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PubMed1990

The use of the general behavior inventory to screen for affective disorders.

Accurate diagnosis of affective disorders and of specific subtypes influences treatment decisions about whether to use psychotherapy alone or in conjunction with medication as well as which is the most appropriate choice of medication. The General Behavior Inventory was used to identify unipolar and bipolar subtypes of major affective disorder in consecutive patients in a private practice and to separate them from anxiety and adjustment disorders. This test was significantly more accurate in separating adjustment disorders from unipolar depression than the Beck Depression Inventory which tended to identify depressive symptomatology regardless of diagnosis and to miss bipolar cases. It was found to be superior to other commonly used screening tests for affective disorders in ease of administration, in choice of language, and in specificity.

Adjustment Disorders↗
PubMed1995

Psychiatric problems of pediatric end-stage renal failure.

Our study compared 53 children with end-stage renal disease (26 children on continuous ambulatory peritoneal dialysis and 27 children with kidney transplants) to a matched sample of 27 healthy children. Seventeen of the children on dialysis (65.4%) exhibited separation anxiety disorder, which was associated with the family psychological environment. After receiving kidney transplantation, school maladjustment continued, and adjustment disorder was seen in eight children (29.6%). The adjustment disorder was related to poor relationships with peers at school.

Adjustment Disorders↗
PubMed2006

[Mental disorders in general hospital patients].

Two major epidemiological studies using standardized instruments for diagnosis have revealed that the prevalence of mental disorders in general hospital inpatients range from 41.3% to 46.5%. The most prevalent groups of psychiatric disorders among general hospital inpatients are organic mental illness, depressive disorders, and alcohol dependence or abuse. The prevalence rates of organic brain syndromes, adjustment disorders with depressed mood, and alcohol dependence in general hospital inpatients are above those of the general population. In nearly half of the studied general hospital inpatients receiving a psychiatric diagnosis Consultation-Liaison (C-L) psychiatry interventions were found to be necessary. However, psychiatric consultation rates found in most recently presented studies in Germany and Austria range from 2.66% to 3.30%, and remain low when compared to the reported prevalence figures of psychiatric disorders and the demonstrated necessity for specific therapeutic interventions among general hospital inpatients. There is also evidence stemming from newly presented C-L follow-up studies that the remarkable advances in intensive care treatment, organ transplantation medicine and cardiac surgery with cardiopulmonary bypass within the past decade have an important impact on the general hospital inpatients; psychosocial outcome. One follow-up study of long-term acute respiratory distress syndrome (ARDS) survivors using the Structural Clinical Interview for the DSM-IV (SCID) has shown that 43.5% of these patients met the criteria for a full posttraumatic stress disorder (PTSD), 8.9% of these patients for a subthreshold or partial PTSD (sub-PTSD) at hospital discharge, and 23.9% of them still suffered from full PTSD, 17.8% of them from sub-PTSD. ARDS-Patients with PTSD symptomatology exhibited major impairments in a variety of dimensions of health-related quality of life. Another outcome study examining concurrently psychiatric morbidity and quality of life in intermediate-term survivors of orthotopic liver transplantation (OLT) survivors has documented that 5.4% of these patients had a full PTSD, and 17.3% of them a sub-PTSD at 4 year-follow-up. OLT- related PTSD symptomatology was associated with maximal decrements in health-related quality of life. The duration of intensive care treatment, the number of medical complications, and the occurrence of acute rejection were positively correlated with the risk of PTSD symptoms subsequent to OLT. Finally, one prospective 1-year outcome study has focused on psychiatric morbidity including postoperative delirium in patients who had undergone cardiac surgery employing cardiopulmonary bypass. Postoperative delirium developed in 32.4% of these patients, however, only in 5.9% of them severe delirium was noted. Short-term consequences of cardiac surgery included adjustment disorders with depressed features (32.4%), acute full in-hospital PTSD (17.6%), and in-hospital major depression (17.6%). The diagnostic status of in-hospital PTSD was linked to postoperative delirium. At 12 months, the severity of depression and anxiety disorders including PTSD improved and returned to the preoperative level. However, patients who were found to have major depression or PTSD before discharge, C-L psychiatric consultations were conducted. In conclusion, PTSD symptoms following medical illness and treatment are not rare. If they are untreated, PTSD symptoms such as intrusive recollections, avoidance and hyper-arousal may impair the patients; quality of life more than the primary disease. This seems to be also true for a subthreshold PTSD. To adequately diagnose and treat patients at risk of developing PTSD, close collaboration between physicians of all subspecialties and C-L psychiatrists will be necessary.

