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Zaniewska-CHLOPIK U.,Zespol Leczenia Srodowiskowego | Soful A.,Zespol Leczenia Srodowiskowego | Janota B.,Kliniczny Oddzial Psychiatrii | Zaluska M.,IV Klinika Psychiatrii
Postepy Psychiatrii i Neurologii | Year: 2013

Aim. Assessment of prevalence and factors connected with abnormal body weight in patients with non-organic mental illness admitted to a psychiatric ward. Methods. A group of 210 schizophrenic, affective and adjustment disorder patients underwent a study procedure aimed at assessing the prevalence of those who are underweight, overweight and obese. The relation between BMI and some demographic factors, as factors connected with the illness, was analyzed. Results. Out of all the patients that were tested, 8.1% were underweight while 47.6% were overweight. There was no relation observed between BMI and clinical diagnosis, as well as sex, educational level and employment. A positive correlation was observed between BMI and age, the presence of a life partner, antipsychotic medication, duration of the illness and the number of previous hospitalizations; however the negative correlation occurred between BMI and abusing the alcohol or other psychoactive substances. In the analysis of regression different predictors of high BMI in different diagnostic groups were found. In the case of patients with adjustment disorders it was low educational level, and having life partner; in schizophrenia the age of the patients and taking antipsychotics whereas no predictors as such were identifi ed in patients with affective disorders. Conclusions. Being overweight and underweight seem to be important features to take into account in the patients admitted to psychiatric wards. In schizophrenia the positive correlation between BMI and medication with antipsychotics underlines the need for monitoring metabolic parameters, and introducing appropriate education to the patients and their families. Among the patients with adjustment disorder the risk factors seem to be connected with the culture and customs. There exists a need for investigation of the risk factors for overweight patients in largerof patients with affective disorders. © 2013 Instytut Psychiatrii i Neurologii.

In depression an increase, decrease, or a relative deficiency of dehydroepiandrosterone (DHEA) and the beneficial effects of its administration were observed. The correlation of low serum DHEA level and increased cardiac risk was confirmed in healthy subjects only in men (not in women). Taking into consideration the increased risk of heart disease in depression, it is interesting to investigate the level of DHEA, DHEA-S, and cortisol, as so its correlation with lipid profile, and reaction to treatment in women with depression. Aim. To assess serum ACTH, cortisol, DHEA and DHEA-S, and their relationship with lipid profile in depressed females, including the treatment response and stress load. Method. In 11 healthy females and 18 with depression, the following were examined before and after treatment: the severity of symptoms (on the Hamilton and Beck Inventory Depression scale), serum cortisol, DHEA, DHEA-S, and lipidogram. The results were compared in healthy and depressed females, and in relation to the therapy and stress load. The correlation of DHEA, DHEAS, and cortisol with lipid profile was analysed. Results. In females poorly responsive to antidepressant treatment higher serum cortisol, ACTH and DHEA. The lipid profile did not vary in the depressed and healthy females. Serum DHEA correlated negatively with serum cholesterol (total and LDL fraction) in healthy women but not in depressed women. Conclusions. DHEA deficiency and the rationale for its supplementation were not confirmed in depressed women. The protective action of DHEA to hypercholesterolemia was confirmed in healthy, but not in the depressed women.

Zaluska M.,IV Klinika Psychiatrii | Kobrzynska-Zochowska E.,Medical University of Warsaw | Dyduch A.,Kliniczny Oddzial Psychiatrii | Balicki M.,Szpital Wolski | And 5 more authors.
Postepy Psychiatrii i Neurologii | Year: 2012

Objectives. To estimate the prevalence of comorbid physical and mental disorders as well as their treatment costs in the total cost of services provided on a psychiatric ward of a general hospital. Method. On the grounds of medical records the number of patients treated for comorbid physical and mental disorders and of those receiving only psychiatric treatment over the period of 12 months (in the year 2008) was calculated in three general hospitals in Warsaw (Bielański, Wolski & Bródnowski). An increase in medical costs incurred by treatment of physical disorders in patients of the psychiatric ward at the Bielański Hospital was calculated as a percentage of the purely psychiatric treatment cost. On these grounds the increase in personal costs of treatment of patients with comorbidities was estimated. Using the person-day cost for delivery of services contracted in the year 2008 and the percentage of psychiatric patients with comorbidities treated on the ward, the amount of underestimation of the actual person-day cost of treatment on the ward was calculated as a percent of the contracted person-day cost. Results. Between 46.9% and 53.3% of patients treated on the wards under study had a comorbid physical disease. The most frequent conditions included cardiovascular, metabolic and endocrine diseases, alimentary tract and pulmonary disorders. The average medical cost of one person-day for the patient with a comorbid physical illness was by 23.6% higher than that for the patient receiving psychiatric treatment only. The average underestimation of only medical and personal costs per one patient treated on the ward amounted to 36.98% of the person-day cost offered in the contract by the National Health Fund (NFZ). Conclusions. Since the costs of services delivered on psychiatric wards of general hospitals are underestimated, it is necessary to change the principles of contracting such services. Approximately 47%-53% of patients treated on psychiatric wards in general hospitals suffer from comorbid physical diseases increasing the total costs of their treatment by 23.6%. The increased costs of services delivery on psychiatric wards should be accounted for in the NFZ contracts in order both to establish new psychiatric wards in general hospitals, and to maintain the already existing ones. © 2012 wydanie polskie, Instytut Psychiatrii i Neurologii.

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