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Biomedical subjects

G S Ungvari

Publications and source records attributed to G S Ungvari.

At least 19 recordsLinked to original sources
PubMed2001

Electroconvulsive therapy in rehabilitation: the Hong Kong experience.

Persistent psychotic symptoms can intrude on an individual's cognitive and psychosocial functioning and interfere with that person's active and constructive participation in social and vocational rehabilitation. Amelioration or elimination of intrusive positive and negative symptoms of psychosis is the major task for clinicians during the acute phase of schizophrenia. Successful treatment permits the patient to transition into stabilization and recovery phases, when psychosocial rehabilitation can take primacy (1). The introduction of clozapine has enlarged the proportion of individuals with schizophrenia whose psychotic symptoms can be controlled (2), but symptoms remain refractory in a large number of patients. One largely unexplored alternative for treating individuals who are chronically disabled is electroconvulsive therapy (ECT). Already known for its efficacy in treating affective disorders, its effectiveness in treating schizophrenia--although more limited--has been documented over more than five decades (3,4). ECT has been found to be particularly effective in treating first-episode cases in which affective and catatonic symptoms are manifested and in 20 to 50 percent of treatment-resistant cases, including those in which the patient was nonresponsive to clozapine (5,6,7,8). Without continuation and maintenance ECT, however, results are usually short-lived (4,7,9). Tang and Ungvari have used ECT in an attempt to increase the responsiveness to psychosocial rehabilitation of patients who have treatment-refractory schizophrenia. They describe their experiences with ECT at a facility in Hong Kong, where long-term hospitalization is still the norm for a sizable proportion of patients with chronic schizophrenia. ECT is more compatible with the biological view of schizophrenia that is prevalent in Asian countries; hence it has greater cultural congruence and acceptability among consumers and families in China than in the United States.

Electroconvulsive Therapy↗
PubMed2000

Reactive psychosis: a classical category nearing extinction?

By presenting two illustrative case histories, the authors stress the importance of the classical category of reactive psychosis which has disappeared from recent international classifications as a distinct nosological entity. Reactive psychosis is essential in the differential diagnosis of acute psychoses as the diagnosis of reactive psychosis has far-reaching therapeutic implications. Clinical and conceptual issues concerning reactive psychosis are briefly reviewed with respect to major classical and modern papers.

Adjustment Disorders↗
PubMed2000

Reactive psychoses revisited.

OBJECTIVE AND METHOD: This paper describes the overlap between reactive (psychogenic) psychosis and other brief psychotic episodes, and explores the gradual disappearance of reactive psychoses as a distinct nosological entity from international classifications. Clinical and conceptual issues concerning reactive psychosis are examined on the basis of a critical review of major classical and modern papers. A brief illustrative case history is also provided. RESULTS: Reactive psychoses are conceptualised as severe disturbances of mental state, on occasion chameleon-like in their shifting form and content, arising in response to a stressful event or life situation. Reactive psychoses have an abrupt onset and usually run their course to complete resolution in a matter of days or weeks. Precipitants include overwhelming fear, threat of imminent destruction, social isolation (as can occur with imprisonment, immigration or deafness), bereavement and intense sexual or interpersonal conflicts. The emergence of a reactive psychosis usually occurs against the background of a predisposing vulnerability in terms of personality disorder, organic impairment, or a history of sensitising experiences, occasionally operating in combination. CONCLUSIONS: The increasing failure to recognise reactive psychoses diminishes clinical psychiatry because it removes an important opportunity for understanding mental disorder in terms of an integration, and totalisation, of developmental history, psychological makeup, social context and current realities, and in so doing lessens our awareness of the links between psychosis and our common humanity.

Adaptation, Psychological↗
PubMed2000

Successful ECT in a case of Leonhard's cycloid psychosis.

In Leonhard's nosological system, acute, episodic psychoses with good short-term and long-term prognoses, characterized by mixed affective and schizophrenic features, confusion, and alternating psychomotor retardation and excitement are called cycloid psychoses. According to clinical lore, patients with cycloid psychoses show an excellent and prompt response to electroconvulsive therapy (ECT). We describe a patient with typical motility psychosis, a subtype of cycloid psychoses, who failed to respond to a combination of antipsychotic and benzodiazepine medication but quickly recovered after the administration of ECT.

Adult↗
PubMed2000

Brief acute psychosis following hysterectomy in ethnopsychiatric context.

The psychiatric morbidity following hysterectomy has received increasing attention. One of the sequelae of hysterectomy has been a brief, acute psychosis with excellent outcome, the etiology and pathomechanism of which is still unclear. Two Chinese patients born of Southeast Asian origin who manifested brief, acute psychosis following hysterectomy are presented. Therapy comprised drug treatment with low dose antipsychotics and benzodiazepines coupled with hypnosis and marital therapy to explore and treat the underlying pathology. Both psychotic states resolved. Follow-up at 12 months revealed stable mental condition in one subject; however, the second patient was lost to follow up. The impact of the womb's removal is explored in the context of the ethnicity of the patients and their sociocultural background.

