General Hospital Psychiatry - Articles in Press

Prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China - Corrected Proof

2010-03-11

Abstract: Objective: To determine the prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China.Method: A total of 513 patients were randomly selected from 1923 inpatients from three general hospitals and evaluated with a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I disorders by eight psychiatrists. Logistic regression was used to identify factors that were associated with depression.Results: The prevalence (95% confidence interval) of all current depressive disorders and major depressive disorder (MDD) was found to be 16.2% (13.0–19.4%) and 9.4% (6.8–11.9%), respectively. The correlates for depression include higher hospital class, divorce/being widowed/separation, low family income, chronic diseases, lack of medical insurance, dwelling in rural area, suffering from severe illness and multiple hospitalization history. None of the patients with current MDD were detected, treated or referred to psychiatric consultation.Conclusions: The prevalence of depression among inpatients of general hospitals in Wuhan, China, was high. None of the depressive patients were recognized or treated for depression, indicating a serious neglect of depression in general hospitals. Our studies suggest an urgent need to improve clinicians' ability to detect and treat depression.

Depressive symptoms in adolescence: the association with multiple health risk behaviors - Corrected Proof

2010-03-02

Abstract: Objective: Although multiple studies of adolescents have examined the association of depression with individual health risk behaviors such as obesity or smoking, this is one of the few studies that examined the association between depression and multiple risk behaviors.Methods: A brief mail questionnaire, which screened for age, gender, weight, height, sedentary behaviors, physical activity, perception of general health, functional impairment and depressive symptoms, was completed by a sample of 2291 youth (60.7% response rate) aged 13–17 enrolled in a health care plan. A subset of youth who screened positive on the two-item depression screen and a random sample of those screening negative were approached to participate in a telephone interview with more in-depth information obtained on smoking and at-risk behaviors associated with drug and alcohol use.Results: Youth screening positive for high levels of depressive symptoms compared to those with few or no depressive symptoms were significantly more likely to meet criteria for obesity, had a poorer perception of health, spent more time on the computer, got along less well with parents and friends, had more problems completing school work and were more likely to have experimented with smoking and a wide array of behaviors associated with drug and alcohol use.Conclusions: Because many adverse health behaviors that develop in adolescence continue into adulthood, the association of depressive symptoms with multiple risk behaviors and poor functioning suggest that early interventions are needed at an individual, school, community and primary care level.

Psychosis in a patient with Danon cardiomyopathy - Corrected Proof

2010-03-02

Danon disease is an X-linked cardioskeletal myopathy related to a primary deficiency in lysosome-associated membrane protein-2 (LAMP-2) . LAMP-2 is a glycosylated protein coating the inner side of the lysosomal membrane. It is suggested that LAMP-2 protects the membrane from the destructive enzymes contained within the lysosome . With a hemizygous mutation in this essential protein, lysosomes become autophagic and are deposited as vacuoles within various tissues, leading to systemic pathology .

Comorbidity between common mental disorders and chronic somatic diseases in primary care patients - Corrected Proof

2010-03-02

Abstract: Objective: To estimate the prevalence of the most common mental disorders in primary care patients with chronic somatic diseases based on physicians' diagnoses and compared with healthy probands.Method: A systematic sample of 7940 adult primary care patients was recruited by 1925 general practitioners (GPs) in a large cross-sectional national epidemiological study. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used as standardized instrument for the assessment of mental disorders. Medical diagnoses were provided by patient's GP.Results: The prevalence rate of mental disorder was significantly higher in patients with chronic somatic diseases (56.8%) compared with physically healthy subjects (48.9%; OR: 1.37). Prevalence of depressive and anxiety disorders is higher among individuals with neurological, oncological or liver disease. The differences are significant in all comparisons, with the exception of anxiety disorders in patients with musculoskeletal disorders. There is an increase in prevalence rates of mental disorders according to the number of somatic diseases.Conclusions: The study provides evidence of the comorbidity of common mental disorders and somatic diseases. We need a predominant focus on affective and anxiety disorders in primary care patients with chronic somatic diseases. Symptoms overlap makes it necessary to discriminate these differences more in detail in future studies.

Peritraumatic reactions and posttraumatic stress symptoms in school-aged children victims of road traffic accident - Corrected Proof

2010-03-02

Abstract: Objective: The purpose of this study is to investigate the power of self-reported peritraumatic distress and dissociation to predict the development of posttraumatic stress disorder (PTSD) symptoms in school-aged children.Methods: School-aged children aged 8 to 15 years admitted to an emergency department after a road traffic accident were enrolled (n=103). Participants were assessed with the child versions of the Peritraumatic Distress Inventory and the Peritraumatic Dissociative Experiences Questionnaire within 1 week. Posttraumatic stress disorder symptoms were then assessed at 5 weeks.Results: A significant association between peritraumatic variables and two measures of PTSD symptoms was demonstrated. However, in a multivariate analysis, peritraumatic distress was the only significant predictor of acute PTSD symptoms (β=.33, p<.05).Conclusions: As has been found in adults, peritraumatic distress is a robust predictor of who will develop PTSD symptoms among school-aged children.

Measuring improvement in depression in cancer patients: a 50% drop on the self-rated SCL-20 compared with a diagnostic interview - Corrected Proof

2010-02-25

Abstract: Objective: To determine the validity of a 50% drop in the 20-item Symptom Checklist Depression Scale (SCL-20) score against the “gold standard” of no longer meeting criteria for major depression as assessed using a diagnostic interview in an outpatient cancer population and also to examine the validity of other potential cut-offs (i.e., percentage drops).Materials and Methods: Secondary analysis of data from a randomized trial which compared collaborative care with usual care for cancer patients with major depression. A total of 194 trial participants who had both SCL-20 scores and depression diagnoses on the Structured Clinical Interview for DSM-IV at both baseline and at 12-week outcome formed the analyzed sample.Results: A 50% reduction in the SCL-20 score from baseline to 12 weeks correctly identified the patients who no longer met criteria for major depression in 153 (78.9%) of 194 (95% CI 73.1% to 84.6%) cases. Most of those misclassified had not achieved a 50% reduction in SCL-20 score despite no longer meeting criteria for major depression. Examination of the performance of percentage drops other than 50% on the SCL-20 using a receiver operating characteristics (ROC) curve and histogram of misclassification suggested that the 50% drop was best if both a low overall misclassification rate and the minimizing of false positives of improvement were required.Conclusions: A 50% reduction in the SCL-20 score performs well as a conservative measure of change in depression status in cancer patients.

