F. Nacef

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries

PurposeThere is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes.MethodsThis is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of ‘low satisfaction’ were examined by comparisons of binary and multivariate associations in multilevel regression models.ResultsA final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38–48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio.ConclusionFurther studies on patients’ satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients’ disempowerment, and power imbalance.

Post - traumatic stress disorder in first episode psychosis: prevalence and related factors.

INTRODUCTION The experience of psychosis or related treatment can be conceptualized as a traumatic event, which might lead to posttraumatic stress disorder (PTSD) or PTSD syndrome (which is defined as the presence of PTSD symptoms irrespective of the DSM-IV criterion A definition of a traumatic event as an actual or threatened harm). Few studies explored the subject so far. METHODS This cross-sectional study included 52 clinically stabilized patients who were hospitalized for a first-psychotic episode during the two years preceding the study. Sociodemographic and clinical information were collected including past trauma history and drug and alcohol use. Patients were administered the Clinician-Administered PTSD Scale (CAPS), the Major Depression Inventory (MDI), the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning scale (GAF), and the Brief COPE. RESULTS A total of 22 patients (42.3%) met full PTSD criteria and 36 patients (69.2%) met PTSD syndrome criteria. Full PTSD as well as PTSD syndrome were both associated with physical restraint, higher scores on the MDI and its maladaptive coping scales. The most distressing symptoms were paranoid delusions, and the most distressing treatment experiences involved physical restraint and problems with other hospitalized patients. DISCUSSION/CONCLUSIONS Our data showed high rates of psychosis-related PTSD. To prevent PTSD, conditions of hospitalization should be optimized and the use of coercive treatments should be limited. Subjects with recent-onset psychosis should be screened for PTSD symptoms. Improving coping abilities with a well-fitted therapy would be useful in these patients.

Clozapine-induced DRESS syndrome with multiple and rare organ involvement

The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a rare, potentially life-threatening and severe adverse drug-induced reaction. The estimated incidence of this syndrome ranges from 1 in 1000 to 1 in 10,000 drug exposures (Fiszenson-Albala et al., 2003). So far, 44 drugs have been found to induce DRESS (Cacoub et al., 2011). The most commonly implicated drugs include allopurinol and aromatic anticonvulsivants, mainly carbamazepine (27% cases). To the best of our knowledge, no case of DRESS syndrome with clozapine has been reported so far.

2870 – Diabete and schizophrenia: retrospective study

Introduction Type II diabetes is more common in patients with schizophrenia than in the general population. Although disorders of glucose metabolism have been described in patients with schizophrenia before the introduction of atypical antipsychotics, a diabetogenic effect of these has been implicated. Objectives The aims of our study were to: - assess the prevalence of diabetes in a population of patients with schizophrenia. - determine the relationship between diabetes, atypical antipsychotics and schizophrenia. Patients and methods This is a retrospective study of 60 patients with schizophrenia. Data collection was done based on patient records. Results The majority of patients were male with a sex ratio of 2. The average age of our patients was 38 years. 40% of patients (25) had diabetes. 33% of patients were put under an atypical anti psychotic. The diagnosis of diabetes succeeded that of schizophrenia in 40% of cases. Conclusion Our results indicate that patients with schizophrenia are more likely to develop type II diabetes. We caution clinicians to consider the risk and be vigilant about this development.

2859 – Depression and diabetes comorbidity: prevalence and clinical features

Diabetes is one of the major health problems in the world. The World Health Organization (WHO) predicts that if current trends continue, the number of people with diabetes will double from 176 to 370 million people by 2030. Many studies have demonstrated that a comorbid state of depression incrementally worsens health compared with depression alone. In Tunisia, according to the survey of mental health in the general population, in 2005, the prevalence of depression was 35%. Objective The aim of our study was to determine the prevalence of depression in diabetic patients who consulted the Tunisian National Institute of Nutrition and to assess risk factors and clinical features of these disorders. Methodology Cross-sectional study including a population of 100 diabetic patients. A form was designed for epidemiological data collection. Depression was measured using the Hamilton Depression Rating Scale (HAMD). Results Our results showed a high prevalence of depression in diabetic subjects. 51% of diabetic patients have moderate to severe depression, 13% had mild depression, while 36% had normal values on the HAM-D. Moderate to severe depression was present in 37% of men and 42% women. Conclusion Diabetes is associated with a significantly increased risk for depressive symptoms. Our study confirms the usefulness of the assessment of depressive symptoms during follow-up of diabetic patients and the importance of an early multidisciplinary care. Pathogenetic mechanisms connecting diabetes with depression deserve further exploration.

Clozapine efficiency in tardive syndromes induced by anti-psychotic treatment

Introduction Tardive syndromes (TS) resulting from prolonged exposure to dopamine receptor blocking agents are frequent. Clozapine is considered to have a low risk of causing new onset TS and accounts therefore as an interesting option in patients with invalidating TS. Objectives Our study aims to describe clozapine indications in patients experiencing TS. Methods Presentation of the clinical cases of five patients, who experienced different kinds of TS secondary to 1st and 2nd generation anti-psychotic treatment. Results We present the cases of AB aged 41, MJ aged 40, HM aged 31 and AS aged 30, diagnosed with schizophrenia; and FB aged 24,diagnosed with schizoaffective disorder. Adverse side effects to conventional anti-psychotics such as limb and trunk tremors were described for AB, choreic limb movements, axial and segmental dystonia for MJ, AS, FB and oculogyration for FB. All patients were switched to atypical anti-psychotics without improvement of the TS. The switch to clozapine, associated with abotulinum injection for MJ, led to regression of the TS and improvement of clinical signs. In fact, according to several studies, clozapine seems to be an interesting option when invalidating TS occurs. The low prevalence of TS under clozapine can be explained by its low affinity for striatal-D2 receptors, its anti-serotonin and anti-cholinergic effects. Conclusions Clozapine should be considered in symptomatic patients who develop TS while receiving other anti-psychotics. Further research on mechanism of TS and clozapine effect on TS is needed.

2832 – Chronic renal failure and sexual functioning

Introduction Sexual function is one aspect of physical functioning. Sexual dysfunction, no matter the etiology, could cause distress. In people with chronic renal failure, sexual problems have often been neglected in clinical practice and research. The aim of this study was to assess the sexual functioning of patients with chronic renal failure. Methods A total of 50 patients with chronic renal failure on hemodialysis were included in this study. The questionnaire included thirty items: sociodemographic data, clinical factors and history, sexual functioning before and after hemodialysis. Data were analyzed using SPSS 17. Results Twenty seven per cent (27%) of the patients stated having no sexual activity at all. Eighty-three per cent (83%) of sexually active patients had sexual dysfunction. Sexual dysfunction in men was due to erectile failure, to loss of sexual interest, and to fatigue. Women reported essentially asthenia, loss of sexual interest and finally dyspareunia. These disorders appeared on average three years after being on hemodialysis. Conclusions The prevalence of sexual dysfunction was high among patients with chronic renal failure. This disorder needs special attention and management from doctors.

2858 – Handicap and quality of life

Introduction Dependence caused by motor impairment negatively impacts on the quality of life. Objectives - To assess the quality of life in people with motor disabilities - To identify the most impaired quality of life domains in our population - To describe the advantages as well as the limitations of using the WHOQOL-100 scale in our context Methods We carried out an epidemiological, cross-sectional and descriptive study in a population consisting of 60 consenting patients aged over 18, suffering from major motor disabilities. The following questionnaires were administered: - A sociodemographic and identification questionnaire. - A questionnaire designed to explore and characterize the motor disability. - The WHO quality of life questionnairein its full 100-item version (WHOQOL-100). Results Sixty people aged from 16 to 87 years were included. Only 8% were legally recognized invalid and received a disability allowance. Approximately one third of subjects did not have any health insurance, 53% of subjects lived at home and 47% lived in institutions. The overall mean score of quality of life for all domains ranged between 46.63 and 74.9. All domains of quality of life were altered except for spirituality. The level of impairment was comparable to that in stroke or in end-stage renal disease. The domain with the lowest score was sexual activity. Conclusions The quality of life of disabled people is multifactorial; it often entangles with many variables, especially the severity of the disability, the place of residence and the possibly associated depression.

2862 – Reason for psychiatric consultation in the elderly

Introduction Aging is a natural and inevitable process leading organizations live to change over time after the phase of maturity. His progress is highly variable from one individual to another. So that the old population is very heterogeneous. But this heterogeneity is also and especially due to the very high frequency and diversity of chronic diseases in this population. Objectives The aim of our study was to evaluate the different patterns of psychiatric consultations in the elderly. Patients and methods This is a retrospective study conducted in the outpatient hospital razi, involving 90 patients aged consultant during 2011. Results In total, 90 cases were recorded. The average age of patients was 77.5 years. The sex ratio (M / F) was 1.04. The majority of consultants had an iron status of married (51.1%) and widowed (41.1%). 77.8% of patients were illiterate. 63% of patients were retired and 49% of cases were low socioeconomic level. Personal psychiatric histories were found in 12% of consultants. The two reasons for consultation were the most common symptoms of depression (sleep problems, headaches, food refusal, sad mood, psychomotor retardation, somatic complaints) and behavioral disorders with 50 and 42.2% of cases. Conclusions The prevalence of psychiatric disorders is important in the elderly because half of those over age 65 suffer from a psychiatric disorder.

710 – Risperidone-associated deep venous thrombosis: case report and review

Deep venous thrombosis (DVT) is a rare but potentially life-threatening adverse effect of antipsychotic medication. In this paper, we present a case of DVT that occurred during the first month of risperidone use. The patient Mr. M., aged 33, presented with a delusion of persecution based on a purely interpretative mechanism. The diagnosis of a delusional disorder of the persecution type was made and the patient was started on risperidone 2mg bid. Two weeks later, the patient was admitted to the internal medicine department for femoro-iliac DVT. Etiological investigation ruled out common congenital as well as acquired causes for thrombophilia, and DVT was hence attributed to risperidone use. The patient quickly responded to heparin then warfarin treatment. Risperidone was switched to amisulpride. Although antipsychotics have been widely used for more than fifty years, their association with DVT has not been discovered until recently. DVT usually occurs during the first three months of antipsychotic use and is more common with atypical and low-potency typical drugs than with high-potency conventional antipsychotics. Amisulpride appears to be the antipsychotic drug least associated with DVT. This case highlights a scarce yet serious side effect associated with antipsychotic use. Caution should be applied when initiating such a treatment in patients with a high risk of thrombosis. Occurrence of DVT in a patient on antipsychotic medication should lead to the current treatment being stopped, and if necessary, switched to either amisulpride or a highpotency conventional drug.