Adjustment Disorders↗
PubMed1996

Posttraumatic stress disorder in survivors of the Brooklyn Bridge shooting.

OBJECTIVE: The authors documented the frequency of posttraumatic stress disorder (PTSD) in civilian victims of urban terrorism. METHOD: A recent shooting attack on a van of Hasidic students provided a unique opportunity to document responses of survivors in this targeted group. Eleven of 14 survivors were compared with age-matched subjects on a variety of questionnaires and clinical evaluations. RESULTS: Of the 11 survivors, four were diagnosed with PTSD (all of whom also had concurrent major depressive disorder), one with major depressive disorder, and two with adjustment disorder. CONCLUSIONS: Findings are interpreted in the context of unique factors contributing to the heightened vulnerability of this group.

Adjustment Disorders↗
PubMed2004

Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview.

The validity and reliability of using psychological autopsies to diagnose a psychiatric disorder is a critical issue. Therefore, interrater and test-retest reliability of the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders and the usefulness of these instruments for the psychological autopsy method were investigated. Diagnoses by informant's interview were compared with diagnoses generated by a personal interview of 35 persons. Interrater reliability and test-retest reliability were assessed in 33 and 29 persons, respectively. Chi-square analysis, kappa and intraclass correlation coefficients, and Kendall's tau were used to determine agreement of diagnoses. Kappa coefficients were above 0.84 for substance-related disorders, mood disorders, and anxiety and adjustment disorders, and above 0.65 for Axis II disorders for interrater and test-retest reliability. Agreement by personal and relative's interview generated kappa coefficients above 0.79 for most Axis I and above 0.65 for most personality disorder diagnoses; Kendall's tau for dimensional individual personality disorder scores ranged from 0.22 to 0.72. Despite of a small number of psychiatric disorders in the selected population, the present results provide support for the validity of most diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders. This instrument can be recommended as a tool for the psychological autopsy procedure in post-mortem research.

Adjustment Disorders↗
PubMed1993

Psychiatric morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome.

Sixty consecutive patients admitted to an oncology unit in a general hospital were systematically assessed to determine the prevalence of psychiatric disorders. Patients' awareness of the diagnosis of cancer and their perception of treatment intention and outcome were assessed independently by another investigator who was blind to the psychiatric diagnosis. Forty percent of the sample had a diagnosis of psychiatric disorder, based on the Diagnostic and Statistical Manual for Mental Disorders (3rd edition, revised). Adjustment disorders comprised most of the psychiatric diagnoses. Major depression was seen in 8 (13%) patients. One third of the patients were estimated to be unaware of the diagnosis of cancer, and 82% of patients perceived the treatment given as curative. Psychiatric morbidity was significantly less common in patients who did not know they had cancer, and in those who considered treatment as curative. The prevalence of depressive disorders in our sample was higher than in medical inpatients. It is concluded that psychiatric disorders, especially affective disorders, are common among cancer patients. Awareness of nature of the illness and expected outcome can affect the prevalence of psychiatric morbidity. Further studies investigating the relationship between psychiatric morbidity and duration of illness, type and stage of cancer, disabilities and coping strategies are warranted.

Adjustment Disorders↗
PubMed1985

Findings in psychiatric consultations with patients with acquired immune deficiency syndrome.