Psychiatric morbidity following miscarriage in Hong Kong - Corrected Proof

Adrian kwan-ho Sham, Michael gar-chung Yiu, Winsom yau-bong Ho — 2010-02-22

Abstract: Objective: The aim of this study is to examine the pattern of psychiatric morbidity up to 3 months following miscarriage and to identify the risk factors of post-miscarriage depressive disorder among Chinese women in Hong Kong.Method: This is a longitudinal cohort study. Women were interviewed immediately after miscarriage to collect psychiatric and sociodemographic data. Three months later, 161 subjects (89%) were assessed by a 12-item General Health Questionnaire (GHQ-12) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) as screening and diagnostic instruments, respectively.Results: Three months after miscarriage, 10% of subjects suffered depressive disorder, 1.2% were diagnosed with anxiety disorder not otherwise specified, and another two subjects each suffered obsessive compulsive disorder (0.6%) and posttraumatic stress disorder (0.6%), respectively. Risk factors of post-miscarriage depression included younger age, history of infertility and past history of depression.Conclusions: Given the local annual figure of more than 7000 first-trimester miscarriages, about 900 local women suffer post-miscarriage psychiatric disorder each year. This finding may prompt general hospitals in Hong Kong to screen for post-miscarriage psychiatric disorders, particularly depression.

Risperidone induced stuttering - Corrected Proof

Devender Singh Yadav — 2010-02-22

Abstract: Stuttering as a side effect of antipsychotics is rare.There are a few case reports of antipsychotic-induced stuttering, namely, chlorpromazine, levomepromazine, trifluoperazine, fluphenazine, olanzapine and clozapine.Risperidone is commonly used as an atypical antipsychotic. It is licensed for both acute and chronic psychosis and mania. There is only one documented case report mentioned on risperidone induced stuttering. One case report of risperidone-induced stuttering is now described. Stuttering is a rare side effect and requires a high index of suspicion for diagnosis.Further study and research to identify the neurophysiological and psychological processes behind adult onset stuttering and identification of the processes involved in risperidone induced stuttering would help our understanding further.

The Child Stress Disorders Checklist-Short Form: a four-item scale of traumatic stress symptoms in children - Corrected Proof

Michelle Bosquet Enlow, Nancy Kassam-Adams, Glenn Saxe — 2010-02-22

Abstract: Objective: To develop a user-friendly scale that measures traumatic stress responses in injured children. Though injured youth are at high risk for traumatic stress reactions and negative sequelae, there are limited options available for assessing risk, particularly in acute settings.Method: Participants were children and adolescents (ages 6–18) hospitalized with burns or acute injuries (N=147). During hospitalization, parents and nurses completed the Child Stress Disorders Checklist (CSDC), a 36-item observer-report measure of traumatic stress symptoms. Other established measures of child traumatic stress were completed by parents and children during hospitalization and 3 months postinjury. A brief version of the CSDC was created using standard psychometric scale development techniques. The psychometric properties of the resultant scale were compared to those of the original CSDC.Results: A four-item scale (CSDC-Short Form, CSDC-SF) emerged that demonstrated internal, interrater, and test–retest reliability and concurrent, discriminant, and predictive validity comparable to that of the full scale.Conclusions: The CSDC-SF assesses traumatic stress reactions in injured children. Because the measure is very short and does not require specialized training for administration or interpretation, it may be a useful tool for providers who treat injured youth to identify those at risk for traumatic stress reactions.

Psychological distress in twins with urological symptoms - Corrected Proof

2010-02-22

Abstract: Objective: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pain condition with unclear underlying etiology. Our objectives were to determine whether psychological distress was higher in twins with urological symptoms commonly found in IC/PBS than in twins without, and if so, did familial influences contribute to this association.Method: Data from 1165 female twins in a community-based sample were used. Urological symptoms, symptoms of posttraumatic stress disorder (PTSD), depression, anxiety and perceived stress were assessed with standardized questionnaires. Generalized estimating equation (GEE) regression models were used to examine the relationship between psychological distress and urological symptoms.Results: Compared to unaffected twins, twins with urological symptoms were more likely to report PTSD symptoms (OR=3.9; 95% CI=2.6–5.8), depression (OR=3.1; 95% CI=2.0–5.0), anxiety (OR=3.4; 95% CI=2.3–5.2) and perceived stress (OR=3.2; 95% CI=2.1–4.9). After adjusting for familial influences, the within-pair effects remained significant for PTSD symptoms (OR=2.2; 95% CI=1.2–3.8) and perceived stress (OR=2.2; 95% CI=1.2–3.8).Conclusion: Familial influences partially explained the relationship between indicators of psychological distress and urological symptoms. Future research should examine shared environmental and genetic mechanisms that may further explain this relationship and improve diagnosis and treatment of this unexplained clinical condition.

Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth - Corrected Proof

Michael A. Lindsey, Sean Joe, Jordana Muroff, Briggett E. Ford — 2010-02-05

Abstract: Purpose: We examined the social and clinical factors associated with arrival status (e.g., involuntary versus voluntary) and civil commitment decisions in psychiatric emergency services (PES) to assess African-American youths' help-seeking patterns and entrée into care.Methods: Patient records were reviewed for 1621 African-American youth from an inner-city PES between October 2001 and September 2002. Multivariate logistic regression was used to examine the social and clinical factors associated with arrival status (e.g., involuntary vs. voluntary admission) and case disposition among youth who were involuntarily and voluntarily admitted (e.g., disposition upheld vs. dismissed).Results: Low-income youth with behavior disorders were less likely to arrive voluntarily to PES. Medical insurance, suicidality, DSM diagnosis, substance involvement, Global Assessment of Function (GAF) scores and time of day the youth arrived to PES were predictors of voluntary arrival. Older age and GAF scores significantly predicted the decision to uphold an involuntary commitment. Age (younger age less likely), higher GAF scores, insurance status, substance abuse involvement and arrival time (evening shift) significantly predicted the decision to uphold a voluntary decision.Implications: Our findings suggest that psychiatric and nonpsychiatric factors influence both how African-American youth arrive to PES and the decisions made regarding their voluntary/involuntary commitment.

