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PubMed1999

Somatoform dissociation discriminates among diagnostic categories over and above general psychopathology.

OBJECTIVE: The primary aim of this study was to investigate the hypothesis that somatoform dissociation would differentiate among specific diagnostic categories after controlling for general psychopathology. METHOD: The Somatoform Dissociation Questionnaire (SDQ-20), the Dissociative Experiences Scale, and the Symptom Checklist-90-R were completed by patients with DSM-IV diagnoses of dissociative disorders (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), bipolar mood disorder (n = 23), and a group of consecutive psychiatric outpatients with other psychiatric disorders (n = 45), mainly including anxiety disorders, depression, and adjustment disorder. RESULTS: The SDQ-20 significantly differentiated among diagnostic groups in the hypothesised order of increasing somatoform dissociation, both before and after statistically controlling for general psychopathology. Somatoform dissociation was extreme in dissociative identity disorder, high in dissociative disorder, not otherwise specified, and increased in somatoform disorders, as well as in a subgroup of patients with eating disorders. In contrast with somatoform dissociation, psychological dissociation did not discriminate between bipolar mood disorder and somatoform disorders. CONCLUSIONS: Somatoform dissociation is a unique construct that discriminates among diagnostic categories. It is highly characteristic of dissociative disorder patients, a core feature in many patients with somatoform disorders, and an important symptom cluster in a subgroup of patients with eating disorders.

Adult↗
PubMed1987

The application of DSM-III diagnostic criteria to school refusal.

The DSM-III diagnostic criteria were applied to school refusal cases, and the possibility of a subclassification of school refusal through the DSM-III was studied. The subjects were 50 cases diagnosed as school refusal following the criteria defined by Sumi and Tatara. As for the Axis I diagnoses, the subjects fell under the separation anxiety disorder (7 cases), avoidance disorder (13 cases), overanxious disorder (8 cases), identity disorder (5 cases), adjustment disorder (11 cases) and others. On Axis II, no case was diagnosed as having the personality disorder, but 14 cases showed pathological personality traits. On Axis III, nine cases showed some physical disorders or conditions. Among the five major diagnostic groups, there were some definite differences concerning the onset age, clinical course, psychosocial stress, response to therapy and prognosis of disorders. These results suggest the availability of a subclassification of school refusal by means of the DSM-III criteria.

Adolescent↗
PubMed1992

Depressive symptoms and depression among elderly people in Athens.

A total of 251 elderly residents of 2 boroughs of greater Athens were examined by a psychiatrist. For the assessment of depressive symptoms, the Center for Epidemiological Studies Depression (CES-D) Scale was used. Cognitive functioning was also evaluated. The prevalence of affective disorders of any type was estimated by a clinical examination with a semistructured psychiatric interview (PEF) supplemented by DSM-III criteria. A total of 27.1% of the elderly respondents reported a significant number of dysphoric or depressive symptoms and were identified as depressed cases. Respondents who had lower socioeconomic status, were widowed, were experiencing stressful life events or were living alone exhibited a significant degree of depressive psychopathology. An association between depressed mood and cognitive impairment was also found. A total of 9.5% of the sample was diagnosed as suffering from any type of affective disorder (1.6% major depression, 0.6% bipolar, 5.5% dysthymic disorder and 2.0% adjustment disorder with depressed mood). Affective disorders constitute nearly half of the total number of psychiatric diagnoses (20.3% at the sample). It is interesting that, of the 27.1% of the sample with depressed mood (> or = 16 score on CES-D Scale), only 9.5% of the sample were diagnosed as suffering from clinical types of depression.

Aged↗
PubMed2006

Migraine with unilateral motor symptoms: a case-control study.

