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Results for “Persons with Psychiatric Disorders”

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PubMed1995

Violent attacks on public figures by persons suffering from psychiatric disorders. Their effect on the social distance towards the mentally ill.

In connection with two attempts on the lives of prominent politicians committed by mentally ill individuals during 1990 there occurred a marked increase in social distance towards the mentally ill among the German public. Even though the level of social distance subsided again during the 2 years following the attacks, it had not yet completely returned to its initial level by the end of 1992. The negative effects of these incidents on the attitude of the general public were able to be replicated on a regional level, after yet another violent attack by a mentally ill assailant in 1993, this time on the life of a famous female athlete.

Adolescent↗
PubMed1994

Protecting mental health research subjects without prohibiting progress.

Federal regulations governing the protection of human research subjects fail to specifically address research involving persons with mental illness. In 1990 the New York State Office of Mental Health issued regulations covering such research. The regulations are designed to respect the autonomy of psychiatric patients to make decisions about participation in research while protecting patients whose capacity to consent may be impaired. Patients who lack sufficient capacity may be included in research with the consent of a specified legally authorized surrogate if the facility's institutional review board determines that the research cannot be done without the participation of incapable subjects and it is considered likely to produce knowledge of overriding therapeutic importance for persons with the patients's condition or it has the possibility of directly benefiting the patient. In all cases involving more than minimal risk, the consent of the patient's treatment team must be obtained.

Clinical Trials as Topic↗
PubMed1984

Self and other directed violence on a closed acute-care ward.

Violence to self and to others on a locked, acute-care unit is reported for a three-year period. Drug abuse correlated strongly with both types of violence. Self-violence appeared to be a more predictable event due to its diagnostic specificity, history of prior violence and timing of the episodes. Assaults occurred more randomly demonstrating only a mild association with schizophrenia, but not with other psychotic disorders.

Acute Disease↗
PubMed1999

Effective treatment relationships for persons with serious psychiatric disorders: the importance of attachment states of mind.

Participants were 54 clients with serious psychiatric disorders and 21 clinical case managers. Clients' serious psychiatric disorders included Axis I diagnoses, such as schizophrenia and bipolar disorder. This study examined how attachment states of mind of both clients and case managers influenced the effectiveness of therapeutic relationships and client functioning. Client and case manager attachment states of mind interacted in predicting the working alliance and client functioning. Specifically, clients who were more deactivating with respect to attachment had better alliances and functioned better with less deactivating case managers, whereas clients who were less deactivating worked better with more deactivating case managers. These findings highlight the importance of clinicians and clients being matched in ways that balance their interpersonal and emotional strategies.

Adult↗
PubMed1995

Treatment refusal by an elderly man suffering intensely from treatment-resistant depression.

The authors consider the ethical issues involved in a case in which an elderly man suffering from recurrent, treatment-resistant depression expressed a wish to forgo life-sustaining treatment should it become necessary. The patient had no immediate life-threatening medical conditions but was in danger of becoming malnourished and dehydrated. The authors conclude that unrelieved suffering resulting from depression, when combined with repeated treatment failures, may justify refusal of life-sustaining treatment in very rare cases.

Aged↗
PubMedDate not supplied

Bipolar II disorder and comorbidity.

The validity and reliability of the diagnosis of bipolar II disorder has been questioned by means of comorbidity with nonaffective disorders, including substance abuse, personality disorders, and anxiety disorders. This study examined the comorbid diagnosis of a sample of bipolar II patients, comparing patients with comorbidity and those with "pure" bipolar II disorder. Forty Research Diagnostic Criteria (RDC) bipolar II patients were assessed by means of the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-L) and Structured Clinical Interview for DSM-III-R axis I (SCID-II) for personality disorders. Patients fulfilling RDC criteria for any psychiatric disorder (except personality disorders) or DSM-IV criteria for any personality disorder were compared with patients without comorbidity. For practical reasons, cyclothymia was not considered as a comorbid diagnosis. Half of the sample had lifetime comorbidity with other psychiatric disorders, mainly personality disorders (33%), substance abuse or dependence (21%), and anxiety disorders (8%). However, only the rates of suicidal ideation (74% v 24%, chi square [chi2] = 9.03, P = .003) and suicide attempts (45% v 5%, chi2 = 8.53, P = .003) were significantly different between patients with and without comorbidity. In summary, although the rates of comorbidity are relatively high in bipolar II disorder, most clinical and course variables are strikingly similar in patients with and without comorbidity except for suicidal behavior, suggesting that comorbidity does not reduce the validity of the diagnosis of bipolar II disorder.