Pseudotumor cerebri in a patient being treated for bipolar disorder - Corrected Proof

Yeşim Yetimalar Beckmann, Yaprak Seçil, Buket Belkız Güngör — 2010-02-01

Pseudotumor cerebri (PTC), also termed idiopathic intracranial hypertension, is a well-recognized disorder of unknown etiology associated with elevated intracranial pressure, normal neuroimaging and normal cerebrospinal fluid composition, found mostly among obese females of childbearing age. Several medications have been associated with PTC. We report a case treated with valproic acid, olanzapine and paroxetine who developed PTC and emphasize the potential role of these drugs in developing PTC.

Association of nonsexual and sexual traumatizations with body image and psychosomatic symptoms in psychosomatic outpatients - Corrected Proof

Martin Sack, Katja Boroske-Leiner, Claas Lahmann — 2010-02-01

Abstract: Objective: A coherent body image is constituted in an interpersonal process during early development. Violations of body self-boundaries (e.g., sexual traumatizations during childhood) could alter the development of a coherent body image and promote symptoms of dissociation and somatization.Method: A total of 240 psychosomatic outpatients underwent a clinical diagnostic interview and a psychometric evaluation including the Posttraumatic Stress Scale (PDS), the Body Image Questionnaire (FKB-20), an inventory of somatoform symptoms (SOMS-7), the Brief Symptom Questionnaire (BSI) and the Dissociative Experiences Scale (DES). Subjects were assigned to one of the following subgroups according to their self-reported trauma status: “nontraumatized,” “nonsexually traumatized” and “sexually traumatized”.Results: Nonsexual traumatizations were more often reported by men (53.4% vs. 35.9%), whereas women more often reported sexual traumatization (9.6% vs. 33.5%). Women reporting sexual traumatizations showed a significantly higher negative validation of their own body and significantly more psychological symptoms (BSI-GSI), whereas both men and women with sexual traumatizations reported significantly more somatoform complaints and more dissociative symptoms when compared with nonsexual or nontraumatized patients.Conclusion: Victims of sexual trauma suffer from a more complex symptom pattern including a more negative perception of their own body compared with patients with nonsexual trauma or no trauma.

Ecchymoses as an adverse effect of fluvoxamine treatment in an adolescent girl - Corrected Proof

Boričević Maršanić Vlatka, Aukst-Margetić Branka, Margetić Branimir — 2010-02-01

Reports of bleeding in patients receiving selective serotonin inhibitors (SSRIs) appeared soon after their introduction. Case reports have described adult patients with various bleeding disorders (e.g., ecchymoses, purpura, epistaxis), while observational studies have focused on upper gastrointestinal bleeding, intracranial bleeding and bleeding during surgery . Bleeding complications of fluvoxamine treatment have been described in adults . However, reports of bleeding complications of SSRI treatment are not limited to the adult population. Several cases of abnormal bleeding under SSRI treatment have been described in children and adolescents with similar clinical manifestations . We report a case of an adolescent girl who manifested ecchymoses during fluvoxamine treatment.

Improving health and productivity of depressed workers: a pilot randomized controlled trial of telephone cognitive behavioral therapy delivery in workplace settings - Corrected Proof

Penny E. Bee, Peter Bower, Simon Gilbody, Karina Lovell — 2010-02-01

Abstract: Objective: To examine the feasibility of telephone-delivered cognitive behavioral therapy (T-CBT) in an occupational context, with reference to participant recruitment, treatment adherence, follow-up and effect.Method: Eligible participants comprised all employees of a large communications company with authorized work absence due to mild/moderate mental health difficulties over a 10-month period. Fifty-three consenting participants were centrally randomized to 12 weeks T-CBT or usual care, with minimization on age, gender and illness severity. Primary (symptom severity) and secondary outcomes (self-rated work performance and productivity) were measured at baseline and 3-months via postal questionnaires. Intention-to-treat analysis comprised multiple regression modeling with adjustment for missing response predictors, minimization variables and baseline values.Results: Twenty-three employees attended one or more T-CBT sessions. T-CBT was associated with medium–large effects sizes on clinical outcomes (0.63–0.77) and work productivity scores (0.75–0.88). Twenty-one patients failed to return 3-month primary outcome data. Non-respondents were more likely to be male and more severely ill.Conclusion: Delivery of T-CBT in an occupational context is feasible with evidence of potential effect. Larger-scale trials are warranted. These studies demand assertive outreach or telephone-based assessment strategies in order to maximize participant recruitment and follow-up.

A case of methamphetamine use disorder treated with the antibiotic drug minocycline - Corrected Proof

2010-01-22

Abstract: Methamphetamine (METH) use is one of the major public health concerns worldwide. Long-term use of METH induces not only dependence but also psychosis which is associated with METH-induced brain damage, including neuroinflammation produced by activated microglia. We report the case of a female patient whose psychotic symptoms in METH use disorder were successfully improved by anti-inflammatory drug minocycline therapy. Although the precise mechanism(s) underlying the efficacy of minocycline in METH use disorder are currently unclear, minocycline appears to be a good candidate for future investigation clinical trials for medication development in METH using populations.

Prevalence of idiopathic and secondary restless legs syndrome in Korean Women - Corrected Proof

2010-01-15

Abstract: Objective: The aim of this study was to identify the prevalence of idiopathic and secondary restless legs syndrome (RLS) and to compare them among Korean women.Methods: A total of 1000 women aged 40–69 years from the general population were included in the study. The questionnaire used to gather data included modified International Restless Legs Syndrome Study Group (IRLSSG) criteria, and questions related to RLS.Results: Of the entire cohort, 65 subjects were diagnosed as having RLS according to IRLSSG criteria. The overall prevalence of RLS was thus 6.5%. Of those subjects with symptoms of RLS, 81.5% complained of insomnia. The age at the onset of RLS was 38.9 ± 8.6 years. RLS symptoms were experienced every day by 18.5% of affected subjects. None of the RLS subjects revealed in this study had previously been diagnosed or treated for their RLS problems.Conclusion: The prevalence of RLS reported herein is low compared with that reported for Western countries. Our study provides further evidence for low prevalence of RLS in Asian populations and supports the view that RLS is poorly recognized by both physicians and the general population, resulting in suboptimal management of the disorder.

