http://www.annals-general-psychiatry.com The latest research articles published by Annals of General Psychiatry 2010-03-06T00:00:00Z 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/ Background: Second-generation antipsychotic drugs have been reported to cause fewer incidences of extrapyramidal side effects (EPSs) than typical antipsychotic drugs, but adverse events such as akathisia have been observed even with atypical antipsychotic drugs. Although understanding of the pathophysiology of akathisia remains limited, it seems that a complex interplay of several neurotransmitter systems might play a role in its pathophysiology. The endoplasmic reticulum protein sigma-1 receptors are shown to regulate a number of neurotransmitter systems in the brain. Methods: We report on two cases in which monotherapy of the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the akathisia of patients with schizophrenia treated with the antipsychotic drug aripiprazole. Results: The global score on the Barnes Akathisia Scale in the two patients with schizophrenia treated with aripiprazole decreased after fluvoxamine monotherapy. Conclusion: Doctors may wish to consider fluvoxamine as an alternative approach in treating akathisia associated with antipsychotic drugs such as aripiprazole. http://www.annals-general-psychiatry.com/content/9/1/11 Tsutomu Furuse Kenji Hashimoto Annals of General Psychiatry 2010, 9:11 2010-03-06T00:00:00Z doi:10.1186/1744-859X-9-11 Annals of General Psychiatry 1744-859X 9 11 2010-03-06T00:00:00Z PDF Background: Relapse of major depressive disorder (MDD) is a common clinical problem. This study was designed to determine whether residual sleep disturbance (insomnia and hypersomnia) predict risk of relapse during the continuation and maintenance treatment of MDD. Methods: A total of 570 patients with MDD were treated with open-label, flexible dose fluoxetine (range 20 to 60 mg; mean dose = 45.8 mg/day; SD = 15.1) for 12 weeks. Under double blind conditions, 262 patients who achieved clinical response were randomly assigned to continue fluoxetine or to switch to placebo for 52 weeks or until relapse. Residual sleep disturbance during the baseline visit of the double-blind phase was assessed using items 4, 5, 6 (insomnia) and 22, 23, 24 (hypersomnia) of the Hamilton Depression Rating Scale (HDRS). Survival analysis was utilized to determine the effect of residual sleep disturbance on risk of relapse. Results: The severities of early (P > 0.05), middle (P > 0.05), late (P > 0.05), or total (P > 0.05) residual insomnia were not found to significantly predict risk of relapse during continuation and maintenance-phase treatment. Similarly, the severities of early bedtime (P > 0.05), oversleeping (P > 0.05), napping (P > 0.05), or total (P > 0.05) residual hypersomnia were not found to significantly predict risk of relapse during continuation and maintenance-phase treatment. Conclusion: The present study did not identify the severity of residual sleep disturbance among fluoxetine responders to predict risk of MDD relapse. The size of our sample may have precluded us from identifying more modest effects of residual sleep disturbance on the risk of relapse in MDD patients. Future studies are needed to further explore the relationship between residual sleep disturbance and relapse in MDD.Trial RegistrationClinicalTrials.gov Identifier: NCT00427128 http://www.annals-general-psychiatry.com/content/9/1/10 Huaiyu Yang Lara Sinicropi-Yao Sarah Chuzi Soo Jeong Youn Alisabet Clain Lee Baer Ying Chen Patrick McGrath Maurizio Fava George Papakostas Annals of General Psychiatry 2010, 9:10 2010-02-26T00:00:00Z doi:10.1186/1744-859X-9-10 Annals of General Psychiatry 1744-859X 9 10 2010-02-26T00:00:00Z XML Background: Depression is common among general trauma patients and is associated with a poor outcome. We evaluated the relationship of psychological distress to physical injury, musculoskeletal complaints, and social factors in a low-income country. Methods: We administered the Self-Rating Questionnaire (SRQ), the Oslo social support questionnaire, and the Brief Disability Questionnaire (BDQ). Results: An SRQ score of 9 or more, which indicates probable depressive disorder, occurred in 45.6% of men and 76.1% of women. A high SRQ score was associated with female sex, little or no education, low income and little social support. Even after these were controlled for there was a significantly higher SRQ score in patients with arthritis, backache/prolapsed disc, major fracture and other bone pathology. Conclusions: Depressive disorder appears to be very common in orthopaedic outpatients in Pakistan; both social circumstances and nature of bone pathology are associated with such depression. http://www.annals-general-psychiatry.com/content/9/1/9 Nusrat Husain Syed Humail Imran Chaudhry Raza Rahman Holly Robinson Francis Creed Annals of General Psychiatry 2010, 9:9 2010-02-15T00:00:00Z doi:10.1186/1744-859X-9-9 Annals of General Psychiatry 1744-859X 9 9 2010-02-15T00:00:00Z XML Background: Nearly all information processing during cognitive processing takes place during periods of sustained attention. Sustained attention deficit is among the most commonly reported impairments in bipolar disorder (BP). The majority of previous studies have only focused on bipolar I disorder (BP I), owing to underdiagnosis or misdiagnosis of bipolar II disorder (BP II). With the refinement of the bipolar spectrum paradigm, the goal of this study was to compare the sustained attention of