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At least 217 records · Page 12Linked to original sources
PubMed1996

Consultation-liaison psychiatry in an Australian oncology unit.

OBJECTIVE: To provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an oncology unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database. METHOD: The MICROCARES prospective clinical database system was used to record data on all oncology inpatients referred to C-L psychiatry, and the hospital clinical database was used to compare referred inpatients with all oncology inpatients. RESULTS: Two hundred and seventy-one referrals were made in the 3 years from 1991 to 1993, a referral rate of 10.4%. The referred patients were younger but there was no bias in sex and marital status. The mean length of stay was twice that for all other oncology admissions, day cases excluded. The most frequent reasons for referral were coping problems, depression, terminal illness issues and anxiety. The most common psychiatric diagnoses were Systemic Family Problems (V codes, 24%), Mood Disorders (23%), Adjustment Disorders (16%) and Organic Mental Disorders (10%). Management involved family conferences in half of the patients and antidepressant medication in one-quarter. Concordance with pharmacological recommendations was 98%. Existential issues and family-centred care are discussed. CONCLUSIONS: Both individual and family-centred care is required in an oncology service; a dedicated liaison attachment offers considerable staff support. Psycho-oncology is underdeveloped in Australia compared to many overseas services; there is scope for substantial growth in preventive and supportive work.

Adaptation, Psychological↗
PubMedDate not supplied

[Mobbing in the workplace: new aspects of an old phenomenon].

In the last ten years there has been increasing concern about the well known old practice of victimization at work, which in recent years has emerged with new characteristics, aims and consequences and is now generally referred to as mobbing behavior. This increased attention seems to be due to increased awareness of individual rights and respect for the dignity of self and others, and to the new economy emphasis on flexibility and reorganizational needs. Moral violence should not be confused with the normal competition and conflicts encountered in work place. Mobbing can be originated by traditional causes such as eliminating an undesired individual or by a precise corporate strategy aimed at reducing the workforce organizations. Mobbing has been recognized as a significant source of individual discomfort and subsequently illness. Lacking specific diagnostic criteria, Post-traumatic Stress Disorder and Adjustment Disorder have been adopted from the international classification of mental diseases (DSM). However, interviews and personality screening highlight specific differences compared with other psychic disorders, not in symptom severity but in the induced loss of parameters which guarantee individual consistency in life, namely self-esteem, event intelligibility, cause-effect relationship, confidence in others, which lead to role and status depletion and eventually acquisition of an invalid personality. The human and economic cost of antisocial behavior at work, with illness, absenteeism and finally unemployment is extremely high for the victims and their families, employers and society. Mobbing control is not only a prevention target but a moral obligation. It should be recognized that interpersonal correctness, respect of individual skills and dignity do not interfere with group efficiency, reorganization, staff reduction and relocation and that these aims can be reached without destroying an individual.

Humans↗
PubMed2002

Psychiatric admission in a general hospital. Patients profile and patterns of service utilization over a decade.

OBJECTIVE: To analyze the socio-demographic and clinical characteristics of admitted patients and the patterns of their service utilization over a decade from March 1988 to March 1998. METHODS: Prospective data compilation using a structured questionnaire, hospital records and follow-up observations at King Fahd Hospital of the University in Al-Khobar, Kingdom of Saudi Arabia. RESULTS: A total of 1366 patients (683 of each sex) had 2217 admissions in 10 years. By the International Classification of Diseases, 10th edition criteria, 19.5% had schizophrenia, 15.2% bipolar disorder, 9.9% depressive episodes, 8.6% acute and transient psychotic disorders, 7.7% adjustment disorders and 7.6% dissociative disorders. Males were more frequently admitted for schizophrenia and females for mood and anxiety disorders. Most non-Arab expatriates were diagnosed as acute and transient psychotic, stress-related or dissociative disorders. Re-hospitalizations constituted 28% of all admissions. The mean length of stay was 25 days per admission and 41 days per patient. The overall bed occupancy rate was 84.9%. A subgroup of 16.9% of patients, mostly with schizophrenia or bipolar disorder, consumed 62.3% of the bed occupancy. CONCLUSION: Gender and immigration were the main determinants of variance in patient characteristics, nosological distribution and pattern of service use. More beds are needed. Psycho-educational programs should be intensified to reduce the social stigma and societal intolerance to mental patients. Active family involvement improves compliance and might reduce re-hospitalization rates. Heavy service consumers should be transferred to long-stay facilities.