Predictors of carbon monoxide poisoning-induced delayed neuropsychological sequelae - Corrected Proof

Hsiao-Lun Ku, Kai-Chun Yang, Ying-Chiao Lee, Ming-Been Lee, Yuan-Hwa Chou — 2010-01-11

Abstract: Objective: Carbon monoxide poisoning (COP) commonly results in delayed neuropsychological sequelae (DNS). The aim of the article is to demonstrate the clinical characteristics and potential predictors of COP-induced DNS later.Method: Retrospective medical record review was performed for patients who had COP in the past year at a National Medical Center in Taiwan. Sixty patients with COP were registered during a one-year period. Fifty-six of them (93.3%) were COP because of suicide attempt. Patients with COP who have a complete medical record of carboxyhemoglobin (COHb) and Glasgow Coma Scale (GCS) and Mini-Mental Status Examination (MMSE) scores were recruited. Multiple regression analysis was performed to search for the predictive factors of DNS.Results: Forty-three patients were recruited. Most had attempted suicide (93.0%) using CO, and thirteen developed DNS later. A longer duration of admission, more sessions of hyperbaric oxygen therapy, and positive findings in brain computed tomography (CT) scans were more often found in patients with DNS than those without DNS. The GCS and MMSE scores and positive findings in brain CT scans were associated with the development of DNS but COHb was not.Conclusions: Our results identified several potential predictors of DNS. This finding may help clinicians understand and treat COP patients efficiently.

“Hospital length of stay for children and adolescents diagnosed with depression: is primary payer an influencing factor?” by Sclar et al - Corrected Proof

Yubo Gao — 2010-01-11

I have read with much interest the article by Sclar et al. which attempted (a) to discern the distribution by primary payer (public vs. private) of US patients aged 5–18 years who were hospitalized with a primary diagnosis of depression and (b) to discern the mean hospital length of stay and mean charge per day by payer type. The topic is good, but, unfortunately, their analytical method is not correct, which may lead the results doubtful, even though the authors intended to use appropriate analytical methods. Specifically, the SAS procedure PROC GLM used in Section 2.3 (“Data Analysis”) is inappropriate in dealing with complex design survey data like the dataset KID they had worked on. The reason is that PROC GLM assumes a simple random sampling design ignoring the stratification, while KID, in fact, is not a simple random sampling design dataset and has stratification information. Complex samples like KID differ from simple random samples (SRS) in that SRS designs assume independence of observations while complex samples do not. Statistics produced by most SAS procedures, including PROC GLM, assume a simple random sample and result in underestimation of variances when analyzing data from complex samples like KID. That makes variance-related values like standard error and P values incorrect. Analysis of data from a complex survey like KID should incorporate the sample design information in order to produce statistically valid inferences . Therefore, the appropriate SAS procedure for that part in Ref. should be PROC SURVEYREG that takes into account stratification information.

Hospital admissions due to physical disease in people with schizophrenia: a national population-based study - Corrected Proof

Carmen Bouza, Teresa López-Cuadrado, José María Amate — 2010-01-11

Abstract: Objectives: To examine nonpsychiatric hospitalizations in people with schizophrenia and to describe the epidemiological features of these admissions.Methods: We analyzed the 2000–2004 Spanish National Hospital Discharge Registry, identified records coded for schizophrenia (295.xx), selected admissions due to non-psychiatric causes and characterized the physical diseases using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) system and the Deyo–Charlson Index.Results: From all 2000–2004 hospitalizations in subjects with schizophrenia, 21 484 records (34%) were eligible for analysis. The mean age was 53 years, 61% were men. The mean number of ICD-9-CM codes was 2.3. The main diagnoses at discharge were injury-poisoning (19%) and respiratory (15%), digestive (14%) and circulatory diseases (12%), but there were significant age and gender-related differences. Inhospital mortality was 6.9% and the mean age of death was 63 years. Circulatory, respiratory diseases and neoplasms accounted for 21%, 18% and 17% of deaths, respectively. Inhospital mortality significantly correlated with age, the Deyo–Charlson Index and some specific processes.Conclusions: Hospitalizations due to physical disease are frequent among people with schizophrenia and associated with a substantial burden and in-hospital mortality in Spain. This information may prove useful for the design and application of preventive and therapeutic programs in the early and silent phases of the most prevalent physical diseases.

Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study - Corrected Proof

2010-01-11

Abstract: Objectives: The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria.Methods: Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed.Results: GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP.Conclusion: GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.

Increased fear of progression in cancer patients with recurrence - Corrected Proof

Eun-Jung Shim, Yong-Wook Shin, Do-Youn Oh, Bong-Jin Hahm — 2010-01-11

Abstract: Objective: This study investigated the fear of progression (FoP) in cancer patients and the discriminant ability of the Fear of Progression Questionnaire (FoP-Q) against the Hospital Anxiety and Depression Scale (HADS), while also examining relationships between FoP, satisfaction outcomes and supportive needs.Method: The FoP-Q and HADS were administered to 112 cancer patients in Korea during June and July 2006. The FoP-Q totals and subscales, and the HADS scores were compared across three groups (patients with recurrence, patients with metastases and controls experiencing neither).Results: Comparison of the FoP-Q total score to HADS anxiety (HADS-A) and depression (HADS-D) scores showed higher FoP in the recurrence group compared to the control group (P=.009). Subscale score comparisons revealed a heightened “affective reaction” (P=.003) to cancer progression and fear of “loss of autonomy” (P=.011) in recurrence patients. FoP-Q score showed a moderate association with HADS-A (r=.54, P=.000) and a significant association with treatment satisfaction (r=−.26, P=.007), medical staff and communication (r=−.31, P=.001), and supportive needs (r=.41, P=.000).Conclusion: The importance of providing supportive interventions tailored to the specific emotional concerns of cancer patients, assessed via appropriate, disease-specific instruments, and the need to pay special attention to the concerns of recurrence patients are suggested.

