The European Journal of Psychiatry

Acute atropine intoxication with psychiatric symptoms by herbal infusion of Pulmonaria officinalis (Lungwort)

Background and objectives: Lungwort infusion is a preparation extracted from Pulmonaria officinalis which is occasionally used as a folk remedy for the common cold. The current report aims to describe acute atropine intoxications with delirium caused by Lungwort infusion in several members of the same family. Methods: Description of three case reports. Search of literature through Medline. Results: Three generations of a same family presented acute and moderately severe atropine intoxications after drinking an infusion prepared with Pulmonaria officinalis. Conclusions: Despite the lack of scientific evidence for its clinical use, medicinal plants continue being widely used. In spite of severe adverse effects reported, the general thought is that herbal remedies are harmless. To our knowledge, this is the first report of acute atropine intoxications with psychiatric symptoms secondary to Pulmonaria officinalis in several members of a family. We suspect that the lungwort infusion may have been contaminated with some other substance with atropinic properties.

An overview of the neurological correlates of Cotard syndrome

Background and objectives: Considerable etiologic ambiguity surrounds Cotard syndrome and a range of psychodynamic, existential and biological theories have been proposed to explain its etiopathogenesis. Despite the often-noted neurological abnormalities on examination and assessment in Cotard syndrome, an in-depth evaluation is lacking. In this paper, we provide an overview of the neurological (neurostructural, neurophysiological and neuropsychological) correlates of Cotard syndrome and discuss the implications of our findings from an etiological and clinical perspective. Methods: We searched electronic databases and key journals using the appropriate search terms. All reported cases of Cotard syndrome with neurological investigations published in English were included in the review. The two authors independently reviewed the full text of over 100 papers and selected the papers for inclusion in the final review. Results: Various organic conditions such as typhoid fever, temporal lobe epilepsy, brain tumours and brain injuries have been reported in association with Cotard syndrome. The most commonly reported neurological abnormalities in these patients include structural brain changes (bilateral cerebral atrophy, dilated lateral ventricles), functional brain changes (hypoperfusion in the frontal and parietal cortices) and neuropsychological abnormalities (impaired face recognition). Conclusions: In summary, although not all, some cases of Cotard syndrome are associated with structural and functional brain dysfunction. From a clinical perspective, it is crucial to maintain a low threshold for suspicion of organicity in cases of this uncommon psychiatric syndrome, and thereafter to consider appropriate neurological investigations.

Adaptation of activity-based-costing (ABC) to calculate unit costs in Mental Health Care in Spain

Background: To date, numerous cost-of-illness studies have been using methodologies that don't provide trustworthy results for decision making in mental health care. Objectives: The aims of this paper are design and implement a cost methodology by process of patient's care to calculate unit costs in mental health in Spain in 2005 and compare the results with the reached ones by traditional methods. Methods: We adapted Activity-Based-Costing to this field analyzing the organizational and management structure of Mental Health's public services in a region of Spain, Navarre, describing the processes of care to patient in each resource and calculating their cost. Results: We implemented this methodology in all resources and obtained unit cost per service. There are great differences between our results and the ones calculated by traditional systems. We display one example of these disparities contrasting our cost with the reached one by the methodology of Diagnostic Related Group (DRG). Conclusions: This cost methodology offers more advantages for management than traditional methods provide.

Shame, sensitivity to punishment and psychiatric disorders

Background and objectives: Various studies have found significant correlations between feelings of shame and psychopathologies, as depression or eating disorders. Since some authors have shown an association between inhibition, neuroticism and shame, we hypothesize that Sensitivitybility to Punishment (SP) would relate positively to shame. We also propose that patients diagnosed with depression should score higher in shame domain than the rest of the diagnostic groups. Finally we predict that psychotic patients, since they have poor self-consciousness, should score the lowest in shame proneness. Methods: The Spanish version of the TOSCA, the Sensitivity to Punishment and Reward Questionnaire (SPSRQ) and The Clinical Global Impressions (CGI) were applied to a sample of 172 individuals, from which 93 were university students and 79 were patients receiving psychiatric treatment. Results: In the Sensitivity to Punishment domain we found statistically significant mean differences between patients with Major Depression and the comparative group. We have found a positive correlation between Sensitivity to Punishment and Shame in the general population and also for the Major depressive subgroup. The relation between depression and shame proneness was statistically significant. Shame and Guilt correlated in the TOSCA and the Major Depressive patients scores higher on both domains. Bipolar and schizophrenics patients showed lower scores in Shame than depressives. Conclusions: Among other conclussions we recomend that future studies in the field should use dimensional diagnoses besides the categorial ones.

