Seventy-four patients with paroxysmal mental disorders in the debut of epilepsy have been examined. To study an age-related aspect of these disorders, all patients have been stratified by age at debut of epilepsy into 3 subgroups (children, adolescence and adult age). Based on a key psychopathological syndrome, three types of simple and complex partial "psychiatric" seizures have been singled out. The higher is the age of debut, the higher are the variability of clinical presentations of psychopathological disorders and more complex clinical presentations of complex partial (psychomotor) attacks in the structure of simple partial seizures. In children aged 7-14 years and people older than 18 years, the simple partial "psychiatric" seizures as well as first manifestations of disease were seen more often than in adolescents. This type of debut was not observed in children younger than 7 years. The age curve of debut of epilepsy with complex partial seizures has two distinct peaks, at the children (up to 7 years) and adult ages. In the group older than 18 years, frequencies of psychomotor seizures and first disease manifestations are inversely correlated with age.
This longitudinal study explored associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood. The baseline data were collected in 1996 from 14-year-old pupils (n = 235; 116 girls, 119 boys) at schools using a structured questionnaire that included a 14-item scale of psychosomatic symptoms. The follow-up data were collected in 2006 from the same persons at the age of 24 using the Symptom Checklist-90. Follow-up questionnaires were returned by 149 (63.4%) young adults (88 women and 61 men). Young adults who had many psychosomatic symptoms in adolescence suffered more often than the others from somatization and anxiety symptoms in early adulthood. In addition, women had more symptoms of depression and paranoid ideation, and men had more interpersonal sensitivity and psychotic symptoms. Psychosomatic symptoms in adolescence might be important signals of mental health and this should be taken seriously in school health and in general primary care.
Patients who had suffered traumatic brain injury were evaluated to determine the occurrence of psychiatric disorders during a 30-year follow-up.
Sixty patients were assessed on average 30 years after traumatic brain injury. DSM-IV axis I disorders were diagnosed on a clinical basis with the aid of the Schedules for Clinical Assessment in Neuropsychiatry (version 2.1), and axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders. Cognitive impairment was measured with a neuropsychological test battery and the Mini-Mental State Examination.
Of the 60 patients, 29 (48.3%) had had an axis I disorder that began after traumatic brain injury, and 37 (61.7%) had had an axis I disorder during their lifetimes. The most common novel disorders after traumatic brain injury were major depression (26.7%), alcohol abuse or dependence (11.7%), panic disorder (8.3%), specific phobia (8.3%), and psychotic disorders (6.7%). Fourteen patients (23.3%) had at least one personality disorder. The most prevalent individual disorders were avoidant (15.0%), paranoid (8.3%), and schizoid (6.7%) personality disorders. Nine patients (15.0%) had DSM-III-R organic personality syndrome.
The results suggest that traumatic brain injury may cause decades-lasting vulnerability to psychiatric illness in some individuals. Traumatic brain injury seems to make patients particularly susceptible to depressive episodes, delusional disorder, and personality disturbances. The high rate of psychiatric disorders found in this study emphasizes the importance of psychiatric follow-up after traumatic brain injury.