Association of major depression and mortality in Stage 5 diabetic chronic kidney disease - Corrected Proof

2010-01-11

Abstract: Objectives: Depression is the most common psychiatric disorder in patients with chronic kidney disease (CKD). We sought to determine the association of major depression with mortality among diabetic patients with late stage CKD.Method: The Pathways Study is a longitudinal, prospective cohort study initiated to determine the impact of depression on outcomes among primary care diabetic patients. Subjects were followed from 2001 until 2007 for a mean duration of 4.4 years. Major depression, identified by the Patient Health Questionnaire-9, was the primary exposure of interest. Stage 5 CKD was determined by dialysis codes and estimated glomerular filtration rate (<15 ml/min). An adjusted Cox proportional hazards multivariable model was used to determine the association of baseline major depression with mortality.Results: Of the 4128 enrolled subjects, 110 were identified with stage 5 CKD at baseline. Of those, 34 (22.1%) had major depression. Over a period of 5 years, major depression was associated with 2.95-fold greater risk of death (95% CI=1.24–7.02) compared to those with no or few depressive symptoms.Conclusion: Major depression at baseline was associated with a 2.95-fold greater risk of mortality among stage 5 CKD diabetic patients. Given the high mortality risk, further testing of targeted depression interventions should be considered in this population.

Comments on “Aripiprazole in major depression and mania: meta-analyses of randomized placebo-controlled trials.” Authors' response - Corrected Proof

Beatriz Arbaizar, Trinidad Dierssen-Sotos, Inés Gómez-Acebo, Javier Llorca — 2010-01-11

Meta-analyses on clinical trials should be periodically updated, especially if they refer to a field in continuous development, as usage of aripiprazole is. The trial of Berman et al. was published in print the same month we performed our last search, so we are pleased to see our meta-analysis updated so soon. The letter by Chi-Un Pae (this issue) confirms what we suggested in our manuscript : augmentation with aripiprazole is effective in major depression when current antidepressive treatments have failed; this result is now based on three randomized clinical trials from the same research group.

Authors' response to Letter to the Editor, re: Sclar DA, Robison LM, Gavrun CA Skaer TL. “Hospital length of stay for children and adolescents diagnosed with depression: is primary payer an influencing factor?” General Hospital Psychiatry 2008;30(1):73–76 - Corrected Proof

David A. Sclar, Linda M. Robison, Corrine Gavrun, Tracy L. Skaer — 2010-01-08

The hallmark of quality in scientific inquiry is use of appropriate analytical methods and reproducibility of results. In the article by Sclar et al., we reported that having adjusting for potentially confounding factors, inclusive of admission type, representing a proxy for severity of illness, patients aged 5–18 years diagnosed with depression (ICD-9-CM codes 296.2–296.36, 300.4 or 311) for whom a public payer was the primary source of health insurance coverage were hospitalized 1.3 days longer (P<.001) than were patients for whom the primary source of health insurance coverage was a private payer . Analyses were conducted using SAS, version 9.1.3 .

Prevalence and rates of recognition of anxiety disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China - Corrected Proof

2010-01-06

Abstract: Objective: Assess the prevalence, risk factors and treating clinicians' rates of recognition of anxiety disorders in internal medicine departments of different types of general hospitals in Shenyang, China.Method: A two-stage screening process using an expanded Chinese version of the 12-item General Health Questionnaire (GHQ) and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) identified 457 persons 15 years of age or older with current anxiety disorders from among 5312 consecutive attendees at the outpatient internal medicine departments of 23 randomly selected general hospitals. Clinical charts were reviewed to determine whether or not the treating internist had made a diagnosis of anxiety or prescribed anxiolytic medications.Results: The 1-month prevalence of any type of anxiety disorder was 9.8% (95% CI=9.0–10.8%). The prevalences of the three most common disorders: anxiety disorder not otherwise specified, generalized anxiety disorder and anxiety disorder due to a general medical condition, were 6.3% (5.6–7.1%), 2.4% (2.0–2.9%), and 0.6% (0.4–0.8%), respectively. Multivariate logistic regression analysis identified the following independent predictors of having a current anxiety disorder: every being married (OR=3.5, 95% CI=2.3–5.4), prior treatment for psychological problems (3.3, 1.8–6.0), having religious beliefs (1.9, 1.3–2.9), low family income (1.5, 1.2–1.9) and never having attended college (1.3, 1.02–1.8). Among the 402 patients with anxiety disorders for whom the clinical chart was reviewed only 16 (4.0%, CI=2.3–6.3%) were diagnosed with an anxiety condition or treated with anxiolytic medications.Conclusion: The prevalence of anxiety in internal medicine outpatients in urban China is lower than that reported in most western countries and the profile of risk factors is somewhat different. The very low rate of recognition of these disorders by internists is related both to the low rates of care-seeking for psychological problems in the general population and to the high-volume collective model of care delivery in the outpatient departments of Chinese general hospitals. Steps to increase the recognition and treatment of anxiety disorders in Chinese general hospitals must focus both on changing attitudes of patients and clinicians and, more importantly, on altering the structure of care delivery.

TakoTsubo syndrome and emotional stress: a Heuristic approach - Corrected Proof

François Sirois — 2010-01-04

Abstract: While acute and reversible coronary syndrome without anatomical damage, called TakoTsubo syndrome, has been repeatedly associated with emotional stress, the specific categories of stressors have been ill-defined. Following a review of variously described emotional stressors associated with that specific cardiomyopathy, a clinical report is presented to raise two issues: the overlap of biological risk factors with emotional stress and the interplay of acute and subacute emotional stressors.

Screening for suicidality in cancer patients using Item 9 of the nine-item patient health questionnaire; does the item score predict who requires further assessment? - Corrected Proof

2010-01-04

Abstract: Objective: To determine whether a higher score on Item 9 of the Patient Health Questionnaire-9 (range zero to three) was more likely to indicate suicidality as determined at subsequent clinical interview in cancer outpatients.Method: Analysis of anonymized data (with ethical approval) obtained from the routine clinical administration of self-report questionnaires and telephone interviews to patients attending a cancer centre in the UK.Results: Complete data were available on 330 patients. Those with higher scores on the item were more likely to be suicidal at interview. However, a substantial number of those (54/235; 23%) who scored only one on the item were also found to be suicidal.Conclusions: A higher score on Item 9 of the PHQ-9 indicates a greater likelihood that the patient is suicidal. However, even patients who score only 1 may be suicidal and consequently also require further assessment.

Catatonia induced by idiopathic hypertrophic pachymeningitis - Corrected Proof

2009-12-21

Abstract: We describe the case of a 63-year-old woman with catatonia induced by idiopathic hypertrophic pachymeningitis (IHP). The patient was treated for IHP with prednisolone for approximately 1 year. When she presented with catatonia, no significant changes could be detected by magnetic resonance imaging (MRI) compared with the previous imaging results; electroencephalography (EEG) revealed a delta-wave focus over the left frontotemporal region. High-dose steroid therapy was effective in resolving the catatonic symptomatology and EEG abnormality.

