Cyclic vomiting syndrome: role of a psychiatric inpatient unit in a general children's hospital.
Explore the source record for details and available documents.
Antiemetics↗
Biomedical subjects
S Fennig
Publications and source records attributed to S Fennig.
Involuntary first admission of patients with schizophrenia as a predictor of future admissions.
OBJECTIVE: The extent to which the legal status of a first psychiatric admission-voluntary or involuntary-predicted the legal status and number of future admissions was examined among patients with schizophrenia. METHODS: Data on all patients in Israel who had a nonforensic first admission between 1978 and 1992 and a diagnosis of schizophrenia (N=9,081) were extracted from the national psychiatric hospitalization case registry. Also obtained from the registry was information about the patients' subsequent hospitalizations through 1995, demographic data, and diagnosis. Analyses adjusted for time since first admission, age at first admission, country of origin, and religion. RESULTS: The first admission of 12.9 percent of the patients was involuntary. The legal status of the first admission was not related to the number of readmissions. However, female patients whose first admission was involuntary were 4.1 times more likely to have an involuntary second admission than female patients whose first admission was voluntary; these odds were 3.4 for males. Further analysis examined the percentage of involuntary admissions among all hospitalizations of the 3,420 patients who had four or more admissions (chronic patients). Among the chronic patients who had an involuntary first admission, 41 percent of subsequent admissions were involuntary. This figure was significantly lower among the chronic patients who had a voluntary first admission-13 percent. The percentage of involuntary admissions was not related to the number of admissions. CONCLUSIONS: The strong association of involuntary legal status at first admission with involuntary status at second admission and with the number of involuntary admissions over time suggests that involuntary first admission might be an important factor in assessing whether patients are likely to be readmitted involuntarily.
Adult↗
Who provides the best retrospective information while assessing adult's premorbid functioning? A methodological study in a first-admission sample with psychosis.
UNLABELLED: The present study investigates the quality of data received retrospectively from subjects in their first psychotic admission and from their relatives in comparison to school records. The sample included 161 subjects out of 309 subjects (51.4%) for whom at least part of the information about the school was received. The study showed that valuable information can be extracted from school records if done systematically. Significant other's (usually the biological mother) report more accurately on academic performance during the early school years than the subject himself. The school records did not always report behavioral and social problems reported by the subject themselves or their relatives. CONCLUSIONS: 1) For retrospective information on academic performance the school records can be considered the optimal source. When records are not available, parents, in general, provide reliable information. The respondent himself can be considered highly reliable when reporting poor grades; 2) Disruptive behaviors during the early school years are reported at high frequency by school records. Parents and respondents tend to report increasing disruptive behaviors during the middle and high school years; 3) When eliciting information about social domains it is important to obtain information from all available sources.
Achievement↗
Diagnosis, treatment, and six-month outcome status in first-admission psychosis.
Six-month outcome status was examined in 202 first-admission inpatients with DSM-III-R schizophrenia spectrum (N = 96), psychotic bipolar disorder (N = 64), and psychotic depression (N = 42) drawn from 10 facilities in Suffolk County, New York. Schizophrenics fared significantly worse on all outcome variables rehospitalization, which ranged from 17.7 to 23.4%. Bipolars had good psychosocial outcomes regardless of clinical outcome, while the two outcome domains were uncorrelated among schizophrenics and psychotic depressed. Schizophreniform patients had significantly better outcome than those with schizophrenia or schizoaffective disorder. Posthospital treatment was generally unrelated to outcome except that fewer rehospitalized schizophrenics received continuous treatment, and patients with psychotic depression with poorer psychosocial outcome received medication less frequently. These findings highlight the different treatment needs of these diagnostic groups, especially as regards the provision of more intensive rehabilitation for schizophrenic patients and the "poor-outcome" psychotic depressed.
Adolescent↗
Childhood hallucinations preceding the first psychotic episode.
Explore the source record for details and available documents.
Adolescent↗
HIV infection among young adults with psychotic disorders.
OBJECTIVE: The authors examined HIV infection among young adults with newly diagnosed psychotic disorders. METHODS: The study was based on a research cohort of 320 first-admission patients aged 20-39 years in a semirural-suburban county. Research assessments and medical records were systematically reviewed for information about HIV status. RESULTS: Despite the fact that few patients were tested for HIV, 12 (3.8%) of the 320 patients had a known HIV infection. In all 12 cases, the HIV infection was contracted before the onset of psychosis. AIDS was the leading cause of mortality in the 320 patients. CONCLUSIONS: The HIV epidemic may be having an important effect on the etiology and the course of psychotic disorders.
Acquired Immunodeficiency Syndrome↗
Developmental disorder, Tourette disorder and schizophrenia: a case study.
We present a unique case of an 18-year-old male who had a classic picture of schizophrenia preceded by a well documented history of Tourette Disorder and a developmental disorder. The subject, a member of an ongoing study on first-admission psychosis, has been systematically evaluated and followed up for two years, and the interesting neuropsychological findings are presented and compared to those of the rest of the sample with a diagnosis of schizophrenia. The triad of schizophrenia, Tourette Disorder and developmental disorder is described for the first time in a subject with an adult type schizophrenia. Possible neurodevelopmental impairments explaining the clinical picture are discussed in view of the recent literature.
