Delirium in general hospital inpatients: German developments.
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Antipsychotic Agents↗
Biomedical subjects
A Diefenbacher
Publications and source records attributed to A Diefenbacher.
Fatty acid ethyl esters in hair as markers of alcohol consumption. Segmental hair analysis of alcoholics, social drinkers, and teetotalers.
BACKGROUND: Fatty acid ethyl esters (FAEEs) are products of nonoxidative ethanol metabolism. After incorporation in hair, they should be suitable long-term markers of alcohol abuse. METHODS: Hair samples from 19 alcoholics in a treatment program, 10 fatalities with verified excessive alcohol consumption, 13 moderate social drinkers who consumed up to 20 g ethanol/day, and 5 strict teetotalers were analyzed in 1-12 segments for four FAEEs (ethyl myristate, ethyl palmitate, ethyl oleate, and ethyl stearate) by external degreasing with n-heptane, extraction with a dimethyl sulfoxide-n-heptane mixture, headspace solid-phase microextraction of the extracts, and gas chromatography-mass spectrometry with deuterated internal standards. The n-heptane washings were analyzed in the same way for FAEEs from the hair surface. RESULTS: The sum of the four ester concentrations in hair calculated for the proximal 0-6 cm segment was 2.5-13.5 ng/mg (mean, 6.8 ng/mg) for the fatalities, 0.92-11.6 ng/mg (mean, 4.0 ng/mg) for 17 of the alcoholics in treatment, 0.20-0.85 ng/mg (mean, 0.41 ng/mg) for the moderate social drinkers, and 0.06-0.37 ng/mg (mean, 0.16 ng/mg) for the teetotalers. In almost all cases the segmental concentrations increased from proximal to distal. There was no agreement between the self-reported drinking histories of the participants and the FAEE concentrations along the hair length. Ethyl oleate was the dominant ester in all samples. CONCLUSIONS: FAEEs are deposited in hair mainly from sebum. Despite large individual differences, FAEE hair concentrations can be used as markers for excessive alcohol consumption with relatively high accuracy.
Alcohol Drinking↗
[Dementia screening in psychiatric consultation for elderly patients in a general hospital].
BACKGROUND: Elderly patients on medical-surgical wards in general hospitals often suffer from cognitive dysfunction that hampers medical treatment of somatic diseases. Symptoms of cognitive dysfunction may not be recognized adequately by non-psychiatric physicians. PATIENTS AND METHOD: We studied the usefulness of a short screening instrument for cognitive dysfunctions (short mini mental state test) in a consecutive sample of 222 psychiatric consultation liaison patients older than 60 years of age. Normative data for the screening test from an epidemiological sample, the Berlin Aging Study, are given and compared with the consultation sample. RESULTS: Mild to moderate deficits in cognitive functions were found in 32% of patients, severe deficits indicating dementia- or delirium syndromes were found in 17.7%. Applying the cut off 4/5, 88.9% correct classifications of dementia patients were obtained. The item analysis demonstrates significant differences with respect to the age-matched population sample for the orientation items, the 2nd and subsequent subtractions of the serial seven task and, to a lesser degree, the memory items. CONCLUSION: A standardized assessment of the 15 items of the SMMS represents a practical, reliable and valid screening for relevant cognitive deficits, which may also serve as documentation of the time course especially in acute organic-psychiatric syndromes.
Aged↗
[Confusion in delirium. How orientation to space and time gets lost].
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Aged↗
Neuropsychiatric aspects in Munchausen's syndrome.
The case of a 27-year-old woman with Munchausen's syndrome is presented, in whom a history of cerebral palsy and pathological findings from electroencephalogram, cranial computed tomography, and neuropsychological assessment were prominent. It is argued that neuropsychiatric aspects may play a role in the development of Munchausen's syndrome in a subgroup of patients.
Adult↗
[Surgical management of psychiatrically ill patients. Particular aspects of perioperative monitoring].
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Adaptation, Psychological↗
Orthostatic challenge during neuroleptic test dose: a possible predictor of short-term outcome.