Adolescent↗
PubMed2004

[The treatment with methylphenidate of demoralisation, apathy and hypoactive delirium in patients with somatic illness].

In 3 patients, 2 women aged 21 and 65 and a man aged 60, admitted for the treatment of B-cell lymphoma, trauma caused by a traffic accident and Kahler's disease respectively, hypoactive delirium, apathy of unknown origin and depressive disorder or adjustment disorder with depressive mood ('demoralisation') were seen and caused somatic recovery to be compromised. The consulting psychiatrist prescribed methylphenidate with good results. They formed part of a group of 34 patients who were given methylphenidate on these indications over a period of 12 months. These indications are not among the accepted indications for this drug. In the literature, the beneficial use of psychostimulants in somatic illness has been described almost exclusively in palliative care and case reports of other somatically-ill patients with a poor prognosis. No reports were found on the effects of methylphenidate used for treatment of patients with hypoactive delirium nor were guidelines for its use in somatically-ill patients with a good prognosis. A randomised clinical trial to substantiate these reported findings is warranted.

Adult↗
PubMed2005

Psychiatric morbidity, stressors, impact, and burden in juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is a chronic painful disorder conceivably with adverse psychological sequelae that might influence the outcome of the disease and its treatment. This study was designed to detect the presence of psychiatric disorders and associated abnormal psychosocial situations among children and adolescents with JIA and to evaluate their impact on and burden for their caregivers. Forty subjects with JIA suffering for at least one year were included in the study. Forty age- and sex-matched healthy subjects were included as controls. Clinical psychiatric assessment was carried out blindly, and psychiatric disorders and stressors on abnormal psychosocial situation were assigned on the basis of ICD-10 clinical diagnoses of multiaxial classification of child and adolescent psychiatric disorders. Chronicity, distress, social impairment, and burden for others were rated with the impact supplement of the strengths and difficulties questionnaire (SDQ). Of the 40 cases of JIA, 24 were boys and 16 were girls aged 10-18 years, with a mean age of 13.25 years. The frequency of psychiatric disorders was 35% in the JIA and 12.5% in the control group (p<0.001). The long duration of illness was associated with a higher proportion of cases with psychiatric disorders. In the JIA group, the diagnoses in decreasing order were depressive disorder (15%), somatoform disorder (12.5%), adjustment disorder (5%), and mixed anxiety and depressive disorder (2.5%). Significantly higher stressors, perceived difficulties, distress, social impairment, and burden for caregivers were reported in the JIA group with psychiatric morbidity. The presence of psychiatric disorders was associated with substantial impairment of learning, peer relationship, and leisure activities. Early psychiatric intervention might increase the likelihood of satisfactory outcome of treatment in JIA.

Adolescent↗
PubMed1990

The prisoner of war.

The prisoner of war (POW) experience is greatly influenced by the environmental and sociocultural factors of the particular captivity setting. Among the most important coping mechanisms are communication, maintenance of military social structure, and personality flexibility. Following repatriation some former POWs develop psychiatric disorders, most commonly 1) medico-psychiatric disorders due to illness, physical trauma, or nutritional deficit, 2) post-traumatic stress disorder, 3) adjustment disorder, 4) depression, 5) anxiety disorders, 6) substance use disorders, and 7) family problems. The severity of captivity and the presence or absence of social supports during and after the POW experience play major roles in the recovery or illness that may occur after repatriation.

Adaptation, Psychological↗
PubMed1989

Psychostimulant response in AIDS-related complex patients.

Methylphenidate or dextroamphetamine was used to treat 17 of 32 patients with AIDS-related complex who were referred for neuropsychiatric evaluation of symptoms representative of cognitive and/or affective dysfunction. All 17 patients were found to have some degree of cognitive impairment. Psychiatric diagnoses included organic mental disorder (8), adjustment disorder (5), and major depression (4). The 17 patients were receiving no other psychoactive or neurotoxic medications nor were they receiving concomitant investigational antiviral or chemotherapeutic agents. Clinical response to psychostimulant therapy was rated using the Efficacy Index of the Clinical Global Impressions. Pharmacotherapy with either psychostimulant was clinically effective in improving affective parameters in 89.5% (15) of the 17 patients, with 79% (13) of the 17 achieving a moderate to marked response. No adverse side effects were encountered.