Acute Disease↗
PubMed1999

Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study.

Acute catatonic syndromes occurring in the context of various medical and neuropsychiatric conditions, including schizophrenia, have been shown to respond well to benzodiazepines (BZD). However, there have been no studies specifically designed to address the BZD treatment response of persistent catatonic states. Eighteen patients with clinically stable chronic schizophrenia, who also displayed enduring catatonic features, underwent a 12-week long, random assignment, double-blind, placebo-controlled cross-over trial with lorazepam (6 mg/day). A comprehensive assessment, including the subjects' clinical and motor (catatonic as well as drug-induced movement disorders) condition, was performed at baseline and four weekly intervals thereafter. Pre-existing medication was kept constant throughout the study. Lorazepam had no effect on the subjects' catatonic signs and symptoms, suggesting that acute and chronic catatonic syndromes associated with schizophrenic illness might have a different neurobiological basis.

Adult↗
PubMed1999

Gradual withdrawal of long-term anticholinergic antiparkinson medication in Chinese patients with chronic schizophrenia.

Previous antiparkinson drug withdrawal studies involving white subjects have yielded inconclusive findings, whereas there is a paucity of data concerning Asian patients. A double-blind, placebo-controlled, randomized trial using gradual withdrawal of antiparkinson medication was conducted to evaluate the need for maintenance antiparkinson therapy for clinically stable Chinese patients with chronic schizophrenia. Seventy-five schizophrenic subjects who had received a diagnosis according to DSM-IV who had been ill for at least 5 years and on antipsychotic and antiparkinson medication for a minimum of 2 years entered the study. After baseline assessment, 58 subjects were matched according to age, sex, age at onset, length of illness, dose and length of antipsychotic and antiparkinson medication, and the presence of various extrapyramidal side effects. Randomly assigned dose-reduction and control groups were formed consisting of 29 subjects each. Trihexyphenidyl (THP), the only oral antiparkinson drug used in the study, was reduced by 1 mg every 2 weeks, whereas other psychotropic medication remained unchanged. Monthly assessment was performed using the Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Abnormal Involuntary Movement Scale, Simpson-Angus Scale, Barnes Akathisia Rating Scale, and the Nursing Observation Scale for Inpatient Evaluation-30. Complete withdrawal of THP was possible in 25 (90%) of the 28 subjects who completed the study, whereas considerable dose reduction was achieved in the remaining 3 subjects. There were no significant differences between dose reduction and control groups on any of the rating scales at the completion of the study. Our results suggest that long-term prophylactic administration of antiparkinson medication is unnecessary in the treatment of the majority of Chinese patients with chronic schizophrenia because withdrawal was accomplished without adverse mental or motor effects.

Adult↗
PubMed1997

Modifying psychotropic drug prescription patterns: a follow-up survey.

Cross-sectional surveys of prescription patterns of psychotropic drugs provide a quick, global estimation of the appropriateness of psychopharmacotherapy. Recurrent inadequacies in prescribing for psychiatric patients include polypharmacy, high doses of antipsychotics (APS), the use of multiple APS simultaneously, and the administration of these drugs in multiple divided doses. Faulty prescribing patterns are difficult to amend. Following a survey in a rehabilitation facility for chronic psychiatric patients, a systematic education program and other measures were introduced to improve prescribing habits. Two years later the survey was repeated. Significant improvements were detected in the following areas: reductions in the doses of APS and antiparkinsonian (AP) drugs, reductions in the number of patients placed on these drugs, and reductions in the percentage of patients receiving multiple antipsychotics simultaneously. Despite these reductions in doses of psychotropic agents, patients' rehabilitative potential was not compromised.

Antiparkinson Agents↗
PubMed1997

A survey of antipsychotic treatment for schizophrenia in Hong Kong.

OBJECTIVE: To obtain information on prescription pattern of antipsychotic drugs for schizophrenic in-patients treated in public hospitals in Hong Kong. Four main areas of antipsychotic treatment are reported in this paper: (1) doses of antipsychotic drugs, (2) the practice of giving multiple antipsychotic agents simultaneously, (3) use of antipsychotics in divided daily doses and (4) co-administration of antipsychotic and antiparkinson drugs. METHODS: A cross-sectional survey of prescriptions of antipsychotic medication for a representative sample of 957 schizophrenic in-patients was conducted on a randomly chosen census day. Questionnaire items included basic demographic and clinical data, as well as inventory for all medications received by patients on census day. RESULTS: The mean antipsychotic dose was 854 +/- 759 (median: 600; range) 0-4450) mg CPZeq. Over two-third of the patients were given more than drug concurrently while less than 20% received the medication in multiple divided doses. Antiparkinson drugs were prescribed with antipsychotic medication in 69.61%, of the subjects. There were few differences between acute and chronic patients with respect to their respective prescription patterns. CONCLUSIONS: Antipsychotic treatment of schizophrenic inpatients in Hong Kong is largely in accord with international standards. Problematic areas identified for closer scrutiny include the concurrent use of more than one antipsychotic drug for both acute and chronic patients, and the higher than recommended doses for antipsychotic drugs and frequent use of antiparkinson medication for chronic patients. Dissemination of these results, accompanied by continuing medical education about psychopharmacology, are planned to further improve the quality of treatment for schizophrenic patients.

