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ACCESSIBLE SUMMARY: Studies have indicated that individuals who are homeless access hospital emergency departments more frequently and may have different needs than individuals who are housed. Successful interventions have been developed and tested to reduce discharge to homelessness for psychiatric inpatients but have not been similarly tested for discharge from emergency departments. This study was developed to provide baseline data on this issue to inform future emergency department interventions. Findings from the current study suggest that discharge from emergency departments to homelessness happens frequently in London, Canada. Participants are unlikely to spontaneously disclose their housing/homelessness issue when first entering the emergency department, which may result in services that do not adequately meet their complex needs. Screening for housing issues is necessary within emergency departments and psychiatric crisis teams as housing issues may be a reason for accessing care or contribute to the presenting condition. Nurses are in an ideal position to evaluate housing needs among emergency department patients. Services outside of the emergency department are also needed to address housing issues, particularly outside of regular office hours. ABSTRACT: Individuals who have mental health issues and are homeless or in housing crisis have been found to access emergency departments more frequently than individuals with stable housing. While emergency departments primarily focus on medical issues, homeless individuals may require psychosocial support as well. This study examined issues around housing crises and emergency department use for individuals with mental illness in Canada. Collecting baseline data about these issues is important to inform subsequent interventions. Administrative data from a hospital emergency department and psychiatric crisis service were collected, and five individuals accessing the emergency department for psychiatric reasons were interviewed. Results indicated that individuals with an identified housing crisis accessed the emergency department 930 times in 6 months. None of the interview participants identified housing as the primary reason for accessing the emergency department, but all noted that housing was a contributing stressor. Future research is needed to examine ways in which discharge to homelessness from emergency departments can be avoided and identify alternative services to address housing concerns, particularly for individuals with mental illness. Crisis service and emergency department staff, especially nurses, can play an important role in screening for housing issues and connecting individuals to outside services.

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Pseudobulbar affect (PBA) manifests in a variety of neurologic illnesses suggesting a heterogeneous pathophysiology with common underpinnings. We report successful treatment of PBA with a selective serotonin reuptake inhibitor (SSRI) in a 54-year-old woman following progressive multifocal leukoencephalopathy (PML). In light of recent focus on dextromethorphan/quinidine (DM/Q) for the treatment of PBA, the clinician is reminded of the effectiveness of SSRIs.

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BACKGROUND: We examined social approachability judgments in a psychiatric population that frequently experiences interpersonal difficulties and reduced social satisfaction, individuals with generalized social phobia (gSP). METHODS: Our objective was to broaden the understanding of the social cognitive tendencies of individuals with gSP by systematically investigating their interpretation of positive facial expressions. We hypothesized that approachability ratings would be lower for positive as well as negative emotional faces in the gSP group compared to the healthy comparison group. Each participant evaluated 24 emotional faces presented on a computer screen. Participants first labeled the faces as either happy, disgust, or angry in emotional expression, and then they rated each face's approachability. Analysis of variance and post hoc analyses were used to identify group, emotion, and group by emotion rating differences. RESULTS: Happy face approachability ratings were higher than disgust and anger in both groups. The central finding was that individuals with gSP rated happy faces as less approachable than the healthy participants and that degree of social anxiety was associated with lower approachability ratings within the gSP sample. Explicit approachability judgments of negative faces did not differ as predicted. CONCLUSIONS: Consistent with earlier indirect evidence of interpretation biases of positive social emotional information, this study reveals that individuals with gSP demonstrate explicit, subjective social interpretation biases of overtly positive social feedback. The therapeutic relevance of these results is discussed.

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Schizophrenia, with its apparent genetic basis, persists despite demonstrating impaired fecundity. Although this has been considered paradoxical, a similar paradigm is observed elsewhere in nature. Honey bee colonies possess sterile task specialists whose presence can best be understood by the evolutionary principle of group selection. Group selection may be pertinent to human history and consequently schizophrenia could represent an ancient form of behavioral specialization. Shamanism and religion demonstrate some similarities to psychosis and may provide clues regarding the origins of schizophrenia.

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OBJECTIVE: To study the prevalence and severity of bone mineral loss and its relationship to sex hormone levels in men on long-term neuroleptic therapy. METHODS: Sixteen men with schizophrenia who were from 19 to 62 years old and had taken neuroleptic medication for 1 to 30 years had bone mineral density (BMD) of the lumbar spine and proximal femur measured by dual-energy x-ray absorptiometry. Results were compared with those from 16 age-matched control subjects. Serum testosterone, sex hormone-binding globulin, free testosterone index (FTI), prolactin, and pituitary gonadotropins were assayed and compared with age-matched Red Cross blood donor controls (N = 23 to 90 for the various assays). RESULTS: At the lumbar spine and at two of the three sites in the proximal femur (trochanter and Ward's triangle but not femoral neck), the BMD was lower in patients than in controls. A statistically significant increase in prolactin and sex hormone-binding globulin and a significantly decreased luteinizing hormone and FTI were found in the treated versus the control group. In the patient group, a significant inverse relationship existed between age and BMD at all sites. Lumbar spine density was related directly to FTI (r = 0.607; P=0.05) and inversely to duration of treatment (r = -0.767; P<0.001), although both correlations were accounted for mainly by age associations in multiple stepwise linear regression. Prolactin values did not correlate with either BMD or FTI. CONCLUSION: BMD was significantly lower with long-term neuroleptic use. In the lumbar spine, these changes may be related to the associated findings of decreased free testosterone and hyperprolactinemia, although the significance of other factors such as an independent drug effect, the psychiatric disease itself, and lifestyle cannot be excluded.

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Serum prolactin levels were measured in 48 consecutive sexually dysfunctional women who presented to a sexuality clinic. The prevalence of hyperprolactinemia and mean prolactin level of this group were compared to a control group (blood donor volunteers) of 93 women. One woman in the study group (2.1%) was hyperprolactinemic (serum prolactin greater than 15 micrograms/L). However, the differences in both prevalence of hyperprolactinemia and mean prolactin levels, between groups, were not statistically significant. Neither were differences found in mean prolactin levels among subgroups of women in different diagnostic categories and in those with single vs. multiple diagnoses. Nonetheless, because hyperprolactinemia is readily treatable, we would recommend prolactin determinations in sexually dysfunctional women, particularly in those with associated reproductive irregularity or in whom organic etiology is clinically suspect.

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