interepisode patients with BP I to those with BP II. Methods: In all, 51 interepisode BP patients (22 with BP I and 29 with BP II) and 20 healthy controls participated in this study. The severity of psychiatric symptoms was assessed by the 17-item Hamilton Depression Rating Scale and the Young Mania Rating Scale. All participants undertook Conners' Continuous Performance Test II (CPT-II) to evaluate sustained attention. Results: After controlling for the severity of symptoms, age and years of education, BP I patients had a significantly longer reaction times (F(2,68) = 7.648, P = 0.001), worse detectability (d') values (F(2,68) = 6.313, P = 0.003) and more commission errors (F(2,68) = 6.182, P = 0.004) than BP II patients and healthy controls. BP II patients and controls scored significantly higher than BP I patients for d' (F = 6.313, P = 0.003). No significant difference was found among the three groups in omission errors and no significant correlations were observed between CPT-II performance and clinical characteristics in the three groups. Conclusions: These findings suggested that impairments in sustained attention might be more representative of BP I than BP II after controlling for the severity of symptoms, age, years of education and reaction time on the attentional test. A longitudinal follow-up study design with a larger sample size might be needed to provide more information on chronological sustained attention deficit in BP patients, and to illustrate clearer differentiations between the three groups. http://www.annals-general-psychiatry.com/content/9/1/8 Chian-Huei Kung Sheng-Yu Lee Yun-Hsuan Chang Jo Yung-Wei Wu Shiou-Lan Chen Shih-Heng Chen Chun-Hsien Chu I-Hui Lee Tzung-Lieh Yeh Yen-Kuang Yang Ru-Band Lu Annals of General Psychiatry 2010, 9:8 2010-02-15T00:00:00Z doi:10.1186/1744-859X-9-8 Annals of General Psychiatry 1744-859X 9 8 2010-02-15T00:00:00Z XML AimTo document Beck Depression Inventory (BDI) II suicidal symptoms among patients admitted to Kenyan non-psychiatric general medical facilities Methods: All consenting adults admitted within a period of 4 weeks at 10 general medical facilities in Kenya were interviewed for suicidal symptoms and depression using the BDI-II. Results: In all, 2,780 patients responded to item 9 (suicidal symptoms of the BDI-II). The prevalence of all BDI-II suicidal symptoms combined was 10.5%. Thoughts of 'killing oneself but have not carried them out' accounted for 9% of the suicidal symptoms. The younger age group had the highest prevalence of suicidal symptoms and the oldest age group had the least prevalence of suicidal symptoms. The more depressed the patients were on the overall BDI-II score, the higher the prevalence of suicidal symptoms. Conclusion: On average 1 out of 10 of the patients had suicidal symptoms, more so in younger than the older people and in the more depressed. These symptoms had not been clinically recognised and therefore not managed. This calls for clinical practice that routinely enquires for suicidal symptoms in general medical wards. http://www.annals-general-psychiatry.com/content/9/1/7 David Ndetei Lincoln Khasakhala Victoria Mutiso Anne Mbwayo Annals of General Psychiatry 2010, 9:7 2010-02-12T00:00:00Z doi:10.1186/1744-859X-9-7 Annals of General Psychiatry 1744-859X 9 7 2010-02-12T00:00:00Z XML Background: Delirium in older adults is a common and serious acute neuropsychiatric syndrome, with core features of inattention and global cognitive impairment. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Methods: We report on two cases in which monotherapy of the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the delirium of patients with Alzheimer's disease. Results: Delirium Rating Scale (DRS) scores in the two patients with Alzheimer's disease decreased after fluvoxamine monotherapy. Conclusion: Doctors should consider that fluvoxamine could be an alternative approach in treating delirium in patients with Alzheimer's disease because of the risk of extrapyramidal side effects by antipsychotic drugs. http://www.annals-general-psychiatry.com/content/9/1/6 Tsutomu Furuse Kenji Hashimoto Annals of General Psychiatry 2010, 9:6 2010-01-20T00:00:00Z doi:10.1186/1744-859X-9-6 Annals of General Psychiatry 1744-859X 9 6 2010-01-20T00:00:00Z XML Background: We present the case of a 52-year-old woman with depression who developed extrapyramidal symptoms (mainly parkinsonism) and suicidal ideation while on fluoxetine. Methods: The patient underwent neurological and neuroimaging examination. Results: The patient's neurological and neuroimaging examinations were normal and there was no other cause of extrapyramidal symptoms. The patient showed remission of the aforementioned symptomatology when fluoxetine was discontinued. Conclusions: This case shows that fluoxetine can be associated with extrapyramidal symptoms, and this may have an aggravating affect on clinical depression progress and the emergence of suicidal ideation. http://www.annals-general-psychiatry.com/content/9/1/5 Christos Christodoulou Athanasia Papadopoulou Emmanouil Rizos Kalliopi Tournikioti Xenia Gonda Athanassios Douzenis Lefteris Lykouras Annals of General Psychiatry 2010, 9:5 2010-01-18T00:00:00Z doi:10.1186/1744-859X-9-5 Annals of General Psychiatry 1744-859X 9 5 2010-01-18T00:00:00Z XML Background: There is an increasing probability that the psychiatrist will, willingly or not, come into contact with mentally ill offenders in the course of their practice. There are increasing rates of violence, substance abuse and other psychiatric disorders that are of legal importance. Therefore, the aim of this work was to investigate the rates of different mental disorders in 100 court reports and to investigate the characteristics of mentally ill offenders. Methods: All cases referred from different departments of the legal system to the forensic committee for assessment of legal accountability over 13-months duration were included. A specially designed form was prepared for data collection. Cases were classified into five groups: murder, robbery, financial offences, violent and simple offences and a group for other offences. Data were subjected to statistical analysis and comparisons between different groups of subjects were performed by analysis of variance (ANOVA). Results: Men constituted 93% of cases. In all, 73% of offenders were younger than 40 years old. Schizophrenia cases made up 13% of the total, substance related cases constituted 56% and amphetamine cases alone made up 21%; 10% of cases were antisocial personality disorders, and 51% of cases were classified as having a low education level. Unemployment was found in 34% of cases. The final decision of the forensic committee was full responsibility in 46% of cases and partial responsibility in 11% of cases, with 33% considered non-responsible. A total of 58% of cases had had contact with psychiatric healthcare prior to the offence and in 9% of cases contact had been in the previous 12 weeks. A history of similar offences was found in 32% of cases. In all, 14% of the offences were murders, 8% were sexual crimes, and 31% were violent/simple crimes. Conclusions: The ability of the legal system to detect cases was good, while the ability of the healthcare system to predict crimes and offences was weak, as 58% of cases had had previous contact with the healthcare system previously. Substance abuse, especially amphetamine abuse, played an important role. http://www.annals-general-psychiatry.com/content/9/1/4 Yasser Elsayed Mohamed Al-Zahrani Mahmoud Rashad Annals of General Psychiatry 2010, 9:4 2010-01-14T00:00:00Z doi:10.1186/1744-859X-9-4 Annals of General Psychiatry 1744-859X 9 4 2010-01-14T00:00:00Z XML Biological rhythms have always been considered to be disrupted in depression, with the predominant theory being that of hyperarousal. However, recent data suggest that it might be more appropriate to suggest that depressed patients are incapable of achieving and maintaining the particular level of internal homeostasis which permits them to function smoothly, to lower the level of arousal during sleep sufficiently so that quality of sleep is good, and to increase this level enough during the day so the person can function properly. Therefore, the transition from one state to another is somewhat problematic, delayed, incomplete and desynchronised. Thus, agents with a 'rhythm stabilising' effect could be beneficial in the treatment of mood disorders. Such an agent should have a beneficial effect on restoring and stabilising the rhythm of a physiological function while not pushing it towards a specific pole, or inducing the opposite pole; it should also allow response to internal and environmental stimuli and zeitgebers, and restore synchronisation of the various body rhythms while not inducing or worsening desynchronisation. Agomelatine could represent the first of a new class of 'rhythm stabilising antidepressants', but further research is necessary to support this theory. http://www.annals-general-psychiatry.com/content/9/1/3 Konstantinos Fountoulakis Annals of General Psychiatry 2010, 9:3 2010-01-13T00:00:00Z doi:10.1186/1744-859X-9-3 Annals of General Psychiatry 1744-859X 9 3 2010-01-13T00:00:00Z XML Background: Although many rehabilitation programmes of prevocational training for chronic mentally ill persons living in the community have been funded, there is scarce literature about the diachronic trends of their long-term employment outcome. Thus the aim of the present study was to compare the 2-year employment outcome of three groups of chronic psychiatric outpatients, having attended similar prevocational rehabilitation programmes in different periods of time. Methods: The first group (1984 to 1986) comprised 67 rehabilitees, the second (1988 to 1989) 53 rehabilitees and the third (2000 to 2001) 56 rehabilitees. The three groups were compared with regard to employment follow-up achievements and hospitalisation rates assessed at the end of the 2-year follow-up period by a constructed overall index, encompassing employment qualitative and quantitative characteristics. Results: The third group compared to the first and second ones presented a worse employment outcome. No differences were found among the three groups with regard to hospitalisation rates. Conclusions: There has been a decline in the employment outcome of prevocational training during the current decade. This decline can be attributed to contextual adverse factors such as unemployment, a more demanding labour market and disability allowances offered by the state (the 'benefit trap'). Moreover, the training itself may be 'old-fashioned' enough, thus providing the trainees with inadequate skills to obtain and maintain a competitive job. http://www.annals-general-psychiatry.com/content/9/1/2 Rossetos Gournellis Eugenia Triantafillou Michael Madianos Niki Tsinia Dimitris Ploumpidis Vlassis Tomaras Annals of General Psychiatry 2010, 9:2 2010-01-06T00:00:00Z doi:10.1186/1744-859X-9-2 Annals of General Psychiatry 1744-859X 9 2 2010-01-06T00:00:00Z XML