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PubMed2000

Psychopathology and psychosocial causes in adult deliberate self-poisoning in Plovdiv region, Bulgaria.

INTRODUCTION: The percentage of deliberate self-poisoning among acute intoxications continues to be high in the medical practice worldwide; in Plovdiv region it reaches 64% of all acute poisoning cases. MATERIAL AND METHODS: A representative retrospective study of 311 acute deliberate self-poisoning cases over 14 years of age, treated in the Regional toxicological center of Plovdiv region between 01.01.1990 and 31.12.1998 was carried out. The following factors were studied: gender, age, type of poisoning, psychiatric diagnosis and psychosocial stressors. The classification criteria of Diagnostic and Statistical Manual--4th edition (DSM-IV) of the American Psychiatric Association were applied. RESULTS: We identified a first attempt of deliberate self-poisoning in 237 patients (71.6%) and a second consecutive attempt in 62 patients (18.7%). Thirty two (9.7%) of the attempts were committed in a state of alcohol intoxication. The percentage of women was statistically significantly higher. The age group of 14-19 years represented the highest percentage (27%). In 168 patients (50.8%) a psychiatric disorder was diagnosed. Adjustment disorder (53.57%) and depressive and schizophrenic disorders (26.79%) were the leading diagnoses among adults committing deliberate self-poisoning. The problems with primary support group (in 61.8% as a single stressor and in 13.71% in combination with other stressors) were the most common psychosocial factors for deliberate self-poisoning. CONCLUSIONS: To reduce the number of adult deliberate self-poisonings, measures including harmonization of the relationships in the primary support group and active treatment of patients with depressive and schizophrenic disorders are needed.

Adjustment Disorders↗
PubMed2006

Onset and maintenance of psychiatric disorders after serious accidents.

The purpose of this study was to prospectively investigate the onset, course, and remission of psychiatric disorders in the first 6 months after a serious accident for consecutive patients in a hospital emergency department. Participants were 58 patients aged 18-65 who were assessed shortly after attending a hospital emergency department and were followed up 6 months afterwards. Patients were interviewed with regard to past and current psychiatric history using different instruments (e.g. SCID for DSM-IV). Prior to their accidents, 35% of all subjects had experienced one or more psychiatric disorders (lifetime prevalence). Shortly after the accident, the incidence of Acute Stress Disorder (7%), subsyndromal Acute Stress Disorder (12%), and adjustment disorder (1.5%) was increased as a reaction to the accident. At this time, 29% of all patients suffered from an acute psychiatric disorder. Six-months after the accident, 10% of the subjects met criteria for Major Depression, 6% for PTSD, 4% for subsyndromal PTSD, and 1.5% for Specific Phobia as newly developed disorders. The course of the psychiatric disorders shows that those patients who met criteria for any psychiatric diagnosis shortly after the accident ran a much higher risk for developing new or comorbid psychiatric disorders in the future.

Abbreviated Injury Scale↗
PubMed1989

Depressive disorders in childhood. IV. A longitudinal study of comorbidity with and risk for anxiety disorders.

As part of a longitudinal nosologic study of major depressive disorder (MDD), dysthymic disorder (DD), and adjustment disorder with depressed mood (ADDM) in a school-age cohort, we examined the prevalence and clinical consequences of comorbid anxiety disorders. We also estimated the risk of a first anxiety disorder and examined its predictors. Of 104 cases, 41% had anxiety disorders in conjunction with their index depression, which was more likely with MDD and DD than with ADDM. The age-corrected risk of a first anxiety disorder was 0.47 up to age 18 years. Separation-anxiety disorder was the most frequent diagnosis of anxiety, followed by overanxious disorder of childhood. Among the MDD cases with comorbidity, the anxiety disorder preceded the depression about two thirds of the time and often persisted after the depression remitted. The effect of comorbid anxiety disorder on the length of index MDD depended on the presence of other clinical features, but it did not seem to affect the risk of subsequent MDD or the course of DD or ADDM. Concurrent maternal psychopathology and poor physical health increased the risk of anxiety disorder in the children, but a history of prior separation from parental figures did not seem to have an effect.

Adjustment Disorders↗
PubMed1984

Depressive disorders in childhood. II. A longitudinal study of the risk for a subsequent major depression.

As part of a longitudinal nosologic study of major depressive disorder, dysthymic disorder (DD), and adjustment disorder with depressed mood ( ADDM ) in a school-aged cohort, the predictive validity of each diagnosis was examined. Using all available data on the course of the disorders, the criterion was the first subsequent major depressive episode. Major depressive disorder and DD signaled a similarly high risk of a new bout of depressive illness. For the children who recovered from their first episode of major depression and then had their second one (40%), the free interval did not exceed two years; an underlying dysthymia increased the risk of recurrence. Major depression and dysthymia were distinct from ADDM and a set of control disorders; the latter two diagnostic groups were associated with a minimal risk for major depression.