Comment In: Evid Based Ment Health. 2003 May;6(2):5912719366
Comment In: Am J Psychiatry. 2002 Aug;159(8):1261-412153815
The occupational factors are assigned one out of main parts to the development of occupational and comorbid pathology. At the same time the social aspects of labor relations act as the most important factors influencing on the workers' self-assessment of health status. Quantitative risk assessment of the common pathological syndromes has identified the excess of share of persons with a minimum level of risk over the medium and high. In the structure of risks of common pathological syndromes there are prevailed risks for disorders of the cardiovascular and nervous systems and borderline mental disorders, which is a response to the impact of not only industrial, but also psychosocial factors. The results of self-assessment of health status and clinical examination of employees in conditions of mercury exposure show the similarity of the structure of diseases in these cases. In either event there are dominated diseases of the nervous and mental sphere, and from the comorbid pathology disorders of the cardiovascular system are prove to be important. Clinical manifestations of the mercury exposure, ranging from pre-clinical manifestations to marked changes from the side of the nervous system in toxic encephalopathy, are characterized by the presence of hyperkinetic syndrome. For pre-clinical and early forms of mercury poisoning there is also typical the presence of asthenic (emotional lability) disorders with autonomic dysfunction. Comorbidities in an internship working was manifested primarily by diseases of visual organs, cardiovascular system and diseases of the musculoskeletal system. Observed disorders of the nervous system and psycho-emotional sphere are caused, inter alia disturbances of the balance of catecholamines (the rise of norepinephrine in dynamics with a concomitant increase in the coefficient reflecting the degree of its metabolism: norepinephrine/epinephrine and norepinephrine/(adrenaline + Normetanephrine)) in the body.
The high cost of mental health surveys of the general population has sparked interest in less costly research methods. Two low-cost mental health survey strategies (mail and telephone) were compared in terms of cost, response rate and quality of data obtained. A total of 1,074 persons agreed to participate in the study as a sample, one-half by telephone and the other half by mail. They completed the Diagnostic Interview Schedule Self-Administered, a questionnaire designed to be self-administered, which was used to assess specific mental disorders and to evaluate risk factors. In addition, 239 respondents who were selected according to the presence or absence of specific diagnoses were reinterviewed face-to-face using the Diagnostic Interview Schedule as an external criterion. The telephone method yielded a better response rate (15% higher) and better control over answers (for example, less missing data). The mail strategy was less expensive and appeared to yield data of slightly better quality, particularly for respondents suffering from anxiety disorders.
Few studies have addressed the relationship between dementia and crime. We conducted a study of persons who got a primary or secondary diagnosis of dementia or cognitive disorder in a forensic psychiatric examination.
In Sweden, annually about 500 forensic psychiatric examinations are carried out. All cases from 2008 to 2010 with the diagnoses dementia or cognitive disorder were selected from the database of the Swedish National Board of Forensic Medicine. Out of 1471 cases, there were 54 cases of dementia or cognitive disorder. Case files were scrutinized and 17 cases of dementia and 4 cases of cognitive disorder likely to get a dementia diagnosis in a clinical setting were identified and further studied.
There were 18 men and 3 women; Median age 66 (n = 21; Range 35-77) years of age. Eleven men but no women had a previous criminal record. There were a total of 38 crimes, mostly violent, committed by the 21 persons. The crimes were of impulsive rather that pre-meditated character. According to the forensic psychiatric diagnoses, dementia was caused by cerebrovascular disorder (n = 4), alcohol or substance abuse (n = 3), cerebral haemorrhage and alcohol (n = 1), head trauma and alcohol (n = 2), Alzheimer's disease (n = 2), Parkinson's disease (n = 1), herpes encephalitis (n = 1) and unspecified (3). Out of four persons diagnosed with cognitive disorder, one also had delusional disorder and another one psychotic disorder and alcohol dependence. An alcohol-related diagnosis was established in ten cases. There were only two cases of Dementia of Alzheimer's type, one of whom also had alcohol intoxication. None was diagnosed with a personality disorder. All but one had a history of somatic or psychiatric comorbidity like head traumas, stroke, other cardio-vascular disorders, epilepsy, depression, psychotic disorders and suicide attempts. In this very ill group, the suggested verdict was probation in one case and different forms of care in the remaining 20 cases instead of prison.
Few cases of dementia or cognitive disorder were identified by forensic psychiatric examinations. All but one suffered from a variety of serious mental and medical conditions affecting the brain. Alcohol abuse was prevalent.