A new spatial orientation memory test: Evaluation in patients with mild Alzheimer's disease and in patients with operated and unoperated mesial temporal lobe epilepsy

Background and objectives: Spatial orientation and spatial learning depend on the medial temporal lobe. A new test of spatial memory in humans is described, and applied to patients with Alzheimer's disease (AD), with presumable damage of that region, and to patients with unilateral mesial temporal sclerosis (MTS) submitted or not to treatment by selective surgical amygdala-hippocampectomy (SAH). Methods: Subjects were asked to go to each of four objects hanging from the wall of a room: a cylinder, a square, a ball and a triangle (trial 1). In trial 2 they repeated this blindfolded; all figures except the cylinder were removed; once the subjects reached the cylinder they had to say what figures should be at the left, right and back. In trial 3, all figures were withdrawn and the subjects, again blindfolded, were instructed first to go to the front, right, left and back, and then to go to the former positions occupied by the cylinder, the ball, the square and the triangle. Results: Experiment 1 studied 10 patients with mild AD and 10 controls matched by age, gender and schooling. Performance was 46% lower in AD patients relative to controls (p < 0.001). Experiment 2 studied 23 patients with MTS, 20 patients submitted to SAH, and 23 healthy volunteers with similar levels of age, gender and schooling. No differences in performance among these three groups were observed. Conclusions: The test distinguished performance deficits of AD patients relative to controls, but not among MTS and STH patients and controls.

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

Objective: Individuals with co-occurring psychiatric and substance abuse problems often exhibit poor outpatient treatment engagement and re-hospitalization following discharge from acute psychiatric services. Although case management can improve treatment engagement and reduce attrition, these services are often delivered indefinitely, limiting the availability of treatment slots. In an effort to reduce re-hospitalization rates and improve outcomes during the transition from inpatient to outpatient treatment, we developed and evaluated Time-Limited Case Management (TLC), an eight-week integrated mental health and substance abuse augmentation intervention. Method: Sixty-five dually diagnosed veterans admitted to inpatient psychiatric treatment were included in the program evaluation, 32 who received the TLC service in addition to Treatment as Usual (TAU) that began during inpatient treatment and continued after the transition to outpatient services, and a comparison group of 33 who received only TAU without transitional support provided through the TLC augmentation service. Results: The TLC group had fewer days and episodes of hospitalization at two and six month post-study entry. Furthermore, the TLC group exhibited greater improvements on the Global Assessment of Functioning from baseline to the six-month follow-up. Conclusion: TLC appears to be an effective transitional augmentation service with benefits that persist beyond the eight weeks of the program. Future research should include a larger and more rigorously controlled trial to confirm the efficacy and unique contributions of the intervention.

Psychosomatic Psychiatry: a European View

Background: Consultation-Liaison (C-L) psychiatry, the discipline practiced by psychiatrists working with medical patients, has expanded considerably and the approval as the newest psychiatric subspecialty in the USA has been welcomed. However, the new denomination chosen, Psychosomatic Medicine, has stirred-up controversies in Europe. Methods: Review of the literature and discussion of historical, empirical and philosophical bases for a new proposal. Results: We argue that a new denomination is appropriate, and consider the term psychiatry unnegotiable: we are dealing with a specialized area in the psychiatric field, the answer from psychiatry to meet doctors' demands; and the complexity of psychopathological problems presented in medical patients requires specialized experience. Furthermore, contrary to some reductionist, biological views, we consider psychiatry a conspicuous, humanistic medical discipline. We also support the adjective psychosomatic, which reflects the history of the humanistic and scientific 'psychosomatic movement' in medicine. However, the ambiguities surrounding the word should be minimized. Psychosomatic views have been and may still be a stimulus for productive research and for advance in the field, but the excesses of some psychogenetic, non evidence-based theories should be firmly criticized. Conclusion: We argue strongly in favour of the denomination Psychosomatic Psychiatry for the discipline practiced by psychiatrists working with medical patients, in the intersection with other medical specialities.