The European Journal of Psychiatry

Haloperidol and risperidone in the treatment of delirium and its subtypes

Background and Objectives: To compare the safety and efficacy of haloperidol and risperidone in the treatment of delirium and its subtypes Methods: We collected sociodemographic data and medical variables in addition to systematically rating all patients with delirium with the Memorial Delirium Assessment Scale (MDAS), Karnofsky Performance Status Scale (KPS) and abbreviated Udvalg for Kliniske Undersogelser (UKU) at baseline (T1), 2-3 days (T2) and 4-7 days (T3) and created an IRB-approved delirium database. For this secondary analysis we extracted all data containing haloperidol (HAL) and risperidone (RIS). Results: We were able to retrieve 32 patients treated with haloperidol (HAL) and risperidone (RIS) each. Both samples did not significantly differ in respect to age, cancer diagnoses or etiologies. The MDAS scores at baseline were higher in HAL treated subjects (20.2) compared to RIS treated subjects (17.7). The treatment results between HAL and RIS were not significantly different: Over the course of treatment MDAS scores improved from 20.2 to 8.3 (HAL) and 17.7 to 7.5 in (RIS), delirium resolution rates were 68.8% (HAL) and 84.4% (RIS). In hypoactive delirium the MDAS scores improved from 18.5 to 9.3 (HAL) and from 15.3 to 6.6 (RIS), delirium resolution rates were 64.3% (HAL) and 91.3% (RIS). In hyperactive delirium the MDAS scores improved from 22.5 to 6.6 (HAL) and 20.1 to 8.4 (RIS), delirium resolution rates were 72.2% (HAL) and 75% (RIS). There were no significant differences in KPS scores at all observation times. Treatment with HAL caused more EPS. Conclusions: Both haloperidol and risperidone may be equally effective in the treatment of delirium and its subtypes. Treatment with haloperidol resulted in more side effects.

Randomised controlled trial of cognitive-motivational therapy program for the initial phase of schizophrenia: a 6-month assessment

Background and Objectives: The aim of this study is to investigate the relative effectiveness of routine care (RC) in addition to a specific early intervention program (PIPE) compared to routine care alone. Methods: A total of 34 participants in the initial phase of schizophrenia took part in randomized, single-blind controlled trial. Participants were randomized to receive either routine care (RC; n = 13) or routine integrated with Cognitive-Motivational Therapy (PIPE; n = 21). PIPE comprised individual and family Cognitive-Motivational therapy plus routine care for 12 months. In this paper we present preliminary results at 6 months after the beginning of the intervention. Clinical assessments were carried out at pre-treatment, and in this manuscript the results at 3 and 6 months after starting the intervention by external raters are presented, using the Positive and Negative Syndrome Scale, Brief Psychiatry Rating Scale, the Clinical Global Impression Scale, the Global Assessment of Functioning scale, and relapses. Mann-Whitney test and MANOVAs analysis for variance effects were used for the statistical analysis. Results: Significant greater clinical effects were observed in those patients treated in RC+PIPE at three months from baseline assessment and at six months in PANSS scale (Mann-Whitney test; p < 0.000). Other benefits of the program included increase in global activity, reduced relapse rates, and reduction of the pharmacological treatment. Conclusions: These findings show the effectiveness of a program of routine care integrated with cognitive-motivational interventions (individual and family therapy) over routine psychiatric care alone for patients who are in the initial phase of schizophrenia.

Estimating prevalence of anxiety and mood disorder in survey data using the GHQ12: Exploration of threshold values

Background and Objectives: Our study explored the validity of different threshold values on the 12-item version of the General Health Questionnaire (GHQ12) for estimating the prevalence of anxiety and mood disorders (AMD) in Ontario population survey data. Methods: Data were drawn from the 2003, 2004 and 2006 cycles of the CAMH Monitor (N = 7,126), an ongoing general population survey of Ontario adults aged 18 and older, which includes the GHQ12. The concordance of different threshold values on the GHQ12 for determination of AMD with a criterion based on individuals who were prescribed either anti-anxiety or anti-depressant drugs in the past 12 months and who reported 14 or more mentally unhealthy days in the past 30 days was examined using receiver operator characteristic (ROC) analysis. Results: Concordance between the GHQ12 determination of AMD and the criterion measure reached "moderate" levels. ROC analysis revealed an area under the curve (AUC) of 0.89. At a GHQ12 threshold value of 4, the specificity and sensitivity values obtained were 0.92 and 0.71, respectively. Also at that value, the estimated prevalence of AMD was nearly identical to that seen in recent Canadian studies using the CIDI. Conclusions: These analyses suggest that the GHQ12 may be suitable for providing a proxy measure of AMD for epidemiological and surveillance purposes. A threshold score of 4 seems to be most suitable for these purposes when using Canadian data.

Impact of psychological disorders after female genital mutilation among Kurdish girls in Northern Iraq

Background and Objectives: This study investigated the mental health status of young girls after genital mutilation in Northern Iraq. Although experts assume that circumcised girls are more prone to psychiatric illnesses than non-circumcised girls, little research has been conducted to confirm this claim. For the purpose of this study, it was assumed that female genital mutilation is connected with a high rate of posttraumatic stress disorders (PTSD). Methods: The psychological impact of female genital mutilation was assessed in Northern Iraq with 79 circumcised Kurdish girls who were between 8 and 14 years of age. Thirty uncircumcised girls from the above area and thirty-one uncircumcised girls from other areas of Iraq served as comparison subjects. A psychological interview and further questionnaires were used to assess traumatization and psychiatric illnesses. Results: The circumcised girls showed a significantly higher prevalence of PTSD (44.3%), depression disorder (33.6%), anxiety disorder (45.6%) and somatic disturbance (36.7%) than the uncircumcised girls. We could not find any significant differences between the two control groups. Conclusions: Within the circumcised group, a mental health problem can be diagnosed that may constitute the first evidence for the severe psychological consequences of juvenile girls´ genital mutilation.

Predictors of negative attitudes toward mental health services: A general population study in Japan

Background and Objectives: As the impact of psychiatric disorders increases in Japan, finding a method of predicting attitudes towards mental health services has become increasingly important. Aims: This study examined the factors that influence negative attitude toward mental health services among a general population in Japan. Methods: Data from a survey asking 2,023 Japanese adults about desire to receive counseling, perceived level of knowledge about counseling, desire to live in the same neighborhood in the future, choice of persons to talk to about psychiatric problems, and demographic information were analyzed. Results: Women reported greater desire to receive psychiatric treatment than men did and were more often willing to consult with friends and family about mental health issues. Older individuals showed more negative attitudes than those in younger age groups. Those who anticipated staying in the same neighborhood also reported being less likely to have desire to seek treatment. Conclusions: Fear of stigma is one of the explanations of the negative attitudes toward psychiatric treatment. Given that age, gender, and perceived knowledge of treatment predicted the negative attitudes toward seeking mental health services, community intervention programs should be developed to target such populations, educate individuals, and ameliorate stigma about such treatment.

A schizoid man

Background and Objectives: More insight is needed into the etiology of schizoid personality disorder in order to construct more adequate diagnostic tools and therapeutic programs. Methods: Presentation and analysis of a case report. Results: A lack of emotional attachments to others and no rewards in social interactions was linked to a lack of motivation to learn how to recognize and respond to the feelings of others. Conclusions: Lasting depression during adolescence might trigger schizoid pathology.