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PubMed1999

A decade of spontaneous long-term course of psychogenic impairment in a community population sample.

BACKGROUND: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. METHOD: Beginning in 1979 (nt1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (nt3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). RESULTS: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. CONCLUSION: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention.

Adult↗
PubMed2002

Service utilisation and costs of first-contact patients in a community psychiatric service in Italy.

This study describes service utilisation under routine clinical activity and the costs of providing mental health care for 24 months for the whole population of 330 subjects who had first contact with the Magenta Community Mental Health Centre during one year. The mean age of patients was 42.5 years, and 61% were females. According to ICD 10 criteria, 7% were diagnosed as having schizophrenia, 22% mood disorders, 37% neurotic disorders, 15% personality disorders and 19% other diagnoses. The clinical routine activity was monitored for 24 months from the first contact for each patient. The mean cost for a schizophrenic patient is more than double that of other patients. In-patient activity and community services accounted, respectively, for 49.7% and 50.3% of the total costs. Total health care costs per patient differ widely according to whether patients had been hospitalised during the observation period. Patients with a previous psychiatric contact and a longer duration of illness were more costly than the other patients. Multiple regression analysis was used to assess the association between all the individual variables and costs. For the whole population, the model explains 50% of the cost variation. Higher treatment costs were positively associated with the presence of previous psychiatric contacts and referral to the CPS by other sources than a general practitioner, and negatively associated with age.

Adult↗
PubMed2003

A multicenter study on the prevalence of psychiatric disorders among new referrals for epilepsy in Japan.

PURPOSE: To investigate the prevalence rate and risk factors of psychiatric disorders among new referrals for epilepsy, a multicenter study was conducted by using the International League Against Epilepsy (ILAE) criteria for epilepsy and the ICD-10 criteria for psychiatric disorders. METHODS: From April 2000 to March 2001, 398 patients with epilepsy, who were referred to nine neuropsychiatric outpatient clinics specialized for epilepsy in the Tokyo metropolitan area, were evaluated by using a newly developed five-axis classification scheme. RESULTS: Forty-two percent of the subjects showed a psychiatric disorder. Twenty-four percent of the total showed psychiatric disorders, including neurotic disorders in 8%, psychotic disorders in 7%, and affective disorders in 1%. In addition, 23% of the total showed mental retardation, and 18% showed personality disorders. A logistic regression analysis revealed that the three risk factors for a psychiatric disorder were mental retardation, temporal lobe epilepsy (as opposed to other subtypes), and a high seizure frequency. CONCLUSIONS: The presence of mental retardation was the primary risk factor for developing a psychiatric disorder, especially a schizophrenia-spectrum disorder. The type of epilepsy alone is not a strong predictor of psychiatric illness, and intractable temporal lobe epilepsy with a high seizure frequency is accountable for the link between the epilepsy and the psychiatric illness.

Adolescent↗
PubMed2003

Recurrent episodes of perceptual alteration in patients treated with antipsychotic agents.

Antipsychotics have been sporadically reported to induce the brief recurrent episodes characterized by hypersensitivity of the visual perception, which is known as paroxysmal perceptual alteration (PPA) mainly in Japan. PPA is characterized by hypersensitivity of perception mainly in visual modalities, which could occur in patients treated with antipsychotics. PPA is occasionally known to be accompanied by an oculogyric crisis (OGC). In this study, we examine the prevalence and the characteristics of patients with PPA. Three hundred thirty-eight patients who were treated with antipsychotics and diagnosed with schizophrenia, mood disorders, or neurotic disorders (International Classification of Disease, or ICD-10) were interviewed. We compared the characteristics between subjects with and without PPA. The mean overall prevalence of PPA was 3.25%, which was higher among patients treated with high-potency antipsychotics (3.91%) than in subjects treated with mid-potency or low-potency drugs (1.16%). PPA occurred simultaneously with OGC at the rate of 36.4%. We also found much similarity between PPA and OGC in terms of phenomenology. We suggest that PPA could manifest itself as an undesirable effect of antipsychotics, especially those of high potency. PPA and OGC may a share common underlying mechanism.

