http://www.cpementalhealth.com The latest research articles published by Clinical Practice and Epidemiology in Mental Health 2009-06-26T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders.A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy. http://www.cpementalhealth.com/content/5/1/16 Nicola Poloni Simone Vender Emilio Bolla Paola Bortolaso Chiara Costantini Camilla Callegari Clinical Practice and Epidemiology in Mental Health 2009, 5:16 2009-06-26T00:00:00Z doi:10.1186/1745-0179-5-16 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 16 2009-06-26T00:00:00Z XML Background: Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments. Methods: the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED. Results: After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies. Conclusion: AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD. http://www.cpementalhealth.com/content/5/1/15 Mauro Giovanni Carta Matteo Balestrieri Andrea Murru Maria Carolina Hardoy Clinical Practice and Epidemiology in Mental Health 2009, 5:15 2009-06-26T00:00:00Z doi:10.1186/1745-0179-5-15 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 15 2009-06-26T00:00:00Z XML IntroductionComplex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. Methods: Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. Results: To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. Conclusion: So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication. http://www.cpementalhealth.com/content/5/1/14 Benedikt Amann Johannes Pantel Heinz Grunze Eduard Vieta Francesc Colom Anamaria Gonzalez-Pinto Dieter Naber Harald Hampel Clinical Practice and Epidemiology in Mental Health 2009, 5:14 2009-06-16T00:00:00Z doi:10.1186/1745-0179-5-14 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 14 2009-06-16T00:00:00Z XML Following the recent debates on the discrepancy between the predominant weight of bipolar disorder (BPD) in the clinical reality and its relatively low prevalence figures emerging from epidemiological surveys, the present paper contends the ability of current operational diagnostic system to properly detect the clinical entity of bipolar disorder.As an episode of mania/hypomania is the necessary requirement for a diagnosis of bipolar disorder to be made, in this editorial we maintain that: a) the most severe forms of mania, characterized by cloudy consciousness, mood incongruent delusions, and physical symptoms are likely to escape DSM IV criteria, that are shaped around hypomania or mild mania; b) the impossibility to diagnose mania when this occurs during antidepressant treatments impedes diagnosing those cases whose natural illness pattern is Depression followed by Mania (known as DMI pattern); c) given that approximately 50% of cases have their onset of BPD with affective episodes other than mania/hypomania any prevalence figure necessarily underestimates BPD; d) the sub-threshold forms of BPD, well described in the concept of Bipolar Spectrum, are beyond the possibility to be recognized using operational diagnoses in spite of their utmost clinical relevance. http://www.cpementalhealth.com/content/5/1/13 Carlo Faravelli Silvia Gorini Amedei Maria Alessandra Scarpato Luca Faravelli Clinical Practice and Epidemiology in Mental Health 2009, 5:13 2009-06-16T00:00:00Z doi:10.1186/1745-0179-5-13 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 13 2009-06-16T00:00:00Z XML Background: Depression is a prevalent health problem among women during the childbearing years. To obtain a more accurate global picture of maternal postnatal depression, studies that explore maternal depression with comparable measurements are needed. The aims of the study are: (1) to compare the prevalence of maternal depression in the first and second year postpartum between a UK and Brazilian birth cohort study; (2) to explore the extent to which variations in the rates were explained by maternal and infant characteristics, and (3) to investigate income-related inequalities in maternal depression after childbirth in both settings. Methods: Population-based birth cohort studies were carried out in Avon, UK in 1991 (ALSPAC) and in the city of Pelotas, Brazil in 2004, where 13 798 and 4109 women were analysed, respectively. Self-completion questionnaires were used in the ALSPAC study while questionnaires completed by interviewers were used in the Pelotas cohort study. Three repeated measures of maternal depression were obtained using the Edinburgh Postnatal Depression Scale in the first and second year after delivery in each cohort. Unadjusted and adjusted analyses were carried out. The Relative index of Inequality was used for the analysis of income-relate inequalities so that results were comparable between cohorts. Results: At both the second and third time assessments, the likelihood of being depressed was higher among women from the Pelotas cohort study. These differences were not completely explained by differences in maternal and infant characteristics. Income-related inequalities in maternal depression after childbirth were high and of similar magnitude in both cohort studies at the three time