Re: psychiatry in the Nazi era.
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Euthanasia↗
Biomedical subjects
Daniel Matusevich
Publications and source records attributed to Daniel Matusevich.
[Psychotic disorder secondary to suprarenal insufficiency caused by exogenous corticoids. Review of literature and a case report].
OBJECTIVE: Since their introduction as therapeutic agents, corticosteroids have been associated with psychiatric symptoms ranging from mood disturbances to (florid) psychosis. By the time there have been reported psychotic reactions in patients receiving steroids or after sudden withdrawal of long time corticosteroid therapy. We communicate a clinical case in which the exogenous short-treatment with corticosteroids produced an hypothalamic-pituitary-adrenal axis inhibition leads to a psychotic disorder two weeks later. METHOD: Case presentation, clinical and research literature review, and theoretical discussion. RESULTS: There is consensus in the literature that corticosteroids may induce psychotic disorders, but the published evidence documenting so is scant, consisting only of case reports. We did not find any reported case provoked by depot steroids like the one we present. CONCLUSIONS: The literature concerned with the prevention and management of corticosteroid-induced psychiatric adverse effects is rudimentary, and contains large amounts of clinical anecdotes. Due to the lack of formal and validated studies, these reports currently provide the only available direction to clinicians in managing these problems.
Adrenal Insufficiency↗
[High-dose fluoxetine-induced mania. Review and case report].
We report the case of a 53 year old woman who attempted suicide taking one high-dose of fluoxetine, developing a manic episode 19 days later. We also make a review about antidepressant-induced mania. In patients with mood disorder, the frequency of antidepressant-induced mania switch has been estimated to be 3.7 to 33%, varying across studies that included different diagnoses and different antidepressant treatments. Among the used data basis (Medline) there are papers reporting fluoxetine-induced mania. All of them include patients receiving adequate dose and time fluoxetine treatment. We found no reports of switch occurring after one high-dose of fluoxetine. As the impact on the clinical management of antidepressant-induced manic switches is quite high, several studies have focused on the possible clinical predictors of this phenomenon. By the time, is not possible to determine whether a manic episode is due to the natural course of bipolar disorder or to the medication. Thus, the phenomenon of antidepressant-induced mania should be defined and investigated with controlled prospective studies.
Bipolar Disorder↗
[QEEG and brain mapping. Historial develoment, clinical practices and epistemological issues].
Although it has been more than two decades since brain mapping was introduced in medicine, its scientific value and clinical practice have not been proved. This paper makes an overview about the historical development of brain mapping, its usefulness in psychiatry and lays epistemological issues concerning the role of technology in medical settings. Both historical and technological development of qEEG gives us the opportunity to think about complexity between ethics, science, technology and medicine.
Brain↗
[Suicide attempts in elderly people. Data from the Hospital Italiano de Buenos Aires].
OBJECTIVE: [corrected] The aim of this paper is to analyze some characteristics of 25 patients, over 60, who attempted suicide and were hospitalized in the Department of Psychiatry of a general hospital in Buenos Aires. METHODS: This is a retrospective study using data from the medical records of patients (1999 to 2002); based on a protocol comprising an analysis of attempted suicides, demographic and clinical variables. Patients were diagnosed following the DSM-IV criteria by two trained GPs and were confirmed by MMPI and Rorschach. RESULTS: 72% were women. The average age was 73,8 % were divorced, 20% never married, 32% widowed and 32% married. The most frequent diagnosis was Major Depressive Disorder of late onset followed by Personality Disorder ( 96%; 48%). The most frequent method was intoxication, (68.75% BDZ). Almost half of the attempts were highly severe. DISCUSSION: We may infer that the elderly person who attempts suicide: is female, 68-78 years old, does not have a partner, lives with someone, has Major Depressive Disorder (at least half of them had Personality Disorder) and a clinical disease. This is her first attempt, is alone at home, and she does not advise others. Reduced hearing is a very frequent co-morbidity.