Adolescent↗
PubMed2004

[Psychosocial rehabilitation at the dawn of the 21st century. I: Principles, population targets, and pathologic causes].

The relatively recent development of the psychosocial rehabilitation has its origins mainly in the progress of modern psychopharmacology, the assertion of the rights of the patients and the result of the studies showing that the evolution of persons suffering from severe and persistent mental illnesses can prove to be positive in many cases. In spite of the heterogeneity of the experiences and of the theoretical references, the core principles of the psychosocial rehabilitation imposed themselves. These principles can be classified according to three levels, that of relational ethics, that of the method of intervention and that of the institutional device. A recent study showed that 2.4@1000 of the general adult population of the Canton of Vaud live in sociotherapeutic and rehabilitation accommodations. In this sample, there is a important percentage of relatively young persons (55.3% are under 40). In institutional accommodation there is a majority of patients suffering from major personality disorders and addiction (40.6%), followed by psychotic disorders (37.2%), persistent mood disorders (12.3%), neurotic disorders (6.6%) and psycho-organic disorders (3.3%). In home based rehabilitation, the ratio of patients with psychotic disorders is more important (53.1%). This difference would indicate that people with schizophrenia would have a better social outcome than personality disorders with addiction.

Ethics, Medical↗
PubMed1985

Neurotic illness: conserving a threatened concept.

With the advent of the American Psychiatric Association's Classification DSM III, the usefulness of the term neurosis as a unitary concept has been questioned. This is largely because of the psychodynamic connotations that invest the term in the USA. However there has been pragmatic development, since the word was introduced into the English language in 1784, that carries epidemiological, behavioural and phenomenological implications. This is demonstrated in the definition contained in ICD 9. Disturbance of self-experience and problems with interpersonal relationships are common to all neurotic disorders, and bodily symptoms of non-organic cause are usual. Neurotic disorders are extremely frequent in the general population, amongst those who consult general practitioners and in psychiatric out-patients; they necessarily concern doctors. It is concluded that what different neurotic disorders have in common is more important for classification than the differences between them. An important practical consideration is that there are general aspects of treatment appropriate for all neuroses which are of less relevance in the treatment of other psychiatric disorders. Also the provision of treatment services require different emphases for the neuroses.

Body Image↗
PubMed1975

Some aspects of psychiatric morbidity in the out-patient population of a general hospital.

A preliminary report on certain aspects of psychiatric morbidity in persons attending the medical out-patients department of the Institute of Post-graduate Medicine, Dacca, have been presented. Out of 652 cases who have been interviewed, 31% had purely psychogenic conditions, 45% were suffering from purely organic diseases and 14.8% complained of symptoms of both organic and psychogenic features. No apparent underlying aetiology have been detected in 8.6% of cases. Of the psychogenic group, neurotic disorders comprised the largest number in the sample; anxiety state and sexual neurosis in males were the commonest neurotic disorders. When the mixed groups are included, 44% of males and 49.8% of females had symptoms which were either purely psychogenic in nature or had conspicuous psychogenic component. Reason for such a high percentage of psychogenic component has been discussed. Most of the patients attending the out-patient department were within the age of 21 to 40 years. Attendance in the number of older age persons were less in the psychogenic group than with organic conditions. Further, in females a significant difference was observed between psychogenic and organic group patients above and below the age of 40 years. Patients younger than 40 years were more in purely psychogenic group compared to organic conditions. Most of the patients have been found to be married both in psychogenic and organic group. However, there was significant difference in attendance rate of single males in the psychogenic group were somewhat over-represented in the sample in comparison to purely organic group. There was no relation of marital states in cases of females.

Adult↗
PubMed1992

[Results of psychological tests in children with long-term follow-up for Reye's syndrome].

Within a 10-year period the authors investigated the incidence of mental disorders in a group of 65 children with a history of Reye's syndrome. From the investigation ensues that the majority of mental disorders is temporary, followed by complete recovery. Most frequently neurotic disorders were observed, disorders of motor coordination, impaired attention. These disorders persisted longest during the follow-up of patients who had suffered previously from the most severe forms of Reye's syndrome. From the total number of 65 children all mental disorders disappeared in 52.3%; 43% of the children ceased sooner or later to attend examinations and only 4.7% of the original group have still, after five years, speech disorders, neurotic manifestations and an impaired motor coordination.