assessments. Conclusion: The burden of maternal depression after childbirth varies between and within populations. Strategies to reduce income-related inequalities in maternal depression should be targeted to low-income women in both developed and developing countries. http://www.cpementalhealth.com/content/5/1/12 Alicia Matijasevich Jean Golding George Davey Smith Ina Santos Aluisio Barros Cesar Victora Clinical Practice and Epidemiology in Mental Health 2009, 5:12 2009-06-05T00:00:00Z doi:10.1186/1745-0179-5-12 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 12 2009-06-05T00:00:00Z XML The natural disaster known as "the Tsunami" occurred in Andaman coast of Thailand in December 2004, and there had been questions whether it could cause PTSD amongst the population who lives in the affected area and how to avoid PTSD condition to occur.The purpose of this study is to establish statistical results of psychosocial factors, and their correlation to PTSD and other mental disorders in order to generate the PTSD database. Cross sectional community surveys had been conducted in two phases from the same sampling group, the first phase is concerned with prevalence of PTSD, depression and related factors. Results were collected from 3,133 samples and shows that 33.6% suffered from PTSD, 14.27% with depression and 11.27% suffered from both. The second phase is focused on chronic PTSD and other mental disorders 2,573 samples were collected and only 21.6% were diagnosed with chronic PTSD.The statistical analysis has identified risks factors that could cause PTSD, and protective actions which could help to prevent PTSD. http://www.cpementalhealth.com/content/5/1/11 Nuntika Thavichachart Sookjaroen Tangwongchai Puangsoy Worakul Buranee Kanchanatawan Siriluck Suppapitiporn Atapol Sukoltapirom na Pattalung Chutima Roomruangwong Ongart Chareonsook Clinical Practice and Epidemiology in Mental Health 2009, 5:11 2009-06-03T00:00:00Z doi:10.1186/1745-0179-5-11 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 11 2009-06-03T00:00:00Z XML AimThe increased rate of psychosis and poorer service-related outcomes in UK African-Caribbeans may in part be related to racism; racism as an aetiological factor remains comparatively under-investigated. We wanted to develop a measure of perceived racism in UK African-Caribbean patients with psychosis Methods: We modified the Perceived Racism Scale (PRS) by substituting a mental-health-services' racism domain for the employment-racism domain and administered it to a sample of 150 individuals. Results: 110 people completed the PRS with a total mean perceived racism score of 54.2 for the previous year and 71.3 for the lifetime. The modified instrument had good internal consistency, and both a similar factor-analytic structure and sampling adequacy to the original instrument.Clinical ImplicationsThe modified PRS was acceptable to the sample, withstands statistical scrutiny and produced similar totals to those in previously-tested populations. Subjective measurement of perceived racism may improve understanding of psychosis in African-Caribbeans, improve engagement and, hopefully, outcome. http://www.cpementalhealth.com/content/5/1/10 Apu Chakraborty Kwame McKenzie Gerard Leavey Michael King Clinical Practice and Epidemiology in Mental Health 2009, 5:10 2009-05-20T00:00:00Z doi:10.1186/1745-0179-5-10 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 10 2009-05-20T00:00:00Z XML Background: Benzodiazepines (BDZ) are the largest-selling drug group in the world. The potential of dependence with BDZ has been known for almost three decades now. In countries like Pakistan where laws against unlicensed sale of BDZ are not implemented vigorously the risk of misuse of and dependence on these drugs is even higher. Previous studies have shown that BDZ prevalence among patients/visitors to general outpatient clinics in Pakistan may be as high as 30%. However, no research has been carried out on the prevalence of BDZ use in psychiatric patients in Pakistan. Methods: We carried out a cross-sectional survey over 3 months in psychiatry outpatient clinics of two tertiary care hospitals in Karachi and Lahore. Besides basic socio-demographic data the participants were asked if they were taking a BDZ at present and if yes, the frequency, route and dosage of the drug, who had initiated the drug and why it had been prescribed. We used chi-square test and t-test to find out which socio-demographic or clinical factors were associated with an increased risk of BDZ use. We used Logistic Regression to find out which variable(s) best predicted the increased likelihood of BDZ use. Results: Out of a total of 419 participants 187 (45%) of the participants had been currently using at least one BDZ. Seventy-three percent of the users had been using the drug for 4 weeks or longer and 87% were taking it every day. In 90% of cases the BDZ had been initiated by a doctor, who was a psychiatrist in 70% of the cases. Female gender, increasing age, living in Lahore, and having seen a psychiatrist before, were associated with an increased likelihood of using BDZ. Conclusion: The study