Over a five-year period of registration in the county of S?r-Tr?ndelag we studied whether the frequency of consulting for one of three major psychiatric diagnostic groups (psychosis, neurosis, or "other") depended on the type of municipality (rural, coastal, urban) where the patient was resident. Diagnoses were based on consultations with a staff member of the regional outpatient psychiatric clinic, and the underlying population was described in the National Census, 1980. The results showed that, in general, urban residents sought help more frequently from the psychiatric outpatient clinic than rural residents did, (relative risk = 1.6, 95% confidence interval 1.4 to 1.8). The increased "risk" was attributed to a relatively larger number of neuroses and "other" diagnoses in the urban areas. The risk of consulting for psychosis was higher among coastal residents (relative risk = 1.8, 95% confidence interval 1.4 to 2.3) than among rural residents, was particularly evident among coastal residents between 16 and 39 years of age (relative risk = 4.1, 95% confidence interval 2.1 to 8.5), and was equally strong for men as for women. This study confirms that, in general, the risk of seeking outpatient psychiatric treatment is higher among urban than among rural and coastal residents. The apparently higher frequency of requests to the outpatient clinic for help for psychosis among coastal residents should be balanced against the tendency for city residents with psychosis to be admitted directly to the psychiatric hospital.
During the period 1985-89, 124 physicians were hospitalized in Norwegian psychiatric institutions. The physicians were compared with 91 nurses, 88 enrolled nurses and 110 teachers from three counties who were hospitalized during the same period. The overall rate of admission to psychiatric institutions seemed to be highest for the enrolled nurses and lowest for the teachers. There were few diagnostic differences between the groups. Relatively more of the female teachers were recruited from the middle age group (41-55 years), while the nurses and the enrolled nurses belonged most often to the youngest group (
Hypertensive disorders may affect the fetal developmental milieu and thus hint at mechanisms by which prenatal adversity associates with mental disorders in later life. We examined if hypertension without proteinuria and preeclampsia in pregnancy predict serious mental disorders in the offspring, and if sex, childhood socioeconomic status, length of gestation and parity modify these associations.
We included 5970 women and men born after a normotensive, hypertensive or preeclamptic pregnancy defined by using mother's blood pressure and urinary protein measurements at maternity clinics and birth hospitals. Mental disorders requiring hospitalization or contributing to death were identified from the Finnish Hospital Discharge and Causes of Death Registers between years 1969 and 2004.
In comparison to the offspring born after normotensive pregnancies, offspring born after pregnancies complicated by hypertension without proteinuria were at 1.19-fold (CI: 1.01-1.41, P-value = 0.04) higher risk of any mental disorder and 1.44- (CI: 1.11-1.88, P-value
OBJECTIVES: The incidence of psychiatric disorders and depressive symptoms was examined in a cohort of American men and women who spent an austral winter at two different research stations in Antarctica to determine whether extended residence of nonindigenous inhabitants in a polar region is associated with psychiatric morbidity. STUDY DESIGN: Debriefings interviews with 220 men and 93 women were conducted by 3 psychiatrists and 1 clinical psychologist at McMurdo Station and South Pole Station at the end of the austral winter between 1994 and 1997. Crewmembers were assigned a DSM-IV diagnosis if they satisfied diagnostic criteria. Debriefed crewmembers also completed the Structured Interview Guide for the Hamilton Depression Inventory-Seasonal Affective Disorders version (SIGH-SAD). RESULTS: Thirty-nine (12.5%) crewmembers presented with symptoms that met the criteria for one or more DSM-IV disorders. After weighting the prevalence to account for the low participation rate of civilian personnel, the incidence of DSM-IV disorders was 5.2%. Mood disorders were the most common diagnoses, accounting for 30.2% of all diagnoses, followed by adjustment disorders (27.9%), sleep-related disorders (20.9%), personality disorders (11.6%), and substance-related disorders (9.3%). Depressive symptoms as measured by the SAD-SIGH were significantly associated with female gender, military occupation, station, year of expedition, and DSM-IV diagnosis. CONCLUSION: Differences in the distribution of symptoms and diagnoses by demographic and expedition characteristics suggests that the social environment may be a more powerful determinant than the physical environment of psychiatric disorders in a polar region.