Adult↗
PubMed1991

Avoidant and dependent personality traits in relatives of patients with panic disorder, patients with dependent personality disorder, and normal controls.

Psychiatric researchers have long wondered whether personality traits might predispose toward or be integral to Axis I illnesses. The question is difficult to address because acute illness can either create personality traits or distort their measurement. The present study bypassed that problem by examining personality traits in relatives of patients. Panic disorder, dependent personality disorder, and control subjects were the proband groups. A cluster of traits that appeared to reflect low social self-confidence combined with a desire for social interaction occurred significantly more often in relatives of patients in both groups.

Adult↗
PubMed2005

Continuity of axes I and II: toward a unified model of personality, personality disorders, and clinical disorders.

In the current standard psychiatric nomenclature, the DSM-IV-TR (APA, 2000), mental disorders are divided into two groups: Clinical Disorders (CDs) and Personality Disorders (PDs), and CD and PD diagnoses are recorded on two separate axes (Axes I and II, respectively). This article considers evidence regarding putative bases for distinguishing between CDs and PDs, and finds that these constructs are more similar than distinct. Links between the domains may be better understood by focusing on how personality connects CDs and PDs. This perspective underlines the need to work toward a more unified model of personality, PDs, and CDs in research and in future editions of the DSM.

Adult↗
PubMed2004

Benzodiazepine prescription practices and substance abuse in persons with severe mental illness.

BACKGROUND: Benzodiazepines have many benefits for persons with severe mental disorders, but they may also lead to or exacerbate substance abuse. An American Psychiatric Association taskforce established practice guidelines in 1990 to assist physicians in managing these and other potential side effects of benzodiazepine use. The objectives of this study were to determine the prevalence of benzodiazepine use among persons with psychiatric disorders and to evaluate compliance with published prescribing guidelines. METHOD: We studied benzodiazepine use among New Hampshire Medicaid beneficiaries aged 18 to 64 years with ICD-9 diagnoses that were grouped under the headings "schizophrenia," "bipolar disorder," "major depression," and "other psychiatric disorders" from Jan. 1995 through Dec. 1999. Rates and length of use, frequency of high-potency/fast-acting prescriptions, and diazepam-equivalent dosages were compared for those with and without retrospectively determined evidence of substance abuse, substance dependence, or a procedure code indicating treatment for a substance use disorder (SUD). RESULTS: Five-year prevalence of benzodiazepine use for persons with and without SUD was 63% versus 54% for schizophrenia, 75% versus 58% for bipolar disorder, 66% versus 49% for major depression, and 48% versus 40% for other psychiatric disorders. Differences were statistically significant over 5 years and in 1999 (p <.0001). Among persons with major depression or other psychiatric disorders, those with comorbid SUD were more likely to use fast-acting/high-potency benzodiazepines; there were no such differences for those with schizophrenia or bipolar disorder. Persons with bipolar disorder or other psychiatric disorders and SUD received significantly higher diazepam-equivalent dosages than did those without SUD. CONCLUSION: Contrary to published guidelines, rates of benzodiazepine use are higher among Medicaid beneficiaries with severe mental illness and co-occurring SUD than among persons with severe mental illness alone. Additional research and possibly a reassessment of prescribing guidelines are recommended.

Adolescent↗
PubMed1986

Assessing depression in community samples of children using self-report inventories: ethical considerations.

Although the methodological problems associated with the use of children's self-report depression inventories have previously been discussed in detail, the ethical problems related to the use of these instruments have been largely ignored. The primary purpose of this survey study was to determine how childhood depression researchers have prepared for and responded to children from community (i.e., nonclinic) samples whose nonanonymous scores on self-report depression inventories have indicated that they might be severely depressed or suicidal. Several recommendations, based upon the results of this survey study, the existing literature relevant to the ethical responsibilities of investigators who conduct research with children, and our own experiences with these instruments and populations, are made to assist researchers in their attempts to use these inventories in an ethical manner.

Adolescent↗