OBJECTIVE: To characterise the clinical features of non-familial migraine with unilateral motor symptoms (MUMS) and compare these features with those of migraine without weakness. METHODS: 24 patients with MUMS and 48 matched controls were identified from a tertiary care headache centre. Using a structured interview, the migraine symptoms of both groups were characterised. Results of previously administered Beck Depression Inventories (BDI), Minnesota Multiphasic Personality Inventories and psychiatric diagnoses were collected, when available, and compared between groups. RESULTS: 9 patients had episodic migraine and 15 had chronic migraine. Patients with MUMS always had weakness involving the arm subjectively, and both arm and leg objectively. A give-way character was always present. Only 17% of patients with MUMS reported facial weakness; 58% reported persistent interictal weakness; 92% reported sensory symptoms. A rostrocaudal march of sensory and motor symptoms was frequently reported. Weakness was ipsilateral to unilateral headache in two thirds of the patients. Compared with controls, patients with MUMS had had similar pain intensities, but were more likely to report other migrainous symptoms, including allodynia. 38% of patients with MUMS were told they had had a stroke, and 17% believed they had had a stroke despite normal brain imaging. Patients with MUMS reported fewer affective disorders and more adjustment disorders than controls, and had similar BDI scores. CONCLUSIONS: A syndrome of severe migraine with accompanying give-way weakness is common in tertiary care headache centres. It is accompanied by other neurological symptoms.

Adult↗
PubMedDate not supplied

Demonic attributions in nondelusional disorders.

OBJECTIVE: Belief in demonic influence has repeatedly been described as a delusion in schizophrenic patients. The goal of this explorative study was to examine the frequency, as well as the psychodynamic and social functions of such beliefs in a sample of nondelusional patients. METHOD: The sample consisted of 343 psychiatric outpatients who described themselves as religious. In semistructured interviews they were asked to give their view of demonic causality of their illness. RESULTS: A high prevalence of such beliefs was not only found in schizophrenic patients (56%) but also in the following groups of nondelusional patients: affective disorders (29%), anxiety disorders (48%), personality disorders (37%) and adjustment disorders (23%). Belief in demonic oppression tended to be associated with lower educational level and rural origin, and was significantly influenced by church affiliation. CONCLUSIONS: Beliefs in possession or demonic influence are not confined to delusional disorders and should not be qualified as a mere delusion. Rather they have to be interpreted against the cultural and religious background which is shaping causal models of mental distress in the individual.

Adolescent↗
PubMed1984

The role of diagnosis in a psychiatric emergency setting.

A sample of 253 psychiatric emergency patients consecutively evaluated in a general hospital was studied to determine the role of psychiatric diagnosis in disposition decisions and the possible influences of patient and staff variables on diagnoses. Except for patients with organic brain syndrome, age and sex were not significantly associated with diagnostic grouping; some racial differences were found. Diagnosis was strongly associated with disposition decisions: schizophrenic and manic patients were more frequently hospitalized, while patients with substance abuse disorders, adjustment and neurotic disorders were more often referred to outpatient treatment. The authors stress the importance of a reliable diagnostic system and the recruitment of diagnosis-oriented staff in improving the quality of psychiatric emergency care.

Adult↗
PubMed1996

Consultation-liaison psychiatry in an obstetric service.

OBJECTIVE: The aim of this paper is to provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an obstetric inpatient unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database. METHOD: The MICRO-CARES clinical database system was used for prospective recording of data on all obstetric inpatients referred to the C-L psychiatry service and the hospital clinical database was used to compare referred inpatients with all obstetric inpatients. RESULTS: Ninety patients were referred in 3 years, a referral rate of 1.2% of obstetric admissions. There was no bias in referral on age, but there were significantly more unmarried patients in the referred group (p < 0.001). Referred patients had a significantly prolonged length of stay: a mean of 9 days for referred patients, with 6 days for all obstetric patients (p < 0.001). The most frequent reasons for referral were: coping problems, depression, anxiety/fear and past history of major psychiatric illness. The most common DMS-III-R psychiatric diagnoses were: Personality Disorders (19%), Mood Disorders (17%), Schizophrenic Disorders (15%) and Adjustment Disorders (13%). At least one confirmed diagnosis was made in 77% of patients, but 42% of diagnoses remained differential. There were significantly more patients with diseases of the nervous system, endocrine and circulatory disorders in the referred group (p < 0.001). Recommendations of psychosocial interventions predominated over psychopharmacological interventions, and concordance with these was 97% and 98%, respectively. Issues in the relationship of obstetrics and psychiatric C-L services are discussed and future directions indicated. CONCLUSIONS: The referral rate was low compared with other specialty units. This is probably due to factors inherent in obstetric practice. A wide spectrum of psychiatric disorders was referred, including a higher than expected number of women with postpartum psychotic disorders, the majority of whom were managed successfully in the obstetric ward. There is a need for increased liaison with obstetric and community services and for collaborative research, with a particular emphasis on the prevention of psychiatric morbidity associated with pregnancy.