Adolescent↗
PubMedDate not supplied

[S-II symptom questionnaire].

"S-II" Symptom Check-list which allows for a fast diagnosis of neurotic disorders. A result of 165 points suggests the incidence of such disorders with the probability of 90%. The methodology of the construction of the check-list intends for the application of questions most common in those ill due to neurotic disorders (owing to the change in frequency) and the most possibly equal amount of questions on the symptoms common to women and men. Thanks to this the norm for women and men is identical. SCL S-II Symptom Check-list is a shortened and actualised version of the "O" Symptom Check-list, developed in 1975. It is similar to the SCL-90 and highly correlated with it, but it does not contain the variables concerning the psychotic symptoms. Thanks to this, its' accuracy (specificity) in the diagnosis of neurotic disorders is high. 4 pairs of questions allow for the judgement of answer reliability. 10 scales were singled out in the questionnaire. They are only of a helpful value and do not allow for a one-sided diagnosis of the type of the disorder, listed in the ICD-10. The scale results can, however make the correct diagnosis easier.

Comorbidity↗
PubMed1997

The National Psychiatric Morbidity surveys of Great Britain--initial findings from the household survey.

BACKGROUND: This paper describes the Household Survey from the National Survey of Psychiatric Morbidity. This covered a sample drawn at random from the population of Britain, with the exception of the Highlands and Islands of Scotland. METHODS: The Postcode Address file was used as the sampling frame. Nearly 13000 adults aged 16-65 were selected for interview, of whom 10108 (79.4%) were successfully interviewed. Eight per cent could not be contacted and 13% refused interview. Psychiatric assessment was carried out by lay interviewers using the CIS-R. Subjects were also screened for psychosis, and screen-positive individuals were examined by psychiatrists using SCAN. RESULTS: Sixteen per cent of subjects scored above the standard cut-off of 12 on the CIS-R. The overall 1-week prevalence of neurotic disorder was 12.3% in males and 19.5% in females. Unmarried and post-marital groups had high rates of disorder, as did single parents and people living on their own. Respondents in Social Class I had notably lower rates of neurotic disorder than the remainder of the sample. Unemployment was strongly associated with disorder. Subjects living in urban areas had a higher overall prevalence, but there was no significant variation by region. Black respondents had higher rates of disorders that were entirely explained by their age, family type and social class. Individual neurotic disorders were all significantly commoner in women, with the exception of panic disorder. The 1-year prevalence of functional psychoses was 4 per 1000, with no sex difference. Alcohol and drug dependence was considerably more prevalent in men. CONCLUSIONS: For the first time, the survey provides data on the prevalence and correlates of psychiatric disorder on a nationwide sample that can be used to inform equitable and effective national psychiatric services.

Adolescent↗
PubMed1999

Primitive defense mechanisms in schizophrenics and borderline patients.

In this study, patients with neurotic disorders, borderline patients, acute schizophrenics, and chronic schizophrenics were studied with regard to primitive defense mechanisms. Primitive defense mechanisms were assessed by means of the Lerner Defense Scale (LDS). In this study, the LDS was applied to the Holtzman Inkblot Technique. With the exception of primitive idealization, borderline patients used all primitive defense mechanisms significantly more frequently than patients with neurotic disorders, that is, splitting, projective identification, primitive denial, and primitive devaluation. Compared with both acute and chronic schizophrenics, borderline patients used primitive devaluation at a significantly higher degree of frequency. Both acute and chronic schizophrenics differed from patients with neurotic disorders by using splitting and projective identification significantly more frequently. However, there were differences concerning primitive devaluation and idealization. The defense structure of chronic schizophrenics was heterogenous. Except for primitive idealization, all primitive defense mechanisms correlated significantly with self-report measures of identity diffusion and impaired reality testing, which is consistent with theoretical assumptions. By a discriminant analysis, 90% of the borderline patients, 80% of the patients with neurotic disorders, 76% of the acute schizophrenics, and 92% of the chronic schizophrenics were classified correctly.