shows how high BDZ use is in psychiatric outpatients in Pakistan. Most of the users were taking it for a duration and with a frequency which puts them at risk of becoming dependent on BDZ. In most of the cases it had been initiated by a doctor. Both patients and doctors need to be made aware of the risk of dependence associated with the use of BDZ. http://www.cpementalhealth.com/content/5/1/9 Syed Ahmer Sumera Salamat Rashid Khan Saleem Iqbal Imran Haider Ayesha Khan Mohsan Zafar Clinical Practice and Epidemiology in Mental Health 2009, 5:9 2009-04-28T00:00:00Z doi:10.1186/1745-0179-5-9 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 9 2009-04-28T00:00:00Z XML Background: Studies from high-income countries have shown intimate partner violence to be associated with depression among women. The present paper examines whether this finding can be confirmed in a very different cultural setting in rural Ethiopia.MethodA community-based cross-sectional study was undertaken in Ethiopia among 1994 currently married women. Using the Composite International Diagnostic Interview (CIDI), cases of depressive episode were identified according to the ICD-10 diagnosis. Using a standardized questionnaire, women who experienced violence by an intimate partner were identified. A multivariate analysis was conducted between the explanatory variables and depressive status of the women, after adjusting for possible confounders. Results: The 12-month prevalence of depressive episode among the women was 4.8% (95% CI, 3.9% and 5.8%), while the lifetime prevalence of any form of intimate partner violence was 72.0% (95% CI, 70.0% and 73.9%). Physical violence (OR = 2.56, 95% CI, 1.61, 4.06), childhood sexual abuse (OR = 2.00, 95% CI, 1.13, 3.56), mild emotional violence (OR = 3.19, 95% CI, 1.98, 5.14), severe emotional violence (OR = 3.90, 95% CI, 2.20, 6.93) and high spousal control of women (OR = 3.30, 95% CI, 1.58, 6.90) by their partners were independently associated with depressive episode, even after adjusting for socioeconomic factors. Conclusion: The high prevalence of intimate partner violence, a factor often obscured within general life event categories, requires attention to consider it as an independent factor for depression, and thus to find new possibilities of prevention and treatment in terms of public health strategies, interventions and service provision. http://www.cpementalhealth.com/content/5/1/8 Negussie Deyessa Yemane Berhane Atalay Alem Mary Ellsberg Maria Emmelin Ulf Hogberg Gunnar Kullgren Clinical Practice and Epidemiology in Mental Health 2009, 5:8 2009-04-28T00:00:00Z doi:10.1186/1745-0179-5-8 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 8 2009-04-28T00:00:00Z XML Background: A computer assisted interview, the GMHAT/PC has been developed to assist General Practitioners and other Health Professionals to make a quick, convenient and comprehensive standardised mental health assessment. It has proved to be a reliable and valid tool in our previous studies involving General Practitioners and Nurses. Little is known about its use in cardiac rehabilitation settings.AimThe study aims to assess the feasibility of using a computer assisted diagnostic interview by nurses for patients attending Cardiac Rehabilitation Clinics and to examine the level of agreement between the GMHAT/PC diagnosis and a Psychiatrist clinical diagnosis. Prevalence of mental illness was also measured.DesignCross sectional validation and feasibility study. Methods: Nurses using GMHAT/PC examined consecutive patients presenting to a cardiac rehabilitation centre. A total of 118 patients were assessed by nurses and consultant psychiatrist in cardiac rehabilitation centres. The kappa coefficient (κ), sensitivity, and specificity of the GMHAT/PC diagnosis were analysed as measures of validity. The time taken for the interview as well as feedback from patients and interviewers were indicators of feasibility. Data on prevalence of mental disorders in an outpatient cardiac rehabilitation setting was collected. Results: The mean duration of the interview was 14 minutes. Feedback from patients and interviewers indicated good practical feasibility. The agreement between GMHAT/PC interview-based diagnoses and consultant psychiatrists' ICD-10 criteria-based clinical diagnosis was good or excellent (κ = 0.76, sensitivity = 0.73, specificity = 0.90). The prevalence of mental disorders in this group was 22%, predominantly depression. Very few cases were on treatment. Conclusion: GMHAT/PC can assist nurses in making accurate mental health assessments and diagnoses in a cardiac rehabilitation setting and is acceptable to cardiac patients. It can successfully be used to gather epidemiological data and help in managing mental health problems in this group of patients. http://www.cpementalhealth.com/content/5/1/7 Murali Krishna Peter Lepping Vimal Sharma John Copeland Lorraine Lockwood Margaret Williams Clinical Practice and Epidemiology in Mental Health 2009, 5:7 2009-04-13T00:00:00Z doi:10.1186/1745-0179-5-7 Clinical Practice and Epidemiology in Mental Health 1745-0179 5 7 2009-04-13T00:00:00Z XML