Adjustment Disorders↗
PubMed1988

Sensitivity and specificity of TRH stimulation test in depressed and nondepressed adolescents.

The thyrotropin-releasing hormone (TRH) stimulation test was carried out in 100 acutely hospitalized adolescents (ages 13-17 years) with a variety of diagnoses. The test was positive (delta max thyrotropin less than or equal to 7 microIU/ml) in 36.6% of adolescents with major depression, 20.8% with conduct disorders, 17% with adjustment disorders, and 43% with substance abuse disorders. A X2 analysis of the data showed no significant difference among these four diagnostic groups. The test was negative in adolescents with attention deficit disorder and dysthymic disorder. Comparison of the six diagnostic groups with regard to the amount of thyrotropin (thyroid-stimulating hormone, TSH) response to TRH stimulation indicated that the groups with major depression and substance abuse disorders had significantly lower values of delta max TSH than the other groups. TSH values did not differ significantly between males and females. Similarly, there were no significant age differences (younger adolescents vs. older adolescents).

Adjustment Disorders↗
PubMed1998

Upregulation of the platelet Serotonin2A receptor and low blood serotonin in suicidal psychiatric patients.

Suicidality has been found to be associated with low pre- and postsynaptic serotonin functioning. The purpose of this study was to examine whether in acutely suicidal psychiatric inpatients, the blood serotonin concentration was related to the underlying psychiatric disorder and whether it was associated with changes in the affinity (dissociation constant, KD) or in the maximal binding capacity (Bmax) of the platelet serotonin2A receptor. We therefore determined the blood serotonin concentrations and the platelet serotonin2A receptor activities of 45 suicidal psychiatric patients and 20 healthy subjects. We found that the blood serotonin concentrations were significantly lower in suicidal patients compared to healthy subjects. In all diagnostic categories (affective disorder, schizophrenia and adjustment disorder) we noted a significantly higher maximal binding capacity of the platelet serotonin2A receptor. These findings support the notion that a reduction in the availability of serotonin and an upregulation of the serotonin2A receptors in psychiatric patients are associated with a loss of control over suicidal impulses.

Acute Disease↗
PubMed2005

Influence of patients' requests for direct-to-consumer advertised antidepressants: a randomized controlled trial.

CONTEXT: Direct-to-consumer (DTC) advertising of prescription drugs in the United States is both ubiquitous and controversial. Critics charge that it leads to overprescribing, while proponents counter that it helps avert underuse of effective treatments, especially for conditions that are poorly recognized or stigmatized. OBJECTIVE: To ascertain the effects of patients' DTC-related requests on physicians' initial treatment decisions in patients with depressive symptoms. DESIGN: Randomized trial using standardized patients (SPs). Six SP roles were created by crossing 2 conditions (major depression or adjustment disorder with depressed mood) with 3 request types (brand-specific, general, or none). SETTING: Offices of primary care physicians in Sacramento, Calif; San Francisco, Calif; and Rochester, NY, between May 2003 and May 2004. PARTICIPANTS: One hundred fifty-two family physicians and general internists recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%. INTERVENTIONS: The SPs were randomly assigned to make 298 unannounced visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. The SPs made a brand-specific drug request, a general drug request, or no request (control condition) in approximately one third of visits. MAIN OUTCOME MEASURES: Data on prescribing, mental health referral, and primary care follow-up obtained from SP written reports, visit audiorecordings, chart review, and analysis of written prescriptions and drug samples. The effects of request type on prescribing were evaluated using contingency tables and confirmed in generalized linear mixed models that accounted for clustering and adjusted for site, physician, and visit characteristics. RESULTS: Standardized patient role fidelity was excellent, and the suspicion rate that physicians had seen an SP was 13%. In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific, general, and no requests, respectively (P<.001). In adjustment disorder, antidepressant prescribing rates were 55%, 39%, and 10%, respectively (P<.001). The results were confirmed in multivariate models. Minimally acceptable initial care (any combination of an antidepressant, mental health referral, or follow-up within 2 weeks) was offered to 98% of SPs in the major depression role making a general request, 90% of those making a brand-specific request, and 56% of those making no request (P<.001). CONCLUSIONS: Patients' requests have a profound effect on physician prescribing in major depression and adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse.

Adjustment Disorders↗
PubMed1996

Cancer and depression.

Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

Adaptation, Psychological↗
PubMed2000

Search for association between suicide attempt and serotonergic polymorphisms.

