Volume 41 Number 2: 1996

Content (Abstract)

Stress of Kaukaroon College Nursing Students

Wanpen Wangwiwatjaroen, Sara Mukdee,

Mental Health Problems in Residents at Ramathibodi Hospital

Amporn Benjaponpitak

Neuroleptic Malignant Syndrome : A review of 12 cases

Damrong Wae-Alee,Waran Tanchaiswad,

Self Amputation of Finger : A case report and literature review

Thawatchai Krisanaprakornkit, Sasithorn Sangpongsanond, Suwan Thong-on

Capgras’ Syndrome in an Epileptic Patient

Orawan Silpakit, Chatchawan Silpakit,

SPECIAL ARTICLES

Clinical application of sleep deprivation

Manote Lotrakul

EDITORIAL Serotonin syndrome

Wanpen Wangwiwatjaroen, M.D.*
Sara Mukdee, M.A. (Counseling Psychology)**

The stress level of six hundred and thirteen nursing students in academic year of 1995-1996 at Kaukaroon College of Nursing were assessed. By using Health Opinion Survey (HOS) questionnaires, we found the average stress score of all the students was 47.67. The highest score was confined to the fourth year student (47.83), while the average stress score for the second year student was the lowest (47.39). The statistically significant causes are their parent relationships, their mother’s health, financial problems, sibling relationships, and their classmate relationships

Amporn Benjaponpitak, M.D. *

Objective : To date, medical practitioners seem to suffer from high level of stress that produces psychiatric problem, especially during the postgraduate medical training years. Hence, the purposes of this study are to investigate the prevalence rate of stress in residents and to identify possible causes. Moreover, this study attempted to assess how the stress affects their attitude about the training programs. Method : All 226 residents in Ramathibodi Hospital from every year (first, second and third) and every department were sent questionnairs in November-December 1995. The questionnairs contained questions about demographic data, self-report of every day life stressors, self-evaluation of training and working in postgraduate year, and the General Health Questionnaire 30 (GHQ 30) to estimate psychiatric morbidity. c2 , Fisher’s exact and t Test were used to study the relationship between stress and various aspects of data. Results : Completed questionnairs were returned by 128 of 226 subjects (56.64 %). With the methods of scoring and validity data for the recommended cutoff from GHQ30, the estimated prevalence of emotional disturbance in this group was 54 cases (42.2 %). Subjects whose spouses were physicians were significantly more stressed than the others. On the contrary, there was no relationship between other demographic data and stress. Owing to the causes, the first three problems which influenced the perception of both stressed and non-stressed groups were problems about the dormitory, finance, and work. Additionally, in comparison, the stressed residents felt more disappointed about their decision in training as a resident position and more hesitated about their competence to finish the training courses than the non-stressed group in a statistically significant difference.

J Psychiatr Assoc Thailand 1996 ; 41(2) :

Key words : mental health problems, residents, GHQ

Damrong Wae-Alee,M.D.**
Waran Tanchaiswad, M.D.**

The patients with Neuroleptic Malignant Syndrome (NMS) admitted in Songklanagarind Hospital from December 1987 to April 1994 are reviewed. The cases consisted of 8 male and 4 female patients,aged 15-69 years (mean age = 37 years). Clinical manifestations of all cases were muscle rigidity, alterationof consciousness, hyperpyrexia (mean 39.2c) and autonomic nervous system disturbances. Laboratory findings were increased WBC over 10,000 cells/cu. mm in 10 cases, and increased creatinine phosphokinase (CPK) over 1000 U/L in 11 cases. Ten patients developed NMS after starting or changing the dosage of antipsychotic drugs and two afterantidepressants. The symptoms occurred in 1-10 days after taking the medications (mean = 4.7 days) and lasted 4-36 days (mean = 18.8 days). Acute renal failure, pneumonia and urinary tract infection were found in 2,3 and 1 case(s) respectively. The patients were treated by immediate discontinuation of the medication and supportive measures. All cases recovered without any serious sequalae. Eight cases were suscessfully rechallenged with another antipsychotic drug without recurrence of NMS. This study suggests that starting or changing the dosage or type of medications might play some role in precipitating the occurrence of NMS, and the intensive supportive treatment should be carried out immediately to save the patients and to prevent morbidity.

Orawan Silpakit, M.D. *
Chatchawan Silpakit, M.D.**

A case of complex partial seizure presented with Capgras’ syndrome is reported. The patient had fixed delusion that her mother had already died and she was kidnapped by the woman who, in fact, was her real mother. EEG showed paroxysmal sharp transient wave over bilateral frontocentral regions. The patient responded well to carbamazepine. No symptoms occurred during the follow-up period of six months.

J Psychiatr Assoc Thailand 1996 ; 41(2) :

Keywords : Capgras’s syndrome, epilepsy

Thawatchai Krisanaprakornkit, M.D. *
Sasithorn Sangpongsanond, BSc. (Psychology) **
Suwan Thong-on, BSc. (Psychology) **

Self mutilation is the expression of violence which affect not only the individuals but also their families and society. The authors present a case of 16 years old male who intentionally cut his left index finger to reduce frustration occured when his separated mother remarried. The unconscious meanings were to cut out the introjected object from his life. The patient had average I.Q.score, depressed mood, pestimism, repressed emotional expression and had the tendency of impulsivity. He came from the broken family which can not play the role of protector and facilitator to adolescent development. As the consequence, the community reacted to the incidence negatively and rejected the patient due to the afraid of his violent acts. The psychodynamic factors, family problems and social support system were evaluated. Supportive psychotherapy, biofeedback assisted relaxation, rehabilitation and social treatment program had been done.The literatures related to the cause of self mutilation of hand and finger were also reviewed.

J Psychiatr Assoc Thailand 1996 ; 41(2) :

Key words: self amputation , finger, hand, self mutilation, self injurious.

Manote Lotrakul, M.D. *

Sleep deprivation is a recent treatment method in psychiatry. Its antidepressant effect is attractive because it acts rapidly and causes few side effects. However most patients relapse with a night of sleep, other treatments should also be given. This paper reviews related articles regarding efficacy, pattern of responses in sleep deprivation and its clinical applications.

J Psychiatr Assoc Thailand 1996; 41(2):

Keywords : sleep deprivation, depressive disorders