Adaptation, Psychological↗
PubMed2000

Treatment refusal: analysis of 15 cases.

BACKGROUND: In this paper, we investigate the reasons for treatment refusal at Linkou and Kaohsiung Chang Gung Memorial Hospitals, and offer ways to improve the doctor-patient relationship. METHODS: Cases were collected during a 2-year period according to the criterion of notification of "refused treatment" on consultation sheets, with a total of 1631 consultation sheets. All cases were discussed once a week in detail by psychiatrists and the consulting medical staff, and were followed up from 1 to 4 weeks. All cases were treated by the processes of informed consent and crisis intervention. The final results for the reasons of treatment refusal and psychiatric diagnoses were made by psychiatrists and the consulting medical staff. RESULTS: The number of cases compatible with the criterion was 15 (10 men and 5 women). The reasons for treatment refusal included poor communication, inadequate information, lack of competency, denial and shock reaction, reappearance of the suffered experience, and autonomy of patients. The distribution of psychiatric diagnoses included 8 with major depressive disorders, 2 with delirium, 1 with schizophrenic disorder, 1 with adjustment disorder, 1 with acute stress disorder (post-traffic accident), 1 with alcohol dependence, and 1 was deferred. After adequate processes of informed consent and crisis intervention, 12 persons accepted medical treatment. CONCLUSION: We should give patients adequate informed consent and crisis intervention to establish a good doctor-patient relationship and to respect the patients' autonomy for their choice of treatment.

Adolescent↗
PubMed2001

Evaluation of post-traumatic stress disorders.

This paper introduces important considerations in the evaluation of psychological reactions to traumatic events. Proper assessment should include consideration of psychometric, cultural, and ethical issues. Mental disorders frequently observed in the aftermath of trauma (acute stress disorder and post-traumatic stress disorder) and stress (adjustment disorders) are defined, and the reader is provided with information on both general and specific resources for their evaluation.

Humans↗
PubMed2002

[Prevalence of psychiatric disorders and factors associated with delirium in patients referred to a psycho-oncology service].

The charts of 628 cancer patients, referred to the psycho-oncology service at the Hôtel-Dieu de Québec from 1994 to 1997, were reviewed in 1997 to determine the nature, the prevalence, and the characteristics of psychiatric diagnoses, particularly delirium. Results showed that among patients diagnosed with a psychiatric disorder, 54.5% had adjustment disorders, 13.1% suffered from delirium and 10.9% from major depression. Statistically significant associations were observed between delirium and the use of opioids (odds-ratio (OR): 3.87, 95% confidence interval (CI) = 2.28-6.57), corticosteroids (OR = 4.33; CI = 2.34-8.08), a history of alcoholism (OR = 2.41; CI = 1.27-4.56), being hospitalized (OR = 6.10; CI = 2.85-13.08), and being older (OR = 1.06; CI = 1.04-1.08). These results confirm the high frequency of psychiatric disorders in patients referred for a consultation in psycho-oncology and underline the importance to develop such services. Delirium is a major psychiatric complication of cancer and is associated with opioids, corticosteroids, alcoholism, being hospitalized, and being older.

Adult↗
PubMed1990

[Clinical evaluation of psychiatric disorders among first-visit patients to a primary care unit].

