised-to-cortex binding indices were also used in order to study effects of ketamine on NMDA receptor availability by region, after correction for global and nonspecific effects.
Results
Ketamine-induced reduction in
123
ICNS-1261 volume of distribution in all regions showed the strongest correlation with BPRS negative subscale (
p
< 0.01). With the normalised-to-cortex measures, NMDA receptor binding in middle inferior frontal cortex showed a significant correlation with BPRS negative subscale (BI1
r
= 0.88, BI2
r
= 95.9,
p
< 0.001).
Conclusions
123
ICNS-1261 binding was modulated by ketamine, a drug known to compete for the same site on the NMDA receptor in vitro. Ketamine may induce negative symptoms through direct inhibition of the NMDA receptor, and positive symptoms may arise through a different neurochemical pathway.
There is evidence that psychiatric patients with psychotic or manic disorders who are incarcerated suffer from the same symptoms as psychiatric patients who are treated in the community. There are ...also indications that their symptoms might be more severe. The aim of this study was to examine the severity of psychotic and manic symptoms, as well as to collect information about the emotional functioning of patients admitted to a prison psychiatric ward. Incarcerated patients with a diagnosis of psychotic or a manic disorder were examined with the Brief Psychiatric Rating Scale–Expanded (BPRS-E). With the scores of 140 assessments, a symptom profile was created using the domains of the BPRS-E. This profile was compared with the clinical profile of three nonincarcerated patient groups described in literature with a diagnosis in the same spectrum. We found high scores on positive and manic psychotic symptoms and hostility, and low scores on guilt, depression, and negative symptoms. High scores on manic and psychotic symptoms are often accompanied by violent behavior. Low scores on guilt, depression, and negative symptoms could be indicative of externalizing coping skills. These characteristics could complicate treatment in the community and warrant further research along with clinical consideration.
Background: Hippocampal atrophy has been described in postmortem and magnetic resonance imaging studies of schizophrenia. The specificity of this finding to schizophrenia remains to be determined. ...The neuropathology of bipolar disorder is understudied, and temporal lobe structures have only recently been evaluated.
Methods: Twenty-four bipolar, 20 schizophrenic, and 18 normal comparison subjects were evaluated using magnetic resonance brain imaging. Image data were acquired using a three-dimensional spoiled GRASS sequence, and brain images were reformatted in three planes. Temporal lobe structures including the amygdala, hippocampus, parahippocampus, and total temporal lobe were measured to obtain volumes for each structure in the three subject groups. Severity of symptoms in both patient groups was assessed at the time the magnetic resonance images were obtained.
Results: Hippocampal volumes were significantly smaller in the schizophrenic group than in both bipolar and normal comparison subjects. Further, amygdala volumes were significantly larger in the bipolar group than in both schizophrenic and normal comparison subjects.
Conclusions: The results suggest differences in affected limbic structures in patients with schizophrenia and bipolar disorder. These specific neuroanatomic abnormalities may shed light on the underlying pathophysiology and presentation of the two disorders.
Reduced levels of membrane essential polyunsaturated fatty acids (EPUFAs), namely, arachidonic acid (AA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acids (DHAs), ...and their association with psychopathology have been consistently reported in both chronic-medicated schizophrenic patients as well as in never-medicated patients soon after the first episode of psychosis. Past supplementation studies with either ω-6 or ω-3 or both EPUFAs generally in chronic-medicated-older patients have reported varying degrees of therapeutic effects, and have suggested that supplementation with primarily ω-3 EPUFAs (EPA>DHA) may be preferable. We report the supplementation with a mixture of EPA/DHA (180:120 mg) and antioxidants (vitamin E/C, 400 IU:500 mg) orally morning and evening to schizophrenic patients (
N=33) for 4 months. The red blood cell (RBC) membrane fatty acid levels, plasma lipid peroxides and clinical measures were carried out by established procedures at pretreatment, posttreatment and after 4 months of postsupplementation period to determine the stability of treatment effects within patients. Levels of fatty acids and lipid peroxides were compared with their levels in normal controls (NC) (
N=45).
Posttreatment levels of RBC EPUFAs were significantly higher than pretreatment levels as well as levels in normal controls without any significant increase in plasma peroxides. Concomitantly, there was significant reduction in psychopathology based on reduction in individual total scores for brief psychiatric rating scale (BPRS) and positive and negative syndrome scale (PANSS), general psychopathology-PANSS and increase in Henrich's Quality of Life (QOL) Scale. The EPUFA levels returned to pretreatment levels after 4 months of supplementation washout. However, the clinical improvement was significantly retained. Future studies need be done in placebo-controlled trials and also with a comparison group supplemented with fatty acids alone in a larger number of patients, both chronic as well as never medicated, and for a longer duration of treatment while the dietary intake is monitored. This may establish the EPUFA supplementation a very effective treatment to improve the outcome for an extended period of time.
Abstract Hypercortisolaemia is a feature of many severe psychiatric illnesses and has been suggested to be both a causal and exacerbating factor of clinical symptoms and neurocognitive impairment. ...The adrenal steroid dehydroepiandrosterone (DHEA) has antiglucocorticoid properties that may have regulatory effects on glucocorticoid action in the brain. However, there is a paucity of data on these steroids and their ratio in schizophrenia and bipolar disorder. We therefore sought to assess cortisol and DHEA levels and the cortisol-DHEA ratio in patients with schizophrenia ( n = 20) and bipolar disorder ( n = 20), on stable medication for a minimum of 6 weeks, and healthy age- and sex-matched control subjects ( n = 20). Steroid levels were measured from plasma samples collected at 30 min intervals from 1:00 p.m. to 4:00 p.m. Cortisol levels were found to be significantly elevated in both patient groups compared with controls. DHEA levels were elevated in schizophrenic patients compared with bipolar patients and controls, but there was no evidence of a difference in the cortisol-DHEA ratio of the groups. These data suggest that afternoon hypercortisolaemia is evident in symptomatic bipolar and schizophrenic patients compared to controls. However, an elevation in DHEA levels may represent a specific endocrine marker in schizophrenia.
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