Serotonergic neurotransmission has been implicated in suicidal behavior. Polymorphisms in the genes coding for tryptophan hydroxylase, serotonin receptor 2A and serotonin transporter were investigated in a sample of suicide attempters (n = 165) and healthy control subjects (n = 99). No significant differences were found for any of the investigated polymorphisms. Neither did any significant differences emerge in comparison with control subjects when the suicide attempters were grouped into different diagnostic categories: unipolar disorder (n = 45), adjustment disorder (n = 37), substance use disorder (n = 37) and personality disorder, cluster B (n = 36). The results suggest that alleles defined by the investigated polymorphisms do not represent a major determinant in suicide attempt. However, a highly significant (P = 0.001; odds ratio, 1.47; 99% confidence interval, 1.42-1.53) allelic association between tryptophan hydroxylase and suicide attempt is indicated after pooling our data with literature data. In light of previous data, a possible association between the tryptophan hydroxylase polymorphism and a phenotype that may become differently stratified within differently selected samples of suicide attempters is discussed.

Adjustment Disorders↗
PubMed1986

Genetic factors in moderately severe and mild affective disorders.

The aim of this study was to investigate the contribution of hereditary factors in the development of affective and depressive adjustment disorders. I interviewed 151 index twins with moderately severe and mild affective illness, as well as their co-twins. The analysis of concordance rates indicates that hereditary factors may be important in the development of bipolar disorder and in major depression, except in non-psychotic, hysterical individuals. Furthermore, hereditary factors may not play any role in dysthymic disorder and depressive adjustment disorder. These findings are tentative and should be viewed against the methodologic limitations of this study, which include small sample size of the subgroups and the use of the Present State Examination as the basis for the DSM-III diagnoses.

Adjustment Disorders↗
PubMed2004

Defense mechanisms in adolescent conduct disorder and adjustment reaction.

The use of defense mechanisms by male and female adolescents with a diagnosis of conduct disorder was compared with the defense use of adolescents with a diagnosis of adjustment reaction. Because conduct disorder has been shown to be associated with a developmental lag in several areas of psychological functioning, we expected that these adolescents would show immaturity in the use of defenses. This expectation was confirmed. As compared with adjustment reaction, conduct disordered youths were more likely to use the immature defense of denial and less likely to use the mature defense of identification.

Adaptation, Psychological↗
PubMed1999

Natural course of adolescent major depressive disorder: I. Continuity into young adulthood.

OBJECTIVE: To examine the course of adolescent major depressive disorder (MDD) by comparing rates of mood and non-mood disorders between age 19 and 24 years in participants with a history of adolescent MDD versus participants with adolescent adjustment disorder with depressed mood, nonaffective disorder, and no disorder. METHOD: Participants from a large community sample who had been interviewed twice during adolescence completed a third interview assessing Axis I psychopathology and antisocial and borderline personality disorders after their 24th birthday: 261 participants with MDD, 73 with adjustment disorder, 133 with nonaffective disorder, and 272 with no disorder through age 18. RESULTS: MDD in young adulthood was significantly more common in the adolescent MDD group than the nonaffective and no disorder groups (average annual rate of MDD = 9.0%, 5.6%, and 3.7%, respectively). Adolescents with MDD also had a high rate of nonaffective disorders in young adulthood (annual nonaffective disorder rate = 6.6%) but did not differ from adolescents with nonaffective disorder (7.2%). Prevalence rates of dysthymia and bipolar disorder were low (< 1%). Adolescents with adjustment disorder exhibited similar rates of MDD and nonaffective disorders in young adulthood as adolescents with MDD. CONCLUSIONS: This study documents the significant continuity of MDD from adolescence to young adulthood. Public health implications of the findings are discussed.

Adolescent↗
PubMed1994

Low vision: how to assess and treat its emotional impact.

For many older adults facing visual loss, the frustration and distress that makes life's activities difficult or impossible may lead to clinically significant emotional problems. Patients may feel a loss of independence and control, poor self-esteem, and strained social relationships. Clinically, the most common emotional problems related to vision loss are adjustment disorder and major depressive episode. For patients with adjustment disorder, counseling or psychotherapy is recommended for both the patient and family members. Patients with major depression must be evaluated and referred for more in-depth psychiatric evaluation and treatment. Resolution of these disorders is important before a patient can pursue adequate rehabilitation.

Adaptation, Psychological↗
PubMed1991

Psychiatric morbidity in HIV infected individuals.