AIDS-Related Complex↗
PubMed1988

Irritable bowel syndrome. Toward a biopsychosocial systems understanding.

The symptoms of irritable bowel syndrome (IBS) are usually a subset of a broader problem that meets DSM-III criteria for depression, anxiety disorder, somatization disorder, or adjustment disorder. A biopsychosocial perspective that addresses multigenerational family patterns of anxiety, depression, and somatization of stress suggests guidelines for understanding and treating patients with IBS symptoms. Effective treatment focuses primarily on helping patients cope with emotional disorders and psychosocial stressors, and secondarily on direct symptom relief. Psychotherapy is a valuable adjunct to medical treatment. The medications most likely to yield lasting benefits are the antidepressants.

Colonic Diseases, Functional↗
PubMed1995

Waivers for disqualifying medical conditions in U.S. Naval aviation personnel.

In the United States Navy, many diagnoses are considered disqualifying for aviation duty, but aircrew may be "waived" to return to flight duties after resolution of the disease or appropriate treatment of the condition. Personnel with waivers are usually subject to more frequent physical examinations and/or special diagnostic procedures. Although the Naval Aerospace and Operational Medical Institute promulgates written aeromedical guidelines as to which diseases may be waived and which may not, waivers are granted on a case-by-case basis considering not only the diagnosis, but the age, experience, and type of aviation duty of the individual in question. This study was undertaken to determine which conditions were most and least likely to be waived. We reviewed all records of aviators entered into the Naval Aviation Medical Data Retrieval System who had been diagnosed with a condition considered disqualifying for aviation duty, totaling over 39,000 records. Cases were stratified by diagnosis and aviation duty, and the percentage waived was calculated for major diagnostic groups. Among designated aviation personnel, approximately 68% of all aviators with a disqualifying diagnosis were recommended for a waiver. Otolaryngologic, musculoskeletal, and cardiovascular disorders accounted for nearly 50% of diagnoses in personnel recommended for a waiver. Fear of flying, personality disorders, and adjustment disorders were the three diagnoses least likely to be granted a waiver. The most frequently occurring disqualifying diagnoses were allergic rhinitis, obesity, disorders of refraction and accommodation, urolithiasis, and alcohol dependence.

Adolescent↗
PubMed1993

[Psychogenic dizziness].

Psychogenic dizziness is defined as recurring or persistent symptoms of balance dysfunction, inconsistent with organic vestibular disease as determined by history, clinical examination and pertinent investigations, and consistent with emotional origin. Of 1,335 patients seen in our dizziness clinic between January 1988 and August 1991, psychogenic dizziness was diagnosed in 180 (13.5%) patients. There were 67 men and 113 women aged from 12 to 77 years (mean age 40.2 years). The characteristics of psychogenic dizziness are: (1) continuous dizziness for long periods of time; (2) younger patients; (3) predominant female; (4) associated symptoms of panic attack, such as headache, breathlessness, nausea, sleep disturbance, paresthesias, anxiety and palpitation; (5) symptoms of aggravation due to stressful life events; (6) normal neurotological bedside examination; (7) hyperventilation reproduced accurately. The electronystagmographic results of 74 patients show normal bithermal caloric responses in 47 patients (63.5%), caloric hyperactivity in 21 patients (28.4%), canal paresis in four patients (5.4%), canal paresis with directional preponderance in two patients (2.7%), large random voluntary eye swings or severe blinking in 35 patients (47.3%), and spontaneous nystagmus (slow phase velocity < 6.5 degrees/s) in four patients (5.4%). There were 31 patients who consulted psychiatrists with diagnoses of anxiety (51.6%), depression (16.1%), insomnia (12.9%), psychosomatic disorder and adjustment disorder. Treatment of patients with psychogenic dizziness must be directed at the underlying anxiety. Psychiatric consultation is necessary.

Adolescent↗
PubMed1996

[Expert assessment of railroad accidents at the beginning of the industrial age--a medical historical excursion with reference to current circumstances].