Posterior reversible encephalopathy syndrome in chronic alcoholism with acute psychiatric symptoms - Corrected Proof

Ryo Kimura, Makoto Yanagida, Aki Kugo, Satoki Taguchi, Hidenori Matsunaga — 2009-12-17

Abstract: Objective: To highlight the association between posterior reversible encephalopathy syndrome (PRES) and chronic alcoholism.Methods: We present a case report, a review of the literature and a discussion.Results: We report on the case of a 51-year-old man with chronic alcoholism, who suddenly developed visual disturbance and confusion. Magnetic resonance imaging (MRI) on admission demonstrated abnormal findings. However, clinical symptoms and imaging promptly improved, indicating the diagnosis of PRES.Conclusion: PRES should be considered when making a diagnosis for disturbed consciousness in alcoholic patients.

Risk factors for depression and anxiety in survivors of acute respiratory distress syndrome - Corrected Proof

2009-12-14

Abstract: Objective: Depression and anxiety are common morbidities of critical illness. We assessed risk factors of depression and anxiety in Acute Respiratory Distress Syndrome (ARDS) survivors at 1 and 2 years post-hospital discharge.Method: Risk factors for depression and anxiety at 1 and 2 years were assessed using stepwise multiple regression analyses, with and without 1-year outcomes.Results: ARDS survivors had depression (16% and 23%) and anxiety (24% and 23%) at 1 and 2 years, respectively. Predictors of depression at 1 year were alcohol dependence, female gender and younger age (P=.006). Predictors of anxiety were ratio of arterial oxygen tension to inspired oxygen fraction and duration of mechanical ventilation (P<.005). Predictors of depression at 2 years were depression at 1 year and the presence of cognitive sequelae (P<.0001). Predictors of anxiety at 2 years was anxiety at 1 year (P<.0001).Conclusions: Medical variables that predicted depression or anxiety at 1 year no longer predicted depression and anxiety at 2 years. Medical variables appear to have a short-term effect on psychiatric outcomes. At 2 years lifestyle behaviors including history of smoking along with cognitive sequelae, depression and anxiety at 1 year predict depression and anxiety.

Bupropion, a brief history of seizure risk - Corrected Proof

Adam C. Tripp — 2009-12-14

I was recently having a discussion with a child psychiatry colleague of mine, regarding bulimia nervosa (BN), comorbid depression, and their treatment. We spoke about selective serotonin receptor inhibitors (SSRIs), and then I suggested bupropion perhaps if there was an anergic depression. She stated, “no, there is an absolute contraindication of bupropion with bulimia. It reduces seizure threshold.” I tried to clarify, “you mean just immediate release, right, the kind no one uses anymore.” She replied, “no, I mean bupropion generally, it's in the literature…”

Addressing stigma of depression in Latino primary care patients - Corrected Proof

William A. Vega, Michael A. Rodriguez, Alfonso Ang — 2009-12-07

Abstract: Objectives: To develop a validated stigma checklist to assist physicians in addressing depression in Latino patients.Method: Two hundred low-income, Spanish-speaking, Latino patients in primary care clinics were screened for depression using Patient Health Questionnaires (PHQ-2 and PHQ-9), and medical records were reviewed. With the use of a wide pool of stigma items, empirical methods were used to develop a stigma checklist from this primary care sample and patient information was used to demonstrate construct validity.Results: Patients reporting higher levels of perceived stigma using the stigma checklist were less likely to disclose their depression diagnosis to their family and friends (P<.05) and also less likely to be taking depression medication (OR=.78; 95% CI, .62–.99). Patients with stigma were less likely to be able to manage their depression (OR=.79; 95% CI, .65–.96) and more likely to have missed scheduled appointment visits (OR=1.44; 95% CI, 1.03–2.02).Conclusion: Given the strong relationship between stigma and care of depression, primary care clinicians should be aware of and address stigma among their depressed Latino patients. The stigma checklist presented for treating Spanish-speaking Latino patients in primary care may be used to assess depressed patients for stigma to help inform clinical management of patients.

Correlates of symptoms of depression and anxiety in chronic hemodialysis patients - Corrected Proof

2009-12-07

Abstract: Objective: Little is known about the demographic, clinical and laboratory variables which may be correlated with symptoms of depression and anxiety in hemodialysis (HD) patients. The present study aimed at evaluating such correlation in HD patients treated at a single HD center in a Mediterranean country.Methods: Eighty HD patients were assessed for depression and anxiety with the Beck Depression Inventory (BDI) and the Hamilton Anxiety Rating Scale (HARS). The scores of BDI and HARS were correlated with demographic, clinical and laboratory variables.Results: Based on the Beck Depression Inventory, 38 patients had no symptoms of depression and 42 had symptoms of depression. Based on the HARS, three patients had no symptoms of anxiety and 38 had mild symptoms of anxiety, whereas moderate or severe symptoms of anxiety were present in 39 patients. In univariate analysis, BDI score correlated significantly with age, the Charlson Comorbidity Index, SF-36 Vitality Subscale, Mini-Mental Status Examination, creatinine, albumin, plasma 25-hydroxy vitamin D and interleukin-6 (IL-6) levels. HARS score correlated significantly with age, Charlson Comorbidity Index, SF-36 Vitality Subscale and parathyroid hormone (PTH) levels. In the multivariate analysis, a direct and an inverse correlation between BDI and IL-6 [P=.042, OR=1.31 (95% CI=1.01–1.71)] and creatinine [P=.050, OR=0.73 (95% CI=0.54–1.00)] was observed. With regard to HARS, only a direct correlation with Charlson Comorbidity Index [P<.001, OR=1.55 (95% CI=1.22–1.96)] was found.Conclusion: Although numerous demographic, clinical and laboratory variables correlated with BDI and HARS in univariate analysis, the multivariate regression analysis showed only a direct correlation between BDI and IL-6 [P=.042, OR=1.31 (95% CI=1.01–1.71)] and an inverse correlation between BDI and creatinine [P=.050, OR=0.73 (95% CI=0.54–1.00)] and a direct correlation between HARS and the Charlson Comorbidity Index [P<.001, OR=1.55 (95% CI=1.22–1.96)].

Suxamethonium induced prolonged apnea in a patient receiving electroconvulsive therapy - Corrected Proof

Avinash Waghmare, Channaveerachari Naveen Kumar, Jagadisha Thirthalli — 2009-12-03

Abstract: Suxamethonium causes prolonged apnea in patients in whom pseudocholinesterase enzyme gets deactivated by organophosphorus (OP) poisons. Here, we present a similar incident in a severely depressed patient who received electroconvulsive therapy (ECT). Prolonged apnea in our case ensued because the information about suicidal attempt by OP compound was concealed from the treating team.

Is pregnancy associated with mood and anxiety disorders? A cross-sectional study - Corrected Proof

Faruk Uguz, Kazim Gezginc, Fatih Kayhan, Serap Sarı, Derya Büyüköz — 2009-12-03

Abstract: Objective: To compare current prevalence of mood and anxiety disorders in pregnant and nonpregnant women.Method: The study sample included 309 pregnant women and 107 control subjects. Mood and anxiety disorders were determined by structured clinical interviews.Results: The rate of any mood or anxiety disorder was 19.4% in the pregnant women. Major depression (5.5%) and obsessive-compulsive disorder (5.2%) were the most common diagnoses in the pregnant women. There was no significant difference between pregnant and nonpregnant women with respect to the prevalence rate of mood and anxiety disorders.Conclusion: The results suggest that pregnancy is not a risk factor for the development of mood and anxiety disorders.

Incidence and correlates of delirium in a West African mental health clinic - Corrected Proof

2009-11-19

Abstract: Objective: To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis.Method: A prospective survey design; 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables.Results: Of individuals presenting to the mental health clinics, 18.2% had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regard to clinical variables duration of current symptoms, referral source and the presence of comorbid physical illness were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%), and most attributed their symptoms to a spiritual cause.Conclusion(s): Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resources.

Delusional parasitosis in neurological patients - Corrected Proof

Jesus Ramirez-Bermudez, Mariana Espinola-Nadurille, Narda Loza-Taylor — 2009-11-16

Abstract: Objective: Delusional parasitosis has been described in a wide range of patients with general medical conditions, but there are few reports about its frequency and possible pathogenic mechanisms in neurological patients. This paper describes this delusional syndrome in a sample of neurological patients.Methods: We reviewed all clinical charts of hospitalized patients at the neuropsychiatry ward of a neurological center, from January 2005 to June 2009. Cases with delusional parasitosis were described in terms of demographic, clinical and brain imaging features.Results: From a total sample of 1598 patients, we identified 636 patients with neurological disease (39.80%); of these, four patients showed delusional parasitosis (0.62% of the neurological sample). Their diagnoses were brain cysticercosis (n=1), cerebrovascular disease (n=2), and dementia due to vitamin B12 deficit (n=1). They were women in late life, with depressive features. Three of them had significant cognitive decline. Two of them had paraesthesia and pruritus related to peripheral neuropathy. One of them had pruritus of unknown origin (possibly hallucinatory).Conclusions: Delusional parasitosis was infrequent in this sample of hospitalized neurological patients. Female sex, advanced age, depressive features, cognitive decline, pruritus and paraesthesia of peripheral or central origin may contribute to delusional parasitosis in this population.

Quality of end-of-life care for dementia patients during acute hospital admission: a retrospective study in Ireland - Corrected Proof

Neelam Afzal, Kurt Buhagiar, Joanne Flood, Mary Cosgrave — 2009-11-13

Abstract: Objectives: To examine the quality of end-of-life care received by patients with and without dementia on acute medical wards during their final hospitalization.Methods: A retrospective clinical case note review of patients aged over 65 who had died on acute medical wards within a 6-month period in a general hospital in Dublin was conducted. Seventy-five multidisciplinary clinical notes were available for scrutiny in order to identify cognitive status, measure the frequency of invasive procedures undertaken and examine the quality of palliative care as benchmarked with the Liverpool Care Pathway for the Dying Patient (LCP) program. Comparison between patients with and without dementia was made.Results: Eighteen (24.0%) subjects had dementia, 32 (42.7%) subjects were described as “cognitively intact” and 25 subjects did not have reference to cognitive status. Of the 50 patients with known cognitive status, 27 (54.0%) had had a Mini Mental State Examination (MMSE) conducted (10 dementia vs. 17 nondementia). Patients were equally subjected to invasive interventions regardless of their cognitive status. However, dementia patients were significantly less likely to be referred to palliative care interventions (P=.007), to be prescribed palliative drugs (P=.017) and to have carers involved in decision making (P=.006).Conclusion: Individuals with dementia may be receiving different end-of-life care from those without. The effective delivery of robust multidisciplinary frameworks for the palliation of symptoms of hospitalized dementia patients remains an important clinical goal.

A case of oxybutynin dependency - Corrected Proof

Sinan Guloksuz, Kenan Eren, Defne Tamar Gurol — 2009-10-30

Anticholinergic abuse in the population with chronic mental illness using antipsychotics is a common problem . However, the abuse of anticholinergics in addicts who are not using antipsychotics is very low. In this case, we report a dependency of oxybutynin (Ditropan) which is an anticholinergic medication used to relieve urinary and bladder difficulties including frequent urination and urge incontinence by decreasing muscle spasms of the bladder . To our knowledge, this is the first case representing a dependency of oxybutynin which has relatively low anticholinergic effect.

Iatrogenic delusional parasitosis: a case of physician–patient folie a deux - Corrected Proof

Jessica E. Bury, J. Michael Bostwick — 2009-10-30

Abstract: This report presents a patient incorrectly diagnosed first with parasitic infestation and then with primary delusional parasitosis (DP). Neither diagnosis was correct. As she traveled from doctor to doctor, however, the primary DP label gained credibility via repetition, with her ongoing symptoms seen as proof of its truth.