It is important for a primary care physician to know the most common psychiatric diagnoses, criteria for these diagnoses, and proper treatment. During a 4-month period from December 1987 to March 1988, the authors conducted this prospective study in a rural group practice center and investigated 189 first-visit patients aged from 16 to 60 years. Among them, 55 cases (29.1%) were diagnosed as having psychiatric disorders which included: psychological factors affecting physical condition, 29 cases; generalized anxiety disorder, 12 cases; adjustment disorder, 10 cases; and others, 4 cases. There were no significant differences in marital status, social class, or family structure between patients with and without psychiatric disorders. However, the patients with psychiatric disorders tended to have a longer duration of illness, to exhibit more salient features of introversion and neuroticism in their personalities, to show poorer family function and to experience more stressful life events. Although all the psychiatric patients presented somatic symptoms as their primary complaints, we also found that they reported significantly higher scores for psychiatric symptoms on a self-rating scale. This study demonstrates that in order to promote comprehensive primary health care, psychiatry and behavioral science are essential training curricula for family physicians.

Adolescent↗
PubMed1988

[HIV infection of the central nervous system: psychiatric consequences].

Cerebral infection with human immunodeficiency virus can result in the development of symptoms covering a wide spectrum of psychiatric disorders and including adjustment disorders, affective disorders, delirium and dementia. The rapid and insidious nature of the disease requires an approach that relies on differential diagnosis, thorough psychiatric and neurological examination and, when indicated, additional tests such as EEG, LP, CT or MRI. The treatment of psychiatric symptoms is based on traditional pharmacological principles, although at lower doses due to the patients' propensity to develop delirium. Supportive psychotherapy and education of the patient and his family on the special aspects of HIV-associated psychiatric disorders are also cornerstones of treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[Behavior therapy in children and adolescents: a utilization study].

Outpatient behavior therapy has been paid for in the Federal Republic of Germany since 1980 as a service of the health insurance system that covers most of the population. This therapeutic approach is used with children, adolescents and adults, but up to now it has played only a minor role in the treatment of psychological and psychiatric problems in children and adolescents. A content analysis of 221 applications for approval of long-term therapy for children or adolescents provided information on sociodemographic data, symptoms, diagnoses, treatment goals and treatment methods. Data were also obtained on the patients' social situation. The analysis suggests that mainly 7- to 11-year-old boys undergo treatment. The number of girls receiving treatment increases during puberty, and during adolescence more girls are treated than boys. Applications for outpatient behavior therapy are predominantly for developmental disorders, hyperkinetic disorders, emotional disorders, phobias, enuresis, adjustment disorders, conduct disorders and eating disorders. The main treatment goals are the development of new behavioral skills and the maintenance of or strengthening of behavior that is incompatible with the symptoms. Cognitive-behavioral methods are frequently used.

Adolescent↗
PubMedDate not supplied

[Psychosocial factors in duodenal ulcer].

"Burn-out" is a kind of assistential laboral stress which affects the professions which involve an interpersonal relationship with beneficiaries of the job, such us health workers. It originates emotional alterations which lead to feelings of emptiness and personal failure or laboral inability. The revisions about studies of mental disorders in health workers fall upon such laboral stress and remark that in such professional people there is a bigger prevalence of disorders because of the use of substances and of depression. To analyse the mental disorders in health workers by means of the retrospective study of a sample in a general hospital which asked for a psychiatric consultation, sociodemographic variables, clinico-diagnostic and variables related to laboral activity were analysed. The sample is constituted by 112 patients of an average age of forty years old and preferentially females (79.5%). In the sample, some professions are represented above all expectations; they are nurses, physicians, the laboral category of "boss and managers" and the laboral regimen of "permanents". The more frequent psychiatric disorders were the adjustment disorders and code V, the affective disorders and the anxiety disorders (23-33%), the disorders caused by the use of substances and the psychotic disorders are limited (5%). The laboral activity was considered an important factor in 43% of the cases and the mental disorder caused laboral inability, transitory or permanent in half of the patients. It is detected a relationship between the diagnostic and variables such as sex, laboral category, laboral inability, psychosocial stress level and GAF and there hasn't been detected any association between mental disorders and age, profession, laboral regimen and laboral stress.

Adult↗
PubMed1993

Physical factors affecting psychