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Cristian Damsa

Publications and source records attributed to Cristian Damsa.

15 recordsLinked to original sources
PubMed2007

Viewing videotape of themselves while experiencing delirium tremens could reduce the relapse rate in alcohol-dependent patients.

AIMS: The aim of this prospective randomized controlled study was to determine whether viewing videotape of themselves while experiencing delirium tremens (DT) reduces the relapse rate in alcohol-dependent patients. Our hypothesis about the efficacy of videotapes exposure to DT is consistent with a cognitive behavior model. DESIGN: Sixty patients with DT and a minimum of 3 years of severe alcohol dependence [Diagnostic and Statistical Manual version IV (DSM-IV criteria] were included in this study. Patients were videotaped during the acute phase of DT and randomized into two groups: group A patients received individual exposure to their videotape and an explanation of the symptoms by a psychiatrist; and control group B patients, who were without videotape experience. Both groups received the same treatment during the acute and the maintenance phases, without aversive therapy or psychotherapy. The two groups did not differ significantly in number of drinks per day prior to admission, age, marital status, social environment, education, professional and financial status or family psychiatric history. SETTING: An in-patient crisis unit for patients with alcohol dependence. MEASUREMENTS: All patients were observed for 6 months during monthly visits. Outcomes included relapse, drinking days per week and number of drinks per drinking day. All patients and their families signed informed consent. FINDINGS: The patients with videotape experience had a significantly lower relapse rate after the first month (0% versus 20%), 2 months (13.33% versus 46.67%) and 3 months (26.67% versus 53.33%). Patients with videotape experience had less severe relapses and consumed fewer units of alcohol than controls. CONCLUSIONS: Videotape exposure in delirium tremens is an original therapeutic method which seems to be effective in reducing relapse risk in patients with alcohol dependence.

Adult↗
PubMed2005

Economic impact of crisis intervention in emergency psychiatry: a naturalistic study.

OBJECTIVE: This is a naturalistic study comparing the outcomes of all emergency psychiatric interventions in the Hospital Center of Luxembourg during two periods of six months each, before and after the introduction of a crisis intervention program. The aim of the study was to investigate the clinical and economic impact of crisis intervention on psychiatric emergency admissions. METHODS: All subjects admitted to the emergency psychiatric unit during the two study periods were considered for participation. Data were collected retrospectively and comparisons were made between patients before (September 1, 2001 to February 28, 2002) and after (September 1, 2002 to February 28, 2003) crisis intervention programs were established. RESULTS: A comparison between the two patient groups demonstrated a significant decrease in the rate of voluntary hospitalizations after crisis intervention, and a significant increase in the number of patients with subsequent outpatient consultations. The cost increase due to ambulatory follow-ups was widely compensated for by the cost decrease due to hospitalization avoidance. CONCLUSIONS: These preliminary findings suggest that crisis intervention leads to a shift from hospitalization to outpatient psychotherapeutic management in emergency psychiatric services, which has a significant economic impact.

Adult↗
PubMed2005

[Major depressive disorders and psychiatric emergencies: a naturalistic study on crisis intervention relevance].

OBJECTIVE: This retrospective study aimed to evaluate the impact of introducing crisis intervention patterns in the emergency unit of a general hospital on the number of admissions and outpatient follow-ups for patients with major depressive disorder. METHOD: The study included all patients with major depressive disorder (DSM-IV criteria) who visited the psychiatric emergency unit in a general hospital during two 8-month periods: before (425 patients) and after (436 patients) crisis interventions were introduced. RESULTS: After crisis interventions were introduced, the voluntary admission rate decreased significantly (from 17.9% to 12.4%), while the number of outpatient follow-ups increased (from 82.1% to 86.2%). Borderline personality disorder was associated with a significant reduction of the admission rate (27.8% against 38.2%), while the admission rate for patients with depressive disorder with psychotic features did not decline after crisis interventions. Crisis interventions were more effective on women. CONCLUSIONS: These outcomes suggest the relevance of crisis intervention in psychiatric emergency settings to improve the management of patients with major depressive disorder. Crisis intervention fosters outpatient multimodal follow-up rather than admission in a psychiatric setting.

Adult↗
PubMed2005

Recurrence of post-traumatic stress disorder and antiretrovirals.

This is the first report of a patient who experienced a recurrence of PTSD repeatedly after 2 attempts to initiate antiretrovirals including efavirenz for HIV infection. After recurrence of PTSD, the patient showed an important decrease in viral load and a higher CD4 level despite a bad compliance to antiretrovirals.

Adult↗
PubMed2005

New fields of research in posttraumatic stress disorder: brain imaging.