Do mental disorders and eating patterns affect long-term weight loss maintenance? - Corrected Proof

2009-10-15

Abstract: Objective: This study aimed to assess the impact of mental disorders on weight loss maintenance among initially successful weight losers who participated in a very-low-calorie diet program.Method: A total of 251 obese individuals were assessed in a prospective longitudinal study over a period of 4 years. Mental disorders and eating patterns were assessed by structured interviews at baseline and by standardized questionnaires at baseline (T1), after 1 year (T2) and on 3-year follow-up (T3). Analyses were performed with an intention-to-treat method.Results: Based on the intention-to-treat sample, 166 successful weight losers at T2 (weight loss ≥10%) were identified. Of those, 47 (28.3%) maintained a weight loss of ≥5% of their pretreatment weight, whereas 119 (71.7%) maintained a loss of less than 5% of their pretreatment weight at T3. History of substance abuse/dependence disorder and grazing prior to treatment increased the likelihood of successful weight loss maintenance. High levels of cognitive control, low levels of disinhibition on 3-year follow-up and initial body mass index also were associated with successful weight loss maintenance.Conclusion: Strategies that helped individuals overcome earlier mental disorders might help to establish better self-regulation and maintain high cognitive control of eating and subsequently increase the possibility of maintaining weight loss in the long run.

Charles Bonnet syndrome and vitamin B12 deficiency: a case report - Corrected Proof

2009-09-25

Abstract: The Charles Bonnet syndrome (CBS) is a condition associated with complex visual hallucinations occurring in the elderly in patients with visual impairment and normal mental health. Here, we report the case of a 78-year-old woman who has a limited visual acuity with a CBS that we postulated to be in relationship to a vitamin B12 deficiency. This case is the first report of vitamin B12 deficiency-associated CBS.

Onset of psoriasis during therapy with fluoxetine - Corrected Proof

Lynnette Tan Pei Lin, Seow Khee Kwek — 2009-09-25

Abstract: Objective: Psoriasis is a commonly diagnosed skin disorder that requires a long-term management and can have a profound impact on the quality of life of patients. Drugs that have been associated with the precipitation or exacerbation of psoriasis include lithium, beta-adrenergic receptor blocking agents and antimalarials. Despite extensive use of selective serotonin reuptake inhibitors (SSRIs) in clinical practice, there have been very few reports of selective serotonin reuptake inhibitor-related psoriasis. The main purpose of this study was to report fluoxetine-induced psoriasis in two Chinese women.Results and Conclusion: Although both patients had been taking fluoxetine for an extended period of time, the time scale of these two case studies suggests that fluoxetine played a causative role in these patients' psoriasis.

A possible case of mixed mania due to neurosarcoidosis treated successfully with methylprednisolone and ziprasidone: another example of frontal–subcortical disinhibition? - Corrected Proof

David R. Spiegel, Christopher S. Thomas, Pallav Shah, Kristin D. Kent — 2009-09-14

Abstract: Sarcoidosis is an idiopathic systemic granulomatous disease recognized by clinical and radiographic findings, which ultimately require histopathologic confirmation of noncaseating granulomas for a definitive diagnosis. Psychiatric manifestations occur in 20% of patient with neurosarcoidosis [http://dynaweb.ebscohost.com.chekov.evms.edu/Detail.aspx?id=306337&sid=bdce39cc-d2bd-4977-9e4d-786f2e768d57@sessionmgr4]. We present a case of suspected mixed mania due to neurosarcoidosis, with the manic symptoms responding early and robustly to ziprasidone.

Major depressive episode secondary to condylomata acuminata - Corrected Proof

2009-08-28

Abstract: Psychiatric and psychological morbidity is often associated with skin diseases. Recent research has focused on the epidemiological and clinical aspects of human papillomavirus infection, whereas the psychosocial and emotional factors related to the disease have not been well established. We describe the experience of a 22-year-old male who, after being diagnosed of condyloma acuminata, developed a major depressive disorder.

Euprolactinemic galactorrhea associated with use of imipramine and escitalopram in a postmenopausal woman - Corrected Proof

Rajnarayan Mahasuar, Pratima Majhi, Jayprakash Rusell Ravan — 2009-08-28

Abstract: Hormonal side effects of antidepressants are infrequent, and galactorrhea is seldom mentioned among tricyclic antidepressant (TCA) and selective serotonin reuptake inhibitor (SSRI)-related side effects. Antidepressants can directly stimulate postsynaptic 5-HT receptors in the hypothalamus or indirectly inhibit the tuberoinfundibular dopaminergic neurons through 5-HT, which may increase prolactin levels and later cause galactorrhea. We describe a case of euprolactinemic galactorrhea in a postmenopausal woman, induced by imipramine and escitalopram. This report highlights the presence of unidentified novel mechanisms of antidepressant-induced galactorrhea and other possible contributors.

Unexpected interaction between quetiapine and valproate in patients with bipolar disorder - Corrected Proof

Chih-Chia Huang, I-Hua Wei — 2009-08-10

Abstract: Quetiapine, a second-generation antipsychotic originally used in the treatment of schizophrenia, was also found to be effective as monotherapy or as an adjunctive therapy for acute mania. Delirium in patients treated with quetiapine seems to be a rare phenomenon; however, we report two patients with bipolar disorder who developed delirium when prescribed quetiapine as an adjunct to valproate for acute mania. Both had previously developed mild renal insufficiency after an episode of lithium intoxication. The delirium resolved after quetiapine was discontinued. Unexpected interactions may occur when medications are combined without being subject to controlled clinical trials.

A presumed case of phantom limb pain treated successfully with duloxetine and pregabalin - Corrected Proof

David R. Spiegel, Erik Lappinen, Michael Gottlieb — 2009-07-06

Abstract: Phantom limb pain (PLP) may occur in nearly 80% of amputation patients. Current research has highlighted several changes that occur in the nociception pathway post amputation. With this knowledge, novel therapies were found that could decrease PLP. Two such drugs are duloxetine and pregabalin, each effecting unique steps in the nociception pathway. We also review the neurobiology and efficacy of this treatment strategy.

Marfan syndrome and schizophrenia: a case report and literature review - Corrected Proof

Mary Lemberg, Alexander W. Thompson — 2009-06-10

Abstract: Introduction: Marfan Syndrome (MFS), a disease of microfibril dysfunction, has been associated with schizophrenia in multiple case reports.Case Report: We present one case and review the literature that suggests these conditions may share a common etiologic pathway.Discussion: A possible underlying mechanism of both schizophrenia and MFS is the abnormal expression of growth factors and signaling cascades.Conclusion: MFS patients should be monitored for psychiatric symptoms and patients with signs of MFS should be referred for appropriate medical care. Also, by understanding shared mechanisms, we may develop better understanding and treatments.