Cardiovascular measurements were used as indicators of autonomic arousal during an orthostatic challenge test without medication and after a test dose of 150 mg perazine in 20 acute schizophrenic patients. Unmedicated schizophrenics showed elevated heart rates and elevated systolic and diastolic blood pressure in comparison to healthy volunteers. After a test dose of 150 mg perazine, responders (using BPRS outcome criteria after 23 days) showed a pronounced orthostatic heart rate reaction in comparison to nonresponders. Results are discussed in relation to arousal theories and central dopaminergic activity in schizophrenia.
Adult↗
[Psychopathologic findings in subdural hematoma--consultation psychiatry as applied neuropsychiatry].
In the era of powerful neuroimaging devices, such as CCT and NMR, the diagnosis of intracranial mass lesions has been increasingly improved. Nevertheless, there are still delays in the detection of such disorders. Two case reports of patients with subdural haematoma are presented, in which the usefulness of a thorough psychopathological examination and the possible contribution of psychiatric consultation, understood as practical neuropsychiatry, in the detection of such disorders is demonstrated.
Adult↗
[Neuropsychiatric nursing in the intensive care unit as an aspect of psychiatric consultation].
Psychiatric training of nurses on ICUs is important, as cerebral dysfunctional states often show disturbances of behaviour. With two case reports of patients seen by our psychiatric service to an ICU, we want to demonstrate the potential benefits of a neuropsychiatric training for nurses. The implementation of psychiatric nurse clinical specialists on ICUs is suggested.
Adult↗
Further evolution of a literature database: the international use of a common software structure and methodology for the establishment of national consultation/liaison databases.
Every day there are 6000-7000 papers published in science. Since the C-L psychiatrist may be asked to consult on a patient with any medical illness, and who may be on any medical drug, methods need to be developed to review the recent literature and have an awareness of current findings. At the same time, teachers need to develop a current listing of seminal papers for trainees and practitioners of this subspecialty of psychiatry. Experts chosen because of their writings and acknowledged contributions to their subspecialty interests have sifted through thousands of articles to select the ones they regard as the most important for trainees in C-L psychiatry. In addition, certain countries--Spain, Portugal, Germany, Mexico, Australia and Brazil are developing national databases of C-L literature not only for their own use, but also to bring them to the attention of other parts of the world. This fifth iteration of the C-L literature database has especially targeted the period of 1996-1999--the millennium issue--in order to have easier access to contemporary essential studies on common problems. Part II of this issue describes the seminal cardiac drug-psychotropic drug interactions that the C-L psychiatrist may encounter in the most common medical disease in the United States--coronary heart disease--with advise to the practitioner as to their management. The use of the Internet and institutional Intranets is described.
Databases, Bibliographic↗
Somatic symptoms in Turkish and German depressed patients.
We determined the pattern and severity of symptoms in Turkish and German depressed inpatients. Psychopathological and somatic symptoms were documented on standardized rating scales of the Association for Methodology and Documentation in Psychiatry (AMDP) System. Of a total sample of 6000 inpatients admitted to the Psychiatric Department of the Free University of Berlin from 1981 to 1989, 28 Turkish inpatients with diagnoses of depression, according to the International Classification of Diseases, ninth revision, were compared with a randomly selected group of matched German depressed inpatients. Turkish patients scored higher only on the Vegetative-somatic syndrome scale but did not differ on the Depressive or Apathetic syndrome scale of the AMDP System.
Adult↗
Implementation of a psychiatric consultation service: a single-site observational study over a 1-year-period.
This study describes changes in consultation process variables and referral patterns after implementation of a psychiatric consultation service at a university hospital in Germany. Two hundred eighty consecutive medical-surgical inpatient referrals for psychiatric consultation during a 1-year period were documented prospectively with a structured database. Changes took place in referral patterns and in psychiatric interventions and recommendations but not in psychiatric diagnoses. In addition, information is given on psychiatric and psychosomatic consultation service delivery in Germany.
Adult↗