PURPOSE OF REVIEW: This paper reviews the most recent literature on brain imaging research in posttraumatic stress disorder. Neuroimagery identifies several cerebral modifications occurring after a significant psychological trauma, and it contributes to a better understanding of the pathophysiology of posttraumatic stress disorder. A systematic search of the literature in English, French, German and Dutch from January 2003 to August 2004 was performed on MEDLINE. References cited in all trials were searched iteratively to identify missing studies. RECENT FINDINGS: There appears to be a consensus in brain imaging findings concerning posttraumatic stress disorder: a diminished volume of the hippocampus uni- or bilateral (on the structural level) and a hyper-reactivity in the amygdala, with a lowered activation in the anterior cingular cortex (at the functional level). These findings are in agreement with several neurological and psychological studies suggesting that hyper-reactivity in the amygdala corresponds to a constellation of symptoms of anxiety in posttraumatic stress disorder, while the lowered activation of the prefrontal and the anterior cingular cortex could reflect slower extinction of a conditioned emotional response. SUMMARY: These neuroimaging findings could contribute to a better understanding of posttraumatic stress disorder. The integration of neurobiological, social and psychological findings may lead to an improved approach to the pathophysiology of posttraumatic stress disorder and perhaps to the development of new pharmacological treatment. Future studies could integrate the disparate findings among numerous biological systems and propose an integrative structural, functional and endocrinological model.

Journal Article↗
PubMed2005

[Psychiatric comorbidity in epilepsy].

Patients with epilepsy have a high prevalence of psychiatric comorbid disorders. Many comorbidities have a significant impact on the medical management and quality of life of these patients. The main psychiatric complications in epilepsy include depression, anxiety disorders, and psychosis. Depression in epilepsy is very common, particularly among patients with partial seizures of temporal lobe origin. Despite its high prevalence, depression and other psychiatric complications remain often unrecognized and untreated in patients with epilepsy, and differential diagnosis may be difficult.. Comorbidity of epilepsy may be due to a shared pathophysiological mechanism, however, coincidence or selection bias cannot always be excluded. In addition, genetic, psychosocial and iatrogenic factors may also contribute to the comorbidity. In this review, we discuss the clinical impact of main psychiatric comorbidities and demonstrate that treatment of epilepsy extends far beyond seizure control.

Anxiety Disorders↗
PubMed2005

[Crisis interventions: a psychotherapeutical challenge for psychiatric emergencies?].

Taking care of patients consulting the emergency psychiatric unit, raises nosological, legal, ethical and even logistic questions for the emergency departments. The need for emergency psychiatric interventions has grown constantly during the last twenty years and clinicians were challenged to find a new psychotherapeutic approach, more focused on the actual symptoms presented by the patients than the 'classic' psychiatric interventions. The goal of this article is to discuss the possibility of a psychotherapeutic approach in an emergency department, departing from a treatment model that has been developed at the psychiatric emergency of the University of Milan. In this approach, the psychotherapeutic treatment is divided in four different stages: preparation, incubation, transformation and verification. The "psychiatric crisis" becomes an opportunity to change for the patient, being a passage rite towards a new and better psychological functioning.

Crisis Intervention↗
PubMed2004

"Dopamine-dependent" side effects of selective serotonin reuptake inhibitors: a clinical review.

OBJECTIVE: Neurophysiologic findings indicate an inhibition of dopaminergic neurotransmission by selective serotonin reuptake inhibitors (SSRIs). This article highlights the relationships between changes in dopaminergic neurotrans-mission induced by SSRIs and the occurrence of certain side effects such as hyperprolactinemia, extrapyramidal symptoms, sexual and cognitive dysfunction, galactorrhea, mammary hypertrophy, and, more rarely, gynecomastia. DATA SOURCES AND SELECTION: A systematic search of the literature in English, French, and German from 1980 to 2004 was performed in MEDLINE, EMBASE, and the Cochrane Library using the keywords SSRI, dopamine, serotonin, side effects, antidepressants, citalopram, escitalopram, sertraline, paroxetine, fluoxetine, fluvoxamine, and nefazodone. References cited in all trials were searched iteratively to identify missing studies. All studies concerning inhibition of dopaminergic neurotransmission by SSRIs and SSRI-related side effects were considered. We retained 62 significant articles debating the subject. DATA EXTRACTION AND SYNTHESIS: We critically reviewed the studies, depending on the methodologies (case reports, clinical reports, randomized studies), and assessed the pertinence of "dopamine-dependent" SSRI-related side effects. The analytic review of these articles suggests that some specific SSRI-related side effects be classified as dopamine-dependent. CONCLUSIONS: At a clinical level, it could be useful to underline dopamine-dependent characteristics of some SSRI-related side effects. This approach would allow clinicians the opportunity to search other dopamine-dependent side effects systematically. At a pharmacologic level, this approach could stimulate the development of molecules with a "corrective" function on dopamine-dependent side effects of SSRIs by facilitating dopaminergic neurotransmission.

Basal Ganglia Diseases↗
PubMed2003

[The impact of crisis intervention on the management of patients with personality disorder].

The aim of this study was to investigate in psychiatric emergency unit at Hospital Center of Luxembourg the impact of crisis intervention on the management of patients with personality disorder. There were included in this study all the patients with the diagnosis of personality disorder (axis II, criteria DSM IV), even the reason for emergency consultation was related to a disorder diagnosed on the axis I (criteria DSM IV). Data were retrospectively collected to compare patients examined in the psychiatric emergency unit during five months, from 1st September 2001 to 31st January 2002, with those examined from 1st September 2002 to 31st January 2003 and able to benefit from a crisis intervention. The results show a significant reduction of voluntary hospitalizations and a significant increase of the number of patients with more than five outpatient consultations, after the introduction of crisis interventions. The theoretical frame of our psychotherapeutic interventions is briefly exposed. The results of this study emphasize the importance of crisis interventions in psychiatry for improving the management of patients with a personality disorder.

Crisis Intervention↗
PubMedDate not supplied

Heisenberg in the ER: observation appears to reduce involuntary intramuscular injections in a psychiatric emergency service.

INTRODUCTION: Chemical restraint is controversial. Appropriate use is ill-defined and chemical restraint may be overutilized. During the period of an unrelated observational study for patients with acute psychomotor agitation in a psychiatric emergency service, we noticed a significant reduction in the number of involuntary intramuscular injections administered. RESULTS: We observed a 27% decrease (P=.015) in the number of involuntary intramuscular injections in the 3-month observational study period, compared to 3-month periods before and after the study. CONCLUSION: We suggest that the observation process itself may have been beneficial and may have reduced the incidence of unnecessary intramuscular injections.

Acute Disease↗
PubMedDate not supplied

Restless legs syndrome induced by citalopram: a psychiatric emergency?

OBJECTIVE: The objective of this case report is to create awareness on restless legs syndrome (RLS) among clinicians working in emergency units. METHOD: We describe a case reporting important aggravation of RLS associated with citalopram, 60 mg/day, in a 48-year-old woman who was sent to the emergency unit by her general practitioner. Citalopram was replaced by bupropion, 150 mg/day, and sertraline, 50 mg/day. RESULTS: Three days later, symptoms of RLS started to diminish and, after 3 weeks, clinical symptoms had disappeared entirely. On 6-month follow-up, the patient did not manifest clinically significant RLS. Ignoring RLS could lead to a worsening of symptoms and could increase the risk for iatrogenic conditions. The prevalence of RLS in the general population is 3-9%; nevertheless, this syndrome is frequently underdiagnosed. CONCLUSION: This case report suggests that RLS could be considered as a possible "dopamine-dependent side effect" of selective serotonin reuptake inhibitors (SSRIs). Bupropion could potentially "correct" dopaminergic dysfunction in RLS, and sertraline appears to be the SSRI that provides the least risk of RLS by blocking dopamine reuptake.

Adenocarcinoma↗
PubMedDate not supplied

Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention.

OBJECTIVE: In spite of much effort to create guidelines on the management of violent behavior (VB) in emergency departments, little is known about the impact of such guidelines on a real-life emergency environment. The aim of this study is to investigate the impact of a staff educational crisis intervention (SECI) on the reduction of VB in patients admitted to emergency departments following drug suicidal attempt. METHOD: The impact of a SECI on VB of patient consulting the ER following a drug suicide attempt was assessed by comparing the occurrence of VB before (5 months) and after (5 months) the introduction of a SECI. RESULTS: A significant reduction in VB (from 17.32% to 7.14%) was found with the comparison of two 5-month periods: before (254 patients) and after (224 patients) the introduction of a SECI program (chi(2)=11.238; P=.0008). CONCLUSION: These preliminary data suggest the need for further prospective randomized studies aiming to prevent VB in emergency departments by developing specific SECI programs.

Crisis Intervention↗
PubMedDate not supplied

Intramuscular olanzapine in patients with borderline personality disorder: an observational study in an emergency room.

OBJECTIVE: Despite the frequency of borderline personality disorder (BPD) in patients with acute agitation in emergency departments (EDs), there are few data about the use of intramuscular (IM) psychotropics in those patients. This is the first open-label study with olanzapine in this setting. METHOD: Measures were collected prospectively for patients with acute agitation in ED. Consent was obtained subsequently and diagnosis ascertained using the Structured Clinical Interview for DSM-IV. A group of 25 patients with severe agitation and BPD received olanzapine 10 mg IM. Efficacy and safety data are available at baseline, 2 h postinjection and at discharge. RESULTS: Significant reductions of agitation associated with good tolerance were observed 2 h after the first IM olanzapine. Sixteen percent of patients required a second IM olanzapine. CONCLUSIONS: Randomized, placebo-controlled studies are needed to confirm the efficacy of IM olanzapine in patients with acute agitation and BPD.

Adult↗