Adult↗
PubMed1996

Psychotropic drug prescription in rehabilitation. A survey in Hong Kong.

Rational pharmacotherapy helping chronic psychiatric patients in the difficult process of reintegration into the community is an important prerequisite of successful rehabilitation. Results of a survey conducted at the opening of a rehabilitation facility in Hong Kong revealed a number of illogicalities in prescription patterns. Frequently encountered faulty treatment decisions incompatible with the recommendations of modern literature included polypharmacy, higher than necessary doses of anticholinergic antiparkinsonian agents and giving psychotropic drugs in inconveniently divided doses. With the newly emerging subspecialty of rehabilitation-community psychiatry in Hong Kong, it is expected that large numbers of chronically hospitalized patients will enter rehabilitation programmes. The present survey indicated that it is imperative to pay continued attention to their medication status.

Adult↗
PubMed1996

A prospective outcome study of patients missing regular psychiatric outpatient appointments.

This paper describes a prospective follow-up study of defaulters of regular psychiatric outpatient appointments in Hong Kong. To establish outcome, 258 patients were traced 6 months after their non-attendance at a follow-up clinic. Results showed that 50% returned while the rest dropped out of treatment. The clinical and demographic variables, including employment, marriage, being seen by faculty rather than resident staff, a past history of default and shorter length of contact at the clinic studied (within a year), were all significant in predicting drop-out. There was a trend for those who reattended to have received a telephone reminder, to be a student and to be single. Out of the 129 drop-out patients, 84 were traced, 23 were admitted to hospital and 5 died. There were no deaths and only 5 patients required hospitalisation among the attenders. We concluded that active reengagement of psychiatric outpatient defaulters is required.

Adult↗
PubMed1996

Shoplifting and robbery in a fugue state.

The case of a 26-year-old Chinese woman with a history of benzodiazepine dependence and shoplifting who committed an act of robbery is presented. The various aetiological factors implicated in this complicated case are discussed in the light of the recent literature.

Adult↗
PubMed1996

Querulous paranoia in Chinese patients: a cultural paradox.

OBJECTIVE: There has been no reported case of querulous paranoia from the Asian population. A prospective study was undertaken to identify patients with querulous paranoia in an outpatient clinic. METHOD: One thousand, five hundred and fifty-one new referrals to a university-affiliated psychiatric outpatient clinic in Hong Kong were screened for querulous paranoia during routine clinical work. RESULTS: Three patients with querulous paranoia (0.19%) were identified during 1 year. The case histories of these three patients are reported. CONCLUSION: Possible reasons for the low reporting rate are discussed and the importance of sociocultural traditions in the development and recognition of querulous paranoia is emphasised.

Adult↗
PubMed1995

An audit study of defaulters of regular psychiatric outpatient appointments in Hong Kong.

This paper describes an audit study of general psychiatric outpatient defaulters in Hong Kong. Defaulters were increased among those who were married, unemployed, housewives, seen within one year, receiving medications and previously admitted to hospital. Clinical diagnoses (ICD-10 Axis-1) of the F1, F2, F3 and F7 groups were also associated with increased defaulting behaviour. However, fewer defaulters were found among those who were aged below 19, single, employed, students, and had diagnostic groups of F4 and F9. These results added new information on the non-attendance behavioral pattern of Chinese patients.

Adolescent↗
PubMed1995

Psychopathology of catatonic speech disorders and the dilemma of catatonia: a selective review.

OBJECTIVE: Over the past decade there has been an upsurge of interest in the prevalence, nosological position, treatment response and pathophysiology of catatonia. However, the psychopathology of catatonia has received only scant attention. Once the hallmark of catatonia, speech disorders--particularly logorrhoea, verbigeration and echolalia--seem to have been neglected in modern literature. The aims of the present paper are to outline the conceptual history of catatonic speech disorders and to follow their development in contemporary clinical research. METHOD: The English-language psychiatric literature for the last 60 years on logorrhoea, verbigeration and echolalia was searched through Medline and cross-referencing. Kahlbaum, Wernicke, Jaspers, Kraepelin, Bleuler, Kleist and Leonhard's oft cited classical texts supplemented the search. RESULTS: In contrast to classical psychopathological sources, very few recent papers were found on catatonic speech disorders. Current clinical research failed to incorporate the observations of traditional descriptive psychopathology. CONCLUSIONS: Modern catatonia research operates with simplified versions of psychopathological terms devised and refined by generations of classical writers.

Catatonia↗