Thirteen of 40 patients with acquired immune deficiency syndrome (AIDS) admitted to the wards of a large city hospital were seen by the staff of a psychiatric consultation service. Eleven were gay men and two were bisexual men. "Depression" was the stated reason for referral of 10 patients; of these, two met DSM-III criteria for major depression, one had dysthymic disorder, and seven had adjustment disorder with depressed mood. Recurrent psychological themes of the 13 patients were: dealing with a life-threatening illness, uncertainty about the implications of an AIDS diagnosis, social isolation, and guilt over their previous life style. The role of the primary physician and of the mental health professional in the psychological care of AIDS patients is discussed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Adequacy of antidepressant treatment by psychiatric residents: the antidepressant treatment history form as a possible assessment tool.

OBJECTIVE: Facility in psychopharmacology is a major goal of psychiatric residency. This study assesses the adequacy of pharmacotherapy provided to depressed patients in a resident clinic. METHODS: Charts of all 285 patients seen in an outpatient triage clinic during 2000 were reviewed. One hundred twelve patients had diagnoses of major depression, dysthymia, depressive disorder not otherwise specified, adjustment disorder with depressed mood, or bipolar disorder with a documented depressed episode during the studied period. Pharmacotherapy prescribed to these 112 patients was rated using the Antidepressant Treatment History Form (ATHF). Also analyzed were weeks in treatment and Clinical Global Impression (CGI) Severity score assigned retrospectively. RESULTS: Of the 112 charts subjected to detailed review, 49.1% documented adequate treatment. Antidepressant Treatment History Form ratings increased with treatment duration. No correlation was found between ATHF ratings and CGI ratings. CONCLUSIONS: Results suggest that time retained in treatment is a major factor in treatment adequacy.

Adjustment Disorders↗
PubMed1996

Relationship between narcissistic tendencies and psychiatric conditions in patients undergoing physical rehabilitation.

This study examined the relationship between psychiatric conditions and narcissism in 78 patients with physical rehabilitation for illnesses such as cerebrovascular disease. The frequency of psychiatric disorders (Major Depression and Adjustment Disorder) was significantly higher for the patient group than for the healthy control group. The patients had significantly higher scores on measures of psychiatric symptoms including depression and lower scores on a narcissistic factor (Self-sufficiency) than the controls. In the patient group, the Self-sufficiency scores were significantly and positively correlated with Vigor scores. In the patient and control groups, although the correlation coefficient was not high and no significant difference was noted, the Self-sufficiency scores were negatively correlated with the Depression scores. These findings suggest that, in patients undergoing physical rehabilitation, poor Self-sufficiency is related to a decrease in vigor as a depressive symptom, perhaps due to the loss of physical functioning.

Adjustment Disorders↗
PubMed1997

Fear of flying--a Singapore perspective.

Fear of flying is a term commonly used in the Aviation Medicine community. However, heterogeneous conditions which can present with fear of flying, demand that a more stringent and systematic approach be made in one's management of the aviator with fear of flying (FOF). Cases of FOF between 1974 and 1995 presented to the Civil Aviation Medical Board and the Aeromedical Centre of the Republic of Singapore Air Force were studied for their psychopathology, psychodynamics, diagnoses, motivation for treatment, type of treatment and response to treatment, and their eventual outcome in relation of flying. 53.3% of 15 cases had Adult Situational Reaction, 26.7% had phobia of flying, 6.6% had Adjustment Disorder, 6.7% had Anxiety Depressive Disorder and 6.7% had Transient Psychosis. All cases of Adjustment Disorder were returned to flying, compared with 25% of Adult Situational Reaction, 66.7% of Phobia of Flying and none of the aircrew suffering from Transient Psychosis. Fear of flying is thus a complex phenomenon, where there is interaction of elements of mental health, neurotic roots, real and imaginary threats and life events affecting eventually the flyer's willingness to fly.

Adaptation, Psychological↗
PubMed2001

Factors associated with the effects of a structured psychiatric intervention on breast cancer patients.

