PubMed · 5441964
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F Post. 1970. Learning from old age.. https://pubmed.ncbi.nlm.nih.gov/5441964/
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BACKGROUND: The authors examined recent changes in the number and proportion of patients prescribed antidepressants by psychiatrists in outpatient private practice and characterized antidepressant prescription patterns by patient age, sex, race, payment source, and clinical diagnosis. METHODS: The authors analyzed physician-reported data from the 1985 and 1993-1994 National Ambulatory Medical Care Survey, focusing on visits to physicians specializing in psychiatry. Logistic regressions were used to examine associations between survey year and antidepressant prescription, adjusting for the presence of other variables. RESULTS: The proportion of outpatient psychiatric visits in which an antidepressant was prescribed increased from 23.1% (95% confidence interval [CI], 19.7%-26.5%) in 1985 to 48.6% (95% CI, 47.5%-49.7%) in 1993-1994. After controlling for several patient variables, psychiatric patients were approximately 2.3 (95% CI, 1.8-2.9) times more likely to receive an antidepressant in 1993-1994 than in 1985. In 1993-1994, selective serotonin reuptake inhibitors accounted for approximately half of the psychiatric visits with an antidepressant prescription. Increases in the rate of antidepressant prescription were particularly evident for children and young adults; whites; new patients; and patients with adjustment disorders, personality disorders, depression not otherwise specified or dysthymia, and some anxiety disorders. CONCLUSIONS: During the late 1980s and early 1990s, there was a significant increase in the prescription of antidepressants by office-based psychiatrists. This increase was greatest for patients with less severe psychiatric disorders.
The consultation-liaison (C-L) psychiatry services of seven university teaching hospitals in the United States, Canada, and Australia (the MICRO-CARES Consortium) used a common clinical database to examine 1039 consecutive referrals. A diagnosis of adjustment disorder (AD) was made in 125 patients (12.0%); as the sole diagnosis, in 81 (7.8%); and comorbidly with other Axis I and II diagnoses in 44 (4.2%). It had been considered as a rule-out diagnosis in a further 110 (10.6%). AD with depressed mood, anxious mood, or mixed emotions were the commonest subcategories used. AD was diagnosed comorbidly most frequently with personality disorder and organic mental disorder. Sixty-seven patients (6.4%) were assigned a V code diagnosis only. Patients with AD were referred significantly more often for problems of anxiety, coping, and depression; had less past psychiatric illness; and were rated as functioning better--all consistent with the construct of AD as a maladaptation to a psychosocial stressor. Interventions were similar to those for other Axis I and II diagnoses, in particular, the prescription of antidepressants. Patients with AD required a similar amount of clinical time and resident supervision. It is concluded that AD is an important and time-consuming diagnostic category in C-L psychiatry practice.
BACKGROUND: The aim of this present study was to compare the characteristics of suicidal attempts of patients with major depression (MD) and adjustment reaction (AR). METHOD: Sixty-nine patients with MD and 86 with AR admitted to the Moscow Institute of Emergency Help after the first suicide attempts were studied. All the attempters were interviewed by at least by two psychiatrists and the diagnosis was made according to agreement and to ICD-9CM criteria. RESULTS: Differences between the two groups were found with regard to social-demographic, clinical-psychological and suicidal characteristics: the AR patients were less educated, had lower social status and in most cases were unmarried, compared with the MD patients. A large number (51.2% of the attempters in the AR group and 34.8% in the MD group) had an unstable parental family, early orphanhood or an emotionally deprived childhood. No differences were found in the methods of the suicidal attempts between the groups. Suicidal attempts under alcohol abuse occurred more often among the AR group (34.9 vs. 10.1%). The interval from the beginning of the disorder until the suicidal attempt was significantly shorter within the AR group. In this group the suicidal attempts were not planned, in comparison with the MD group. LIMITATION: The sample is a selected study, because the research included only inpatients with AR and MD after their first suicidal attempt. CONCLUSION: We believe that our data may be important for improving the assessment of suicidal risk and in planning treatment strategies for prevention of repeated suicidal attempts.