Aged↗
[Major depressive disorder in suicide attempts among over 60 years old patients].
OBJECTIVE: [corrected] We analyze the presentation and duration of symptomatology and the treatment received by depressed patients prior to their suicide attempt. METHOD: This is a retrospective study using data from the medical records of patients -over 60- who were hospitalized for attempted suicide in Hospital Italiano, Buenos Aires (1999 to 2002). Diagnoses: DSM-IV criteria (by 2 trained GPs) and MMPI, Rorschach, and HDS. RESULTS: The initial symptomatology was: asthenia, weight loss, anhedonia and hopelessness. 83% with 1 to 6 months of duration. Patients who were under treatment with a psychiatrist (45.8%) were receiving: 7 adequate antidepressant doses (100% with SSRI), 3 insufficient doses (Tricyclic), and 1 no AD at all. 100% were on BDZ. 63% with neuroleptics. Of the remaining 13 patients, 11 were under treatment with a GP. This group were receiving: 2 the right antidepressant therapy (SSRI), 1 insufficient doses of Amitriptyline, and 8 were under no antidepressant therapy (72.7%). 6 of these 8 patients received BDZ and 1 was medicated with Haloperidol. CONCLUSIONS: The entire group taken into account, were not receiving the right treatment for Major Depressive Disorder. The duration of the depressive symptomatology prior to the attempt was long enough to be detected.epidemiological
Age Factors↗
[Dementia, suicide attempts and suicide. A case study].
The prevalence of suicide or attempts to suicide in patients with any sort of dementia has not been sharply established. The only figures found through a bibliographic search on Medline belong to a paper by Larson (13) dated 1963, who points out that only 0,8 per cent of men and 0,3 per cent of women suffering dementia commit suicide. Although persons over 65 years old are less than the 13 per cent of the world total population, they actually commit between the 17 per cent and the 25 per cent of all the suicides. Usually it was claimed that people with dementia do not commit suicide, on one hand, because of the failure in the executive abilities and in the capability to carry it on, and due to the lost of insight, on the other, both of them acting as protective factors. The aim of this article is to analyse the five clinical cases of patients with dementia that were hospitalized in a psychiatric service of a general hospital after trying to commit suicide, and then compare these cases with other four cases of patients with dementia that commit suicide reported in the international literature.
Aged↗
[A comparative study of suicide notes in over 65 years old patients (preliminary data)].
OBJECTIVE: To determine, in older suicide attempt inpatients, differences between leaving a suicide note and not leaving it as regards age, sex, marital status, religion, living alone, level of education, present psychiatric treatment, severity of suicidal attempt, previous suicidal arousal, afterwards suicidal arousal, suicidal ideation, hopelessness, depression, dementia, narcissistic personality disorder, physical pain, previous suicide attempt, familiar history of suicide or suicide attempt. MATERIAL AND METHODS: This is a comparative, prospective, observational, transversal, single blind study. RESULTS: We studied 31 patients. Statistical significant associations were found between leaving a suicide note and hopelessness (p=0.03;OR=8.57;IC=1.19-95.33) and severe suicide attempt (p=0.022;OR=8.40;IC=1.28-63.88). DISCUSSION: Although associations between writing suicide notes and hopelessness have not been reported, our results are not surprising because, on one side, the severity of the suicide attempt is more related to hopelessness than to any other depressive parameter and, on the other side, leaving a suicide note is associated to severe suicide attempts. Finally, to feel hopeless and to leave a suicide note are associated to severe suicide attempts.
Aged↗
[Qualitative analysis of eight suicide notes of elderly people].
We analize and classify eight suicide notes left by elderly patients who attempted suicide; older adults leave more frequently suicide notes. We used the typologie created by Jacobs in 1967 who classifies the notes in five categories. The issues which frequently appear are: physical illnes, cronic pain, loneliness, disability, depression and isolation.