The authors developed a structured group intervention for Japanese breast cancer patients. This program is a series of five 90-minute sessions including psycho-education, problem-solving, psychological support, relaxation training, and guided imagery. The aim of this study was to investigate discriminating factors between the improving and non-improving group. From November 1996 through November 1998, 110 patients participated in this study. Out of 110 patients, 9 failed to complete the five sessions. Nine did not return the questionnaire 6 months later, due to death of 3 individuals and re-location of 6. The remaining 92 patients were analyzed. The subjects were administered the Profile of Mood States (POMS) at entry and 6 months after the completion. According to the overall change in Total Mood Disturbances scores of the POMS, 69 subjects were categorized into the improving group and 23 into the non-improving group. This study defined several factors which discriminated between the improving and the non-improving group. These factors can be summarized as: (1) 'good relationship with doctors', (2) 'family support/understanding', (3) 'more intervention benefit', and (4) 'no comorbid adjustment disorders' at entry. Further modification is suggested such as an educational approach for family members to increase their understanding/support and also additional support for patients with adjustment disorders is suggested.

Adjustment Disorders↗
PubMed1997

Prevalence of antithyroid antibodies in mood disorders.

We examined the prevalence of antimicrosomal and antithyroglobulin antibodies in psychiatric inpatients with unipolar depression (N = 218), bipolar disorder manic (N = 51), bipolar disorder depressed (N = 19), and bipolar disorder mixed (N = 26) in comparison with two control groups: psychiatric inpatients with adjustment disorder (N = 80) and family medicine outpatients without current psychiatric illness (N = 144). A statistical analysis that controlled for age and sex revealed the frequency of positive antibody titers not to be increased in patients with a diagnosis of unipolar depression (6.9%) or bipolar disorder manic (3.9%), when compared with patients with adjustment disorder (2.5%) and non-psychiatric subjects (6.9%). There was a weak trend toward an increased prevalence of antithyroid antibodies in patients with bipolar disorder, mixed (19%) or depressed subtype (16%). The excess occurrence of antibodies in patients with either mixed or depressed bipolar disorder did not appear to be related to lithium exposure, which was similar in all bipolar subgroups. When the intervening influences of age and sex are taken into account, unipolar depression does not appear to be associated with an excessive rate of antithyroid antibodies; however thyroid autoimmunity may be weakly associated with subtypes of bipolar disorder in which depressive symptoms are prominent.

Adult↗
PubMed1993

[Postoperative psychiatric complications following liver transplantation].

BACKGROUND: The aim of the study was to describe the psychiatric complications of the postoperative period of liver transplantation. METHODS: Sixty-three adult liver transplant recipients were seen weekly before surgery and during the postoperative period until discharge. They were assessed through Goldberg's Clinical Interview Schedule (CIS) and diagnosed according to DSM-III-R criteria. RESULTS: Psychiatric morbidity was 29%. Organic mental disorders were the most prevalent, especially delirium (13%), followed by adjustment disorders (8%), major depression (5%) and organic anxiety disorders (3%). One of the depressed patients showed subsequently a rapidly cycling bipolar course. Most patients had a good outcome of their psychiatric disorder at discharge. In contrast, patients with delirium presented a higher mortality rate. CONCLUSIONS: The prevalence of short-term psychiatric complications in patients undergoing liver transplantation is close to 30%. Delirium, which is significantly related to mortality, is the most frequent of them, followed by adjustment disorders and affective disorders, which, in contrast, seem to have a good prognosis.

Adult↗
PubMed1986

Psychostimulant treatment of depressive disorders secondary to medical illness.

Hospital charts were reviewed for 66 medical and surgical patients who received dextroamphetamine or methylphenidate to treat a depressive disorder. Approximately three-fourths showed some improvement; in half of the sample, improvement was marked or moderate. Of those who improved, 93% reached their peak response within the first 2 days. Relapse occurred in only 5 patients. Side effects were minimal. Nonsignificant trends suggested that dextroamphetamine was more effective for major depression than adjustment disorder, while methylphenidate tended to be more effective for adjustment disorder. Psychostimulants appear to be a therapeutic option in the medically ill depressed population and may be more rapidly effective with fewer side effects than tricyclic antidepressants.