Forty six subjects infected with the human immunodeficiency virus (HIV) were followed up, for recording psychiatric morbidity if any, before and after the information regarding their HIV status was revealed to them. Among these, four patients had the AIDS syndrome, while 42 individuals were HIV carriers. The pre-information morbidity in the AIDS group included two individuals who presented with delirium and one with an adjustment disorder. The psychiatric diagnosis among the HIV carriers revealed one patient with major depression, four with adjustment disorders and four with alcohol dependence syndrome. The additional morbidity after the diagnoses was revealed included major depression and adjustment disorders which could be managed by psychological intervention and counselling in most cases. The individual who developed major depression later, committed suicide. The study though preliminary in nature, suggests that it may be beneficial to include psychiatric management as part of the general care of individuals with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Psychiatric evaluation of physical rehabilitation patients.

We conducted a study to demonstrate the frequency and types of psychiatric/psychological symptoms. A Structured Interview according to the DSM-III-R was conducted which demonstrated that 46 (41.4%) of 111 rehabilitation inpatients met the criteria for some forms of psychiatric disorders: 34 patients for major depression, 10 for adjustment disorder with anxious mood, and 2 for posttraumatic stress disorder. The remaining 65 patients (58.6%) showed normal reactions to their diseases. Average length of hospital stay for patients with major depression was significantly longer than those with no or the other types of psychiatric disease. They were also tested with Zung's Self-Rating Anxiety Scale (SAS), Zung's Self-Rating Depression Scale (SDS), and Profile of Mood States (POMS). Three psychological tests were useful in detecting depression or adjustment disorder among rehabilitation patients; however, these tests are not always specific to the type of psychiatric disorders. Patients with higher scores in those three tests should be referred to a psychiatric consultant for detailed examinations and proper treatments, if necessary.

Adjustment Disorders↗
PubMed1992

Relaxation therapy reduces anxiety in child and adolescent psychiatric patients.

The immediate effects of relaxation therapy (RT) were assessed in 40 hospitalized children and adolescents with diagnoses of adjustment disorder and depression. These effects were assessed using a within subjects pre-test/post-test design and by comparison with a control group of 20 depressed and adjustment disorder patients who watched a 1-h relaxing videotape. The 1-h RT class consisted of yoga exercise, a brief massage and progressive muscle relaxation. Decreases were noted in both self-reported anxiety and in anxious behavior and fidgeting as well as increases in positive affect in the RT but not the video group. In addition, adjustment disorder patients and a third of the depressed patients showed decreases in cortisol levels following RT, while no changes were noted in the video group. Thus, both diagnostic groups appeared to benefit from the RT class.

Adjustment Disorders↗
PubMedDate not supplied

Common types of mental disorders in adult cancer patients seen at Shaukat Khanum Memorial Cancer Hospital and Research Centre.

BACKGROUND: Mental disorders such as depression, anxiety and adjustment disorders occur in a significant number of cancer patients, particularly as disease advances and as cancer therapies become more aggressive. METHODS: 365 newly diagnosed adult cancer patients were interviewed by clinical psychologist and data was collected regarding patients' age, gender, education, home atmosphere, family support system and type of cancer. The Mini Mental State Examination (MMSE) and Structured Clinical Interview according to Diagnostic and Statistical Manual fourth version (SCID-IV) were used to record the presence and absence of type of a mental disorder. Data thus collected was analyzed by utilizing SPSS for Windows version 10.0. RESULTS: Adjustment disorders was the most common type of mental disorders seen in 20.8%; depression in 17.8% and anxiety in 16.8%. A statistically significant association between types of mental disorders and patients' age, gender, education, home atmosphere and family support system was observed. CONCLUSION: A significant number of cancer patients suffer from one or other type of mental disorder. They need special attention of healthcare professionals for proper psychological assessment and management.

Academic Medical Centers↗
PubMed1994

Psychiatric evaluation of rehabilitation patients.

Patients undergoing physical rehabilitation have experienced a severe object loss and it is suggested that many patients in rehabilitation might have psychiatric disorders. We conducted a study to demonstrate the frequency and kinds of psychiatric and psychological symptoms. A Structured Interview according to the DSM-III-R was conducted, which demonstrated that 27 (43.5%) out of 62 rehabilitation inpatients met the criteria for some form of psychiatric disorders; 22 patients for major depression and five for adjustment disorder with anxious mood. The remaining 35 patients (56.5%) showed normal reactions to their diseases. They were also administered Zung's Self-rating Anxiety Scale (SAS), Zung's Self-rating Depression Scale (SDS) and Profile of Mood States (POMS). These three psychological tests were useful in detecting depression or adjustment disorder among rehabilitation patients; but they were not always specific to the type of psychiatric disorders. Patients with higher scores in these inventories should be referred to a psychiatric consultant for detailed examinations and proper treatment if necessary.

Adjustment Disorders↗