Aged↗
[Suicidal behavior in adolescents. Risk factors (bibliography review and descriptive-analytical study)].
UNLABELLED: In the United States suicide is the third cause of death among adolescents. Suicidal behavior has increased a hundred percent over the last three decades; it is one of the most frequent psychiatric emergencies and the first cause of admission among inpatients between 15 and 24 years. OBJECTIVE: This paper is divided in two parts. The first one is made up of a review about risk factors for suicidal behavior in adolescents. The objective of the second part study is to estimate the frequency of risk factors for suicidal behavior in a sample of inpatients and to correlate them with high lethality suicidal attempts. METHOD: This is a retrospective, observational, descriptive, analytic transversal study based on information from 23 medical records. Variables were processed by bivariated analysis; relative risk was obtained considering high lethality suicidal attempt as dependent variable. RESULTS: Statistically significant relationships were found between high lethality suicidal attempt and no Axe II diagnosis and with the appearance of hopelessness. DISCUSSION: Suicidal attempts in adolescents with an Axe II diagnosis could be more related to self-harming than to a wish to die. Hopelessness can be considered an independent variable that determines the lethality of the suicidal attempt.
Adolescent↗
[First non harm: the role of psychiatry in nazi Germany].
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Germany↗
[Ethical aspects of psychiatric practice in Argentina: a survey].
The following paper is the last one of three, whose primary target consists of reflecting on the present psychiatric practice and about the ethical questions that of her are given off. We expose the results of a study, made from a survey to a population of psychiatrists of Argentina that investigate our intellectual and clinical reality. We describe the different characteristics, some of which we considered essential for the clinical practice and tried to determine the relevance that formation and readings in ethics have for the psychiatrists, along with the relevance granted to the social and anthropological aspects of our specialty at the moment of clinical attention.
Argentina↗
[Pictures of autism in the American cinema].
The aim of this article is to analyze the different ways in which the autism appears in the american cinema; the genres chosen are comedy, thriller and road movie because they represent classical movie patterns. The movies commented are: Mercury rising, Rainman, Who eats Gilbert Grape.
Autistic Disorder↗
[Hospitalization of patients with eating disorders: an eight years review].
Eating disorders (Eds) are pathologies with a multifactorial etiopathogenesis. Their treatment requires an interdisciplinary team. The aim of this paper is to discuss in patient treatment (n=80) of patients with eating disorders during eight years. This treatment was in charge of the Eating Disorders Team of the Hospital Italiano of Buenos Aires. The approach to critical stages of eating disorders envolves the clinical or psychiatric admission of the patients as the principal means to ward off patients from death or the appearance of cronifications. 77,5% of the patients were admitted to the psychiatric ward, 5% to a clinical ward and 17,5% to a clinical followed by a psychiatric ward. The average B.M.I. in admission was 16,83. The average time in psychiatry was 35 days. During inpatient treatment 21,25% required a nasogastric tube and 82% received psychopharmacological treatment. The mortality rate was 1,25%. During the ambulatory treatment that followed hospitalizations, 32,5% were readmitted to the psychiatric ward and there were 10% of dropouts. Hospitalization of these patients looks after the achievement of healthier eating habits and the establishment of a therapeutic alliance which allows the follow up of an ambulatory treatment.
Adolescent↗
[Therapeutic community model in short psychiatric hospitalization. Descriptive study on the dynamic psychiatric inpatient unit of the Italian hospital of Buenos Aires].