Acute Disease↗
PubMedDate not supplied

[Neurotic symptoms frequency].

The analysis of symptom checklists completed by 3196 patients before treatment--1970 females and 1226 males starting the therapy due to neurotic disorders--revealed that 12 symptoms occur im more than 80% of patients; 9 symptoms in 70-80%, 18 dysfunctions in 70-60% and 17 other dysfunctions in 60-50% of examined population. This means that a large number of symptoms including tension, mood depression an anxiety as well as difficulties in concentration, lack of self-confidence, sense of tiredness, loss of energy, persistent thoughts and images, constant fear, absent-mindedness, motor tensions, pessimism, thought flood, the sense of difficulty in thinking and tachycardia occur in almost all patients suffering from neurotic disorders, mo matter what these disorders are. Tle largest group consisted of patients with the diagnosis of anxiety disorders like phobias and the like (ca. 25%). Results of the study suggest the necessity of verification of the present views on the picture of dysfunctions combining into neurotic disorders. A similar occurrence rate of ca. 30% of the 95 analysed dysfunctions in the subgroups of females and males as well as a higher occurrence rate of 10% of the dysfunctions in the male group also make it necessary to verify the prevalent convictions about the sex-dependent differences in the picture and course of neurotic disorders.

Adult↗
PubMed1997

Early self-experienced neuropsychological deficits and subsequent schizophrenic diseases: an 8-year average follow-up prospective study.

The aim of the present study was to investigate the potential predictive value of early self-experienced neuropsychological deficits for the subsequent development of schizophrenia. A total of 96 patients with DSM-III-R diagnoses of personality disorders (formerly called 'neurotic disorders') who had been examined for the presence of such subjective experiences of deficits with standardized instruments were re-examined for the possible development of schizophrenic symptoms. After an average follow-up period of about 8 years, more than 50% of the patients had developed schizophrenia according to DSM-III-R criteria. In 77% of cases the outcome 'schizophrenia vs. no schizophrenia' was correctly predicted by the earlier presence or absence of self-experienced disturbances of thought, speech, memory, perception and action. These findings suggest that certain self-experienced neuropsychological deficits are able to indicate susceptibility to psychosis.

Adolescent↗
PubMed1997

Temperature and pulse chronomes in patients with neurotic and affective disorders treated with some antidepressants and tranquillizers.

The axillary temperature and the pulse rate for 1 minute were taken hourly from 7:00 a.m. to 11:00 p.m. in 65 physically and mentally healthy individuals and in 365 inpatients with neuroses and affective disorders. In approximately one fifth of the sample these measures were taken in the night hours too. Some of them were examined before and after treatment with antidepressants (imipramine, amitriptyline, maprotiline, trimipramine, clomipramine, viloxazine) and tranquillizers (benzodiazepines). The total number of cases adds up to 615 patients. The data were analyzed with the method of F. Halberg for cosinor-analysis (cosinor-rhythmometry). Our findings indicate that the temperature and pulse mesors in patients with neuroses and affective disorders before treatment are higher than in healthy individuals. In both patients groups (neuroses and affective disorders) these psychotropic drugs produce desynchronosis between pulse and temperature. The distribution by diagnoses show that the same antidepressant can transform the pulse and temperature chronome in different ways. This is due, on the one hand, to the different etiology of the disease process in each patient and, on the other hand, to the external agent (the drug).

Anti-Anxiety Agents↗
PubMedDate not supplied

[Scales of the "O" symptom questionnaire].

The article presents the scales of the "O" Symptom Check-list which were derived on the basis of an analysis of a patient population of over three thousand. The patients filled out the "O" Symptom Check-list before treatment. 14 variables of various syndromes were constructed, which corresponded with most of the neurotic disorders classified in ICD-10. The results obtained were compared with the scales constructed 20 years ago, in an attempt to explain the dynamics of the psychopathology in the course of those years. It was noted that the analysis of the results of the single scales can be helpful in defining and observing the most common neurotic disorders and noting their comorbidity.

Comorbidity↗