The interpersonal aspect of the decision making process in the psychiatric emergency room.
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Decision Making↗
Biomedical subjects
S Fennig
Publications and source records attributed to S Fennig.
[Tardive akathisia and tardive dyskinesia].
Akathisia and tardive dyskinesia are thought to be different entities, while tardive akathisia is considered a variant of akathisia. In the case presented, tardive akathisia first appeared when phenothiazine medication was stopped and then, following a cerebrovascular accident, tardive akathisia disappeared with the emergence of tardive dyskinesia. This case suggests the possibility of a relationship between these 2 disorders.
Aged↗
[Decision-making in the psychiatric emergency room].
The decision-making process in the emergency room is evaluated in accordance with the literature and our growing experience. Research until now emphasized correlations among different variables, demographic, clinical, and the individuality of clinicians and systems, on the decision to admit. Many subtle and difficult-to-describe variables were not considered in most of the studies; we have tried to describe some of them. There is a place for clinical research in the decision-making process.
Decision Making↗
The effect of trihexphenidyl (Artane) on memory in schizophrenic patients.
The anticholinergic effect of trihexphenidyl on memory function of 20 schizophrenic patients has been investigated in a double blind crossover design. Impairment of immediate memory and short term memory was evident after trihexphenidyl treatment in comparison with placebo. Sensory short term memory tested by visual tasks and remote memory showed no significant statistical differences. Our data suggested that trihexphenidyl due to its anticholinergic effect might impair memory function.
Adult↗
[Treatment of Gilles de la Tourette Syndrome with haloperidol and clonidine].
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Adolescent↗
Best-estimate versus structured interview-based diagnosis in first-admission psychosis.
In a sample of first-admission psychotic patients, best-estimate diagnoses made by psychiatrists at entry to the study (N = 310) and 6 months later (N = 228) were compared with Structured Clinical Interview for DSM-III-R (SCID) algorithm diagnoses. Sensitivity, specificity, and agreement (kappa) at entry and at 6-month follow-up evaluation were satisfactory for schizophrenia (sensitivity, .89 and .98; specificity, .96 both times; kappa, .86 and .92) and bipolar disorder with psychosis (sensitivity, 1.00 and .94; specificity, .96 both times; kappa, .89 and .88), moderate for major depression with psychosis (sensitivity, .90 and .81; specificity, .94 and .95; kappa, .75 and .72), but mixed for the organic psychoses (sensitivity, .50 and .23; specificity, 1.00 both times; kappa, .66 and .36). Reasons for disagreement included the role of drugs and other organic factors in the etiology of the disorder, and clinical judgment versus the rules of the structured interview. We conclude that the SCID, when administered by closely supervised experienced nonpsychiatrist clinicians and incorporating information from other sources, can produce a reliable diagnosis of schizophrenia and bipolar disorder. However, the best-estimate procedure seems mandatory in studies investigating a broad range of psychoses, where the use of drugs is not an exclusion criterion.
Bipolar Disorder↗
Bizarre delusions and first-rank symptoms in a first-admission sample: a preliminary analysis of prevalence and correlates.
This report examines the prevalence and correlates of bizarre delusions and Schneider's first-rank symptoms (FRS) in a first-admission sample with psychosis. A total of 196 patients were assessed with the Structured Clinical interview for DSM-III-R (SCID) and given a consensus diagnosis. Project psychiatrists blind to the consensus diagnoses coded each delusion and hallucination in the sample for both FRS and DSM-III-R bizarreness. Interrater reliability of bizarreness was lower than that of FRS (kappa = .681 v 861). The majority of symptoms (72%) were neither bizarre nor FRS, and of the remainder, bizarre delusions that were not also FRS were extremely uncommon. The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression. For seven schizophrenic patients (7.45%), diagnosis of that disorder depended on the presence of a DSM-III-R bizarre delusion to meet criteria. There was a trend for FRS to be associated with poorer prognostic features in the schizophrenic sample. We concluded that although the constructs of bizarre delusions and FRS overlap, FRS were a more important feature in schizophrenia than bizarreness. The rarity of bizarre delusions that were not FRS, combined with the lower reliability of their assessment as compared with that of FRS, raises questions about the continued emphasis on this phenomenon in the definition of schizophrenia.
Adolescent↗
Diagnostic delays and dilemmas. Management of affected patients in the psychiatric inpatient unit of a general children's hospital.
We present the role of the medical-psychiatric unit in the management of children and adolescents with somatic symptoms in whom diagnosis remains uncertain or delayed, which can lead to severe impairment in the child's normal development and functioning and cause anger and hostility in the families. We describe two patients, one with cyclic vomiting syndrome, considered a medical disorder, and the other with conversion disorder, considered a psychiatric disorder. Both patients had had multiple ER admissions and outpatient visits with elaborate and expensive diagnostic workups. On admission to our unit, a coherent and integrated treatment plan was finally formulated and successfully implemented. We discuss the advantage of the medical-psychiatric unit for simultaneous medical and psychosocial intervention early in the development of symptoms and signs. The units need to be ready and able to cope with a wide range of medical and psychiatric disorders with different levels of gravity.
Case Management↗
Management of encopresis in early adolescence in a medical-psychiatric unit.
The aim of this work is to present the role of a medical-psychiatric unit in the treatment of chronic resistant encopresis in adolescence as an effective alternative to the standard approach. Four case reports are presented. The integrative program is based on full patient cooperation and involves separating the patient from the family environment and the use of medical intervention combined with modified behavioral therapy and parental education and guidance. The patient is given full responsibility for the cure. The median full hospital stay for our patients was 2 weeks, and outcome in all cases was complete remission. This experience suggests that chronic resistant encopresis in adolescents requires a different approach from the standard because of the patient's developmental stage and the often hostile family dynamics. A medical-psychiatric setting provides an excellent management milieu and can lead to a dramatic improvement in this chronic disabling condition.
Adolescent↗
The consistency of DSM-III-R delusional disorder in a first-admission sample.
The temporal consistency of the research diagnosis of DSM-III-R delusional disorder was assessed. Subsequent to their first psychiatric hospitalization, psychotic patients were diagnosed twice using a best-estimate procedure after 6- and 24-month follow-up. Only 57.1% of the 7 subjects diagnosed at the 6-month follow-up conference retained the diagnosis at the 24-month review. Conversely, 50.0% of the 8 subjects given this diagnosis at 24 months had different 6-month diagnoses. By contrast, 100% of a matched control group maintained the same diagnosis at both time points. Course and outcome in this sample varied considerably, with 2 of the subjects making severe suicide attempts. Longitudinal assessment in psychotic patients in their first episode is mandatory, and an initial diagnosis of delusional disorder has to be interpreted as provisional.
Adolescent↗