OBJECTIVE: the aim of this paper is to communicate a project of short term psychiatric hospitalization, based on a therapeutic community model, considering qualitative and quantitative aspects in the present socio - cultural context. INTRODUCTION: this psychiatric hospitalization model that embraces psychodynamic and pharmacological interventions is focused in the intensity of interactions between members of the therapeutic community and integrated to the administrative structure of a general hospital; this will be the key to consider patient's return to the community and to move forward over the prejudices that inpatients suffer. MATERIAL AND METHODS: quantitative, prospective, observational and transversal study on a Dynamic Psychiatric Inpatient Unit. 605 patients were included. RESULTS: mean length of stay was 16.34 days; principal causes of admission were depression (19.4%), suicide ideas (17.7%), suicide attempt (17.6%), substance abuse or dependence (14.3%), psychosis (13.8%), behavioral and psychological symptoms of dementia (6%). There were 75 readmissions. 14.88% patients were physically restrained. Principal Axis I diagnosis were depression (32.1%), substance dependence (13.2%), bipolar disorder (10.2%), dementia (7.6%), schizophrenia (7.5%), and psychotic disorder (5.8). Axis II diagnosis were borderline personality disorder (27.3%), narcissistic personality disorder (8.9%), histrionic personality disorder (5.3%). DISCUSSION: this kind of approach shows a structural model that allows possible and persistent favorable changes for psychiatric inpatients.
Argentina↗
[Sexuality and dementia: a case study].
In this paper we will discuss about sexuality in people with dementia, trying to show difficulties that arise and that affect the patient, his or her partner, the family and the geriatric institute if the patient lives there. Five clinical cases are described and deeply analyzed. Many times psychotropic medications are central in the treatment plan for people with dementia and some kind of sexual difficulty; but this is not enough. We think that it is necessary to combine pharmacologic approaches with others from human sciences that fit with our patients' difficulties.
Aged↗
[Psychogeriatric unit within a General Hospital. Descriptive analysis of outpatient assessment, diagnosis and treatment].
OBJECTIVE: To assess the frequency of some epidemiological variables in 200 patients over 65 years old that came to admission as outpatients in the psychogeriatric area in the psychiatric unit at the Hospital Italiano in Buenos Aires, Argentina. METHOD: A specific questionnaire was completed by both patient (or relative) and the physician. RESULTS: 83% were female and 17% male. The most important diagnosis were depressive disorder (34%), adaptive upheavals (28%) and dementia (16%), within this group, major depressive disorder and Alzheimer dementia. Only a 31% patients went under a neuropsychological assessment psychotherapy was indicated to 18% of the patients, pharmacology for 39%, memory improvement group for 18% and combined treatment for 25%. CONCLUSION: This paper brings data regarding outpatients over 65 years old with psychogeriatric treatment. This may improve the health system in psychogeriatric area taking into account socio-cultural and economic factors.
Aged↗
[Adolescents' suicide attempt with their parent's psychotropic medication: descriptive study].
OBJECTIVE: To determine the frequency in adolescents under 21 years old hospitalized in the Psychiatric Unit of Hospital Italiano of Buenos Aires because of suicide attempt with pills taken by their parents. POPULATION AND SAMPLE: This study was carried out in a population of patients under 21 years old hospitalized in the Psychiatric Unit of Hospital Italiano of Buenos Aires between September 2004 and February 2006. MATERIAL AND METHOD: This is a quantitative, prospective, observational and transversal study. The variables considered were age, gender, cause of admission, suicide method. When the attempt was done with pills we considered what kind of pills and whom they belong to; we also asked about familiar psychiatric history and familiar history of suicide attempt and suicide. RESULTS: We analyzed data from 85 patients. 67% (n=57) were female and 33% (n=28) male. Age range was between 13 and 21 years with a media of 18,05 +/- 2 years. The principal cause of admission was suicide attempt (40,5 +/- 3,68%) (n=45). The suicide attempt method most frequently used was the ingestion of pills (77,8 +/- 9,6%) (n=35). DISCUSSION: The majority of adolescents who took pills did it with medication belonging to their parents ( 82,8 +/- 16,32%) (n=29). Within this medication 93% (n=27) were psychotropics. The availability of suicide methods is related directly to suicide. Without this methods near many autoagressive impulses may be restrained. The importance of this availability of this methods is often underestimated instead of being modified by prevention.
Adolescent↗