Adjustment Disorders↗
PubMed1993

DSM-III-R disorders in Vietnamese refugees. Prevalence and correlates.

This study's purpose was a) to determine the prevalence of DSM-III-R disorders in newly arrived ethnic Vietnamese and ethnic Chinese refugees from Vietnam and b) to determine the correlates of DSM-III-R disorders. A Vietnamese-speaking psychiatrist administered translated sections of the Structured Clinical Interview for DSM-III-R to 201 Vietnamese new arrivals undergoing mandatory health screening. Overall, 18.4% had one or more current disorders: 8.5% had adjustment disorder and 5.5% had major depression. Ethnic Vietnamese, compared with ethnic Chinese, had significantly (p < .05) higher rates of current posttraumatic stress disorder and generalized anxiety disorder. Ethnic differences in psychopathology were largely explained by the fact that ethnic Vietnamese refugees had experienced more traumatic events and separation from family. After adjusting for ethnicity, refugees who reported traumatic events, refugees who were married, and veterans were significantly (p < .05) more likely to have one or more psychiatric disorders.

Adult↗
PubMedDate not supplied

[The psychiatric consultation-liaison program and posttraumatic stress disorder due to burns].

Sixty-five acute burned inpatients were evaluated prospectively by structured questionnaire and clinical interview. All of the subjects hospitalized in a Burn Unit were referred for psychiatric examination to a psychiatric consultation-liaison programme. Most of the patients suffered adjustment disorders (n = 40), and post-traumatic stress disorder (PTSD) was diagnosed in 5 cases. The carefully assessment of PTSD was an objective of the Study. There were no significant differences among patients with PTSD and Adjustment Disorder for severity and type of burn injuries. The discussion deals with PTSD is a frequent missed disorder by the medical staff of burn units, and also the importance of the patients subjective appraisal of the stressor as a factor precipitating PTSD.

Adjustment Disorders↗
PubMedDate not supplied

Demographics of and diagnoses in Operation Enduring Freedom and Operation Iraqi Freedom personnel who were psychiatrically evacuated from the theater of operations.

OBJECTIVE: The objective of this study was to characterize the demographic and clinical information of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) military personnel who were psychiatrically evacuated from the theater of operations. METHOD: Records of 1264 consecutive OEF/OIF patients who were medically evacuated for primarily psychiatric reasons between November 4, 2001, and July 30, 2004, were reviewed to collect demographic information and psychiatric diagnoses. RESULTS: When compared with all returned OEF/OIF veterans (N=213,150), psychiatric evacuees were more likely to be: female, under the age of 31 years, African-American or Hispanic, enlisted and National Guard/Reserve. Over 80% of patients were evacuated during the first 6 months, compared with 17% during the second 6 months of deployment. The most common diagnostic categories were adjustment disorders (37.6%), mood disorders (22.1%), personality disorders (15.7%) and anxiety disorders (15.4%); 16.5% received no psychiatric diagnosis. Only 5% of evacuees were returned to OEF/OIF duty. CONCLUSION: Almost half of evacuated patients received no diagnosis or no adjustment disorder diagnosis, suggesting clinical improvement since a decision for evacuation was made. Potential areas of focus for preventing psychiatric evacuations are identifying service members who are at risk during early stages of deployment and studying whether there are gender-specific deployment stressors.

Adjustment Disorders↗
PubMedDate not supplied

Neuropsychological screening in the psychiatric emergency room.

In a pilot study, a neuropsychological minibattery of tests consisting of Trail-Making Test A (TMA), Trail-Making Test B (TMB), and the Visual Reproduction subtest (VR) of the Wechsler Memory Scale was administered to patients with common psychiatric diagnoses in a psychiatric emergency room (ER). Patients with adjustment disorders were not distinguishable from normal controls, while patients with affective disorders and schizophrenia were more impaired than both of these samples. It is suggested that this or a similar minibattery of tests can be of use as an adjunct screening device for differential diagnosis of adjustment disorder versus more serious psychopathology in psychiatric ERs.

Adjustment Disorders↗