The European Journal of Psychiatry

Do locked doors in psychiatric hospitals prevent patients from absconding?

Background and Objectives: In the acute treatment of acute psychiatric patients coercive measures are often required and therapeutic relationships can be affected by such measures. In this study we assessed whether opening the entrance door of an acute psychiatric ward influences absconding behaviour. Methods: An acute psychiatric ward was primarily closed (91.4%) for six months and primarily open (75.6%) for six months over the time period of one year. In this one year period, 337 patients were treated (206 male, age: 40 ± 16 years): 60.2% of the patients had schizophrenia, 13.6% had affective disorders, 11.6% suffered from addiction and 14.5% displayed other diagnoses. Results: In terms of age (t = 0.026, df = 335, p = 0.979), gender (chi² = 1.6, df = 1, p = 0.13), diagnoses (chi² = 7.337, df = 1, p = 0.062) and duration of stay (t = -0.90, df = 335, p = 0.928), we found no significant differences between the patients admitted in the closed and those admitted in the open ward period. Absconding (df = 1, chi² = 5.107, p = 0.029), aggressive incidents (chi² = 4.46, df = 1, p = 0.050) and coercive medications (chi² = 4.646, df = 1, p = 0.037) were observed significantly more often in the closed door period. Moreover, the duration up to readmission was reduced in the closed time period (t = 2.314, df = 54, p = 0.025). Conclusions: We hypothesize that open doors reduce patient's discomfort, improve ward atmosphere and aggressive acts and do not appear to increase the risk of absconding.

The anxiety between individuals with and without joint hypermobility

Background and Objectives: This study was performed to compare the anxiety disorders between individuals with and without joint hypermobility. Methods: A total of 94 Turkish volunteers, 40 subjects (38 females, 2 males) with joint hypermobility and 54 controls (47 females, 7 males) without joint hypermobility, were included in this study. We evaluated the joint hypermobility by using the Beighton scoring system in the participants and a Beighton score of at least 4 was considered as joint hypermobility. In addition, all cases were evaluated with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and Hamilton Anxiety Rating Scale by a psychiatrist in order to define their psychyatric disorders and anxiety levels, respectively. Results: Age, gender and educational levels of the participants were similar between these two groups. Mean of anxiety score was higher statistically in the study group (13.5 ± 5.3) than that of the control group (11.1 ± 4.9) (p < 0.05). No statistically a significant difference in the ratio of psychyatric disorders according to SCID-I were observed between cases with and without hypermobility. Conclusions: Anxiety scores have been found significantly higher in the group with hypermobility than that of the group without hypermobility. We strongly recommend the assessment of medical conditions, including joint hypermobility syndrome, in anxiety patients.

Impact of interaction between somatic illness and trait neuroticism on depressive symptoms

Background and Objectives: An interaction between neuroticism and burden of illness supports depressive symptoms even at subclinical level. We have assessed its effect in groups of patients with different kind of somatic illness. Methods: Depressive symptoms (SCAN 2.1) and a level of neuroticism (EPQ-R) were assessed in inpatients from 3 different hospital wards, namely the general internal, hematological and infectious wards, and in controls from the general population. Results: A total of 184 adult subjects were examined (45 with haematological malignancies, 46 treated for other, non-malignant internal diseases, 48 with HCV infection before treatment and 45 healthy persons as control). Differences in mean neuroticism scores were not statistically significant (ANOVA, F = 1.44, p = 0.23) whereas differences in mean depression scores were statistically significant (ANOVA, F = 6.34, p < 0.001). Results of ANCOVA for separate-slopes model analysis revealed a statistically significant level of interaction between groups and neuroticism in their influence on depression mean scores (F = 22.9, p < 0.001). The residual effect of the group variable was weak (F = 0.54, p = 0.21). Conclusions: The interaction is a significant factor related to depressive symptoms and can be used in estimating the extent of the psychological impact of a burden of illness.

Metacognition in schizophrenia spectrum disorders: Methods of assessment and associations with neurocognition and function

Background and Objectives: Research has confirmed that many with schizophrenia experience deficits in metacognitive capacity defined as impairments in the ability to think about thinking, both with regards to their own thinking and the thinking of others. These difficulties are related to, but not reducible to symptoms. One question posed here regards how these deficits are linked to other forms of cognitive deficits, including deficits in neurocognition, and how they and other forms of cognitive deficits are related to the ability to function. As neurocognition is degraded in schizophrenia, does the ability to think about one´s own thinking diminish? Do deficits in metacognition affect function in a manner semi-independent of deficits in neurocognition? Methods: To explore these possibilities, this paper reviews recent studies of metacognition as assessed within personal narratives of self and illness spontaneously generated by adults with schizophrenia spectrum disorders. Results: Studies are reviewed which suggest that impairments in verbal memory and executive function may interfere with the ability to form and sustain representation of one´s own internal state as well as the internal states of others. Additionally, results are detailed which suggest that metacognitive deficits directly affect function prospectively and may mediate the impact of neurocognitive deficits on functioning. Conclusions: Results are consistent with the possibility that a certain level of neurocognition is needed to think about thinking in a complex manner and that the ability to think about thinking is intimately related to the ability to work and relate to others among persons with schizophrenia.

Retinal nerve fiber layer thickness measured by optical coherence tomography in patients with schizophrenia: A short report

Background and Objectives: Our study aims to assess retinal nerve fiber layer (RNFL) thickness in patients affected by schizophrenia. Methods: Ten schizophrenic patients (mean age 39 +/- 13 years, best corrected visual acuity > 20/20, refractive error between +/-2 diopters, and intraocular pressure <18 mmHg) were enrolled. They were compared with 10 age-matched controls. In all subjects, optic nerve head (ONH) measurements, peripapillary RNFL thickness, macular thickness and volume were measured by optical coherence tomography (OCT). Results: Schizophrenic patients showed an statistically significant reduction of the overall RNFL thickness (95+/-13 µm, range: 53-110) compared with those values observed in control eyes (103+/-8 µm, range: 88-119) (p = 0.047, Mann-Whitney U test). We also observed reduced peripapillary RNFL thickness in nasal quadrant in schizophrenic patients (75+/-17 µm, range: 41-111) when compared with controls (84+/-10 µm, range: 67-105) (p = 0.048, Mann-Whitney U test). The remaining peripapillary RNFL quadrants, macular thickness and volume did not reveal differences between both groups. No statistically significant differences were observed between the control group and schizophrenia patients with regard to ONH measurements, macular thickness and volume. Conclusions: Schizophrenia patients had a reduction of peripapillary RNFL thickness evaluated by OCT. To our knowledge, neither reduced RNFL thickness nor macular thickness and volume have been previously documented in patients diagnosed with schizophrenia. These findings suggest that neuronal degeneration could be present in the retina of schizophrenic patients as previously observed in neurodegenerative disorders.