A historical excursus seems sometimes useful to overlook actual problems in medicine. The example of the railway accidents shows the problems of the medical appraisal with regard to the consequences of an accident. After initiation of a third party insurance in Germany 1871 with reference to the new means of transportation a lot of people tried to get a compensation after imaginary or real injury following a railway accident. Very soon physicians had to give an expert's opinion on the complaints of those concerned. 1879 Rigler and 1918. Horn published monographs regarding this problems. Apart of real impairments very often complaints had no organic reasons. Oppenheim introduced 1889 the concept of "traumatic neurosis". The scientific discussion remained in the following decades and finally it was rejected until to our times. Today the terms "posttraumatic stress disorder", "psychogenic pain disorder" or "adjustment disorder" are valid. The discussions more than 100 years ago seem nowadays still actual. The terms have changed, the problems remain.

Accidents↗
PubMed1997

[Traffic accidents from the social medicine viewpoint--a medical history connection with present time].

A historically excursus seems sometimes useful to overlook actually problems in medicine. The example of the railway accidents shows the problems of the medical appraisal with regard to the consequences of an accident. After initiation of a third party insurance in Germany 1871 with reference to the new means of transportation a lot of people tried to get a compensation after imaginary or real injury following a railway accident. Very soon physicians had to give an expert's opinion on the complaints of those concerned. 1879 Rigler and 1918 Horn published monographs regarding this problem. Apart of real impairments very often complaints had no organic reason. Oppenheim introduced 1889 the concept of "traumatic neurosis". The scientific discussion remained in the following decades and finally it was rejected until to our times. Today the terms "posttraumatic stress disorder", "psychogenic pain disorder" or "adjustment disorder" are valid. In present times the problem of the whiplash injuries takes the place of the railway accidents. Here also are either organic reasons discussed or psychogenic reactions presumed. The modern techniques in neuroimaging and neuropsychology are inconsistent and the results not generally accepted. In the individual case they are often little helpful. The medicolegal problems are still important and often reason for prolonged forensic confrontations. The discussions more than 100 years ago seem nowadays still actual. The terms have changed, the problems remain.

Accidents↗
PubMed1997

Major depressive disorder with delusion of having AIDS: a case report.

Acquired immune deficiency syndrome (AIDS) has become a topic of increasing public concern. Several conditions have been described in patients who are afraid that they have acquired AIDS, including depression, somatization disorders, hypochondriasis, adjustment disorders and various psychoses. This paper presents a case study of a young man with persistent fear of having AIDS. In spite of negative HIV test results, the patient still insisted that he suffered from AIDS. The psychiatric diagnosis was major depressive disorder with delusion of having AIDS. The patient was treated with fluoxetine 40 mg qd and sulpiride 400 mg qn. After two weeks on medication, his fear of AIDS subsided and he improved remarkably. The most important intervention in patients with delusion of having AIDS is to identify and treat the underlying psychopathology. The following case is representative of our experience.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Usefulness of the nurse-assisted screening and psychiatric referral program.

BACKGROUND: Major depression and adjustment disorders are common psychiatric disorders in patients with cancer, but they are often overlooked in clinical oncology settings. The nurse-assisted screening and psychiatric referral program (NASPRP) has been introduced in clinical practice to facilitate psychiatric treatment for major depression and adjustment disorders. This study assessed the usefulness of the NASPRP and compared it with usual practice. METHODS: The program consists of two stages. In the first stage, consecutive patients newly admitted to the Oncology/Hematology Unit are administered the Distress and Impact Thermometer (DIT) by nurses as a brief screening tool for major depression and adjustment disorders. In the second stage, the nurses recommend psychiatric referral to patients with scores above the cutoff point. Patients' records were reviewed for a 3-month period before the start of the program and during the 3-month period after the start of the program. These records were then compared. RESULTS: Of 157 patients newly admitted during the program period, 86.0% (135/157) completed the DIT and results were positive in 49.6% (67/135), but only 28.2% (19/67) accepted psychiatric referral. Ultimately, 11.5% (18/157) of patients newly admitted were diagnosed with major depression or adjustment disorders and treated by psychiatric service, a significantly higher proportion than during the preceding 3-month period, before the program was begun (2.5%; P = 0.001). CONCLUSION: The NASPRP enabled identification of major depression and adjustment disorders in patients with cancer and introduced them to psychiatric treatment. Nevertheless, there is room for improvement in the program.

Adaptation, Psychological↗
PubMed2000

Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders.

Consecutive child psychiatric outpatient admissions with disruptive behavior or adjustment disorders were assessed by validated instruments for trauma exposure and posttraumatic stress disorder (PTSD) symptoms and other psychopathology. Four reliably diagnosed groups were defined in a retrospective case-control design: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), comorbid ADHD-ODD, and adjustment disorder controls. ODD and (although to a lesser extent) ADHD were associated with a history of physical or sexual maltreatment. PTSD symptoms were most severe if (a) ADHD and maltreatment co-occurred or (b) ODD and accident/illness trauma co-occurred. The association between ODD and PTSD Criterion D (hyperarousal/hypervigilance) symptoms remained after controlling for overlapping symptoms, but the association of ADHD with PTSD symptoms was largely due to an overlapping symptom. These findings suggest that screening for maltreatment, other trauma, and PTSD symptoms may enhance prevention, treatment, and research concerning childhood disruptive behavior disorders.

Adjustment Disorders↗
PubMed1983

Depression in childhood and adolescence. A prospective study of six cases.

Two cases of recurrent major depression, three cases of dysthymic disorder (depressive neurosis), and one of adjustment disorder with depressed mood beginning in childhood or adolescence have been identified in the 133 subjects of the New York Longitudinal Study. The prospective behavioral data from early infancy to early adult life in each of the six cases are summarized. Differences in etiology are emphasized and the implications for treatment indicated. There was no evidence for a separate clinical entity of depression for the childhood period. Review of the longitudinal data did not show a significant earlier life tendency to negative mood temperamentally. The dysthymic and adjustment disorder cases also did not show significant differences in environmental stresses or parental functioning from other clinical cases in the longitudinal study without depressive symptoms.

Adjustment Disorders↗
PubMed2004

A case for establishing complicated grief as a distinct mental disorder in DSM-V.

In this paper, we contend that complicated grief (CG) constitutes a distinct psychopathological diagnostic entity and thus warrants a place in standardized psychiatric diagnostic taxonomies. CG is characterized by a unique pattern of symptoms following bereavement that are typically slow to resolve and can persist for years if left untreated. This paper will demonstrate that existing diagnoses are not sufficient, as the phenomenology, risk factors, clinical correlates, course, and outcomes for CG are distinct from those of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and adjustment disorder (AD). It is argued that the establishment of CG as a diagnostic entity is essential because its symptoms are associated with enduring mental and physical health morbidity and require specifically designed clinical interventions. We conduct a critical review of all published evidence on this topic to date, demonstrating that the advantages of standardizing the diagnostic criteria of CG outweigh the disadvantages. In addition, recommendations for future lines of research are made. This paper concludes that CG must be established in the current nosology to address the needs of individuals who are significantly suffering and impaired by this disorder.

Adjustment Disorders↗
PubMed1998

Betaxolol in anxiety disorders.

Betaxolol, a long-acting beta-adrenergic blocker that enters the central nervous system, was examined for therapeutic effects on the persistent anxiety of anxiety disorders. Prior studies of beta-blockers examined only agents that were short-acting or did not enter the brain. Betaxolol was administered to 31 patients in open trials. Of 13 outpatients, 11 had generalized anxiety disorder (GAD) and 2 had adjustment disorder with anxiety. Five with GAD had concurrent panic disorder. Of 18 inpatients, 16 had GAD and 2 had adjustment disorder with anxiety. Betaxolol doses were increased until the patient responded or declined further dosage. Severity was rated on a 4-point global scale. Before betaxolol, all were moderately or severely ill. In all patients with panic disorder panic attacks stopped within 2 days (p<0.001). Anxiety decreased to no more than marginally ill in 85% of outpatients (p<0.0001) and all inpatients (p<0.0001). Betaxolol doses were usually 5 mg once or twice daily; four inpatients took 10 to 20 mg twice daily. In sum, betaxolol administration was rapidly followed by improvements that were easily noticed by the doctor, even in patients with longstanding anxiety and obsessive-compulsive personality disorder. Preliminary observations in posttraumatic stress disorder are similar.

Adrenergic beta-Antagonists↗