Adult↗
Insight in first-admission psychotic patients.
BACKGROUND: The prevalence of insight was examined longitudinally in psychotic patients with schizophrenia (n = 86), bipolar disorder (n = 52), major depressive disorder (n = 35) and other psychoses (n = 16). METHOD: Before discharge and at 6-month follow-up, insight in first-admission patients from 10 facilities in Suffolk County, New York was rated as part of a modified Hamilton Depression Scale. RESULTS: Initially, 80% of depressives but approximately half with other diagnoses manifested insight. At follow-up, most patients demonstrated insight except for the schizophrenic patients. After controlling for diagnosis, significant correlates of baseline insight were being married, hospitalized in a community or academic facility, intelligence and negative symptoms. At follow-up, after controlling for diagnosis and baseline insight, prior treatment was predictive. This finding held for schizophrenic patients separately. CONCLUSION: Lack of insight is more prevalent in schizophrenia and improves over time. The components of prior treatment leading to better insight should be explored.
Adult↗
Mood-congruent versus mood-incongruent psychotic symptoms in first-admission patients with affective disorder.
The distribution of mood-congruent and mood-incongruent symptoms in 49 first-admission DSM-III-R psychotic bipolar and 35 psychotic depressed patients is presented. Most patients had mood-incongruent symptoms (77.4%). 73% of mood-incongruent bipolars and 32% of incongruent depressives had a combination of mood-congruent and mood-incongruent symptoms. Demographic and clinical variables were unrelated to incongruence. The only 24-month clinical outcome predicted by mood incongruence was poorer GAF rating. 15 of the 16 patients whose diagnosis was changed at follow-up from affective to nonaffective psychosis had mood-incongruent features initially. The findings raise questions about the general prognostic utility of mood congruence.
Adult↗
Diagnosis and six-month stability of negative symptoms in psychotic disorders.
Negative symptoms were examined in 150 primarily first-admission patients diagnosed with schizophrenia, schizoaffective disorder, psychotic depression, psychotic bipolar disorder, and 'other' psychoses. The analysis focused on patients who were rated on the Scale for the Assessment of Negative Symptoms (SANS) within 45 days of admission and at follow-up 6 months later. Significantly more schizophrenics had moderate to severe negative symptoms at each time point compared with other psychotic patients. The SANS scores were found to be relatively stable over time in all five diagnostic groups. Although the DSM-IV includes alogia, affective flattening, and avolition in the A criterion for schizophrenia, only alogia and affective flattening were found to be specific to this disorder. Our results point to the existence and enduring quality of negative symptoms in the early phase of psychosis and its specificity to schizophrenia even at this early stage.
Adolescent↗
The Suffolk County Mental Health Project: demographic, pre-morbid and clinical correlates of 6-month outcome.
The diagnostic specificity and predictive utility of the classical prognostic indicators in schizophrenia were examined in psychotic patients enrolled in the Suffolk County Mental Health Project. First-admission psychotic patients with schizophrenia (N = 96), major depression (N = 42), and bipolar disorder (N = 64) drawn from 10 facilities in Suffolk County, New York, were assessed during their initial hospitalization and at 6-month follow-up. Longitudinal consensus diagnoses were determined after the 6-month interview. The diagnostic groups shared similar background characteristics, but schizophrenics had poorer pre-morbid adjustment, longer periods of psychosis before hospitalization and more negative symptoms initially. Except for rehospitalization, schizophrenics had the worst and bipolars the best functioning at follow-up. Among the classical prognostic indicators, the best predictor of 6-month outcome for each diagnostic group was premorbid functioning.
Adolescent↗
Assessment of insight in psychotic disorders.
This paper presents a selected review of the concept insight as regards recognition of the presence of illness among patients with psychotic disorders in general and with schizophrenia in particular and the development of new instruments for its assessment. Lack of insight appears to be a common pathway for different psychopathological processes and may have different meanings in different stages of the illness. Three major dimensions of the concept include: (1) awareness of having a mental illness; (2) the need for treatment; and (3) relabeling symptoms and signs as pathological and attributed to a mental illness. This complexity must be addressed by studies with a design using instruments which are appropriate to the research goals and carefully identify the stage of illness of the target population.
Awareness↗
Mood-congruent vs. mood-incongruent psychotic symptoms in affective psychotic disorders.
This review of the literature on the importance of congruence of mood to identify nosological sub-categories among the affective disorders showed the limited value of this concept. The reported prevalence rates of affective psychoses with mood-congruent, mood-incongruent and a combination of these symptoms vary widely among the different studies. This categorization seems neither to identify sub-groups with distinct demographic and onset characteristics nor to predict course and outcome. Furthermore, the ambiguity of the guidelines and the different use of this concept in the studies increase the confusion. The only heuristic value of the use of this concept seems to be its prediction of change of diagnosis. The authors suggest eliminating the concept of mood congruence from the categorization of affective disorders and, if not, to state more concise and explicit guidelines for research and clinical use.
Affect↗
Pseudopregnancy, prenatal, and postpartum psychosis: a case study.
Explore the source record for details and available documents.
Adult↗
Psychotic patients with unclear diagnoses. A descriptive analysis.
This report describes the clinical characteristics of psychotic patients who received a 6-month longitudinal research diagnosis of psychosis not otherwise specified (NOS) or for whom no consensus diagnosis was reached. The reasons why these subjects could not be classified into a specific DSM-III-R category, their classification under the proposed DSM-IV criteria, their reclassification at 24-month follow-up, and differences between these groups and patients with schizophrenia and affective disorders in demographic characteristics, initial clinical features, and short-term course are explored. Data were drawn from the first phase of the Suffolk County Mental Health Project. Longitudinal consensus procedures were used to derive 6- and 24-month DSM-III-R diagnoses based on information from a structured diagnostic interview, an interview with the patient's clinician, the medical record and discharge summary, and significant others. Thirteen subjects (4.7%) received a diagnosis of psychosis NOS, and 12 (4.3%) had no consensus diagnosis. Seven with psychosis NOS had an acute onset with rapid remission; this subgroup met DSM-IV criteria for brief psychosis without stressors. As a group, the psychosis NOS subjects were significantly older and had a lower rate of lifetime alcohol abuse/dependence than the schizophrenic and affective disorder groups. Their short-term course was significantly better than that of the schizophrenics and similar to that of patients with an affective disorder. Subjects with no consensus diagnosis were more likely to have lifetime drug abuse/dependence than the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Advances in the study of mood disorders in childhood and adolescence.
Studies summarized in this review explore the nosology, course, and treatment of depression. The observation that depressive disorders in children often occur in conjunction with other psychiatric symptoms seems to affect outcome--in terms of suicidal behavior and possibly recurrence. Family factors seem to contribute to the severity of depressive symptoms, and it is possible that the level of criticism, as operationalized by "expressed emotion," is one of the mediating factors. Unfortunately, although several studies addressed treatment, both psychopharmacologically and psychotherapeutically, it is clear that considerably more research is needed before effective interventions are found for serious and disabling mood disorders in youth.
Adolescent↗
Gender, premorbid characteristics and negative symptoms in schizophrenia.
The interrelationships among gender, premorbid functioning, and negative symptoms were examined in a first-admission inpatient sample with DSM-III-R schizophrenia. Fifty-two subjects were assessed with the Schedule for the Assessment of Negative Symptoms (SANS) at baseline and 6-month follow-up. Three indicators of premorbid functioning were examined: the Premorbid Adjustment Scale, the Quick Test, and the GAF for the best month in the year prior to the baseline interview. Men and women had relatively similar ratings on each of the 5 SANS global subscales at both times; they were also relatively similar on most of the indicators of premorbid functioning. The men and women were categorized into low vs moderate-high negative symptom groups at baseline, and no differences in premorbid functioning were detected. When the sample was classified into those with and without consistent negative symptoms at baseline and 6-month follow-up, the enduring negative men and women had significantly poorer premorbid functioning in several areas than the consistently non-negative patients. Our findings support the importance of assessing negative symptoms longitudinally and suggest that gender is not strongly associated with negative symptoms and premorbid functioning in patients ascertained at early stages of schizophrenia.
Adult↗
Epidemiology, diagnosis, and course of brief psychoses.
OBJECTIVE: This study investigated acute and nonacute brief psychoses. On the basis of previous work, the authors proposed that 1) acute brief psychoses occur predominantly in females, 2) they often do not conform to the diagnoses of DSM-III-R, 3) they are temporally stable, and 4) nonacute brief psychoses do not share these distinctive features. METHOD: The data are from a follow-up study of 221 first-admission patients with affective and nonaffective psychoses. Patients were given extensive assessments at initial evaluation, 6-month follow-up, and 24-month follow-up. The research team made consensus ratings of the presence of psychosis, DSM-III-R diagnosis, mode of onset of disorder, and course of disorder. Brief psychoses were defined by a diagnosis of nonaffective psychosis at the initial evaluation and a rating of full remission at 6-month follow-up; acute brief psychoses met the additional criterion of acute onset as defined by ICD-10. RESULTS: Twenty (9%) of the 221 psychoses were brief psychoses. Only seven (3%) were acute brief psychoses, but among these, six occurred in women, five were undiagnosable, and none had evolved into an affective disorder or a chronic disorder by the time of the 24-month follow-up. The 13 nonacute brief psychoses did not exhibit distinctive features, and five of them later evolved into chronic disorders. CONCLUSIONS: Acute brief psychoses emerged as a highly distinctive and temporally stable form of psychosis that may merit a separate diagnostic classification. The more numerous nonacute brief psychoses may represent mild forms of nonaffective psychoses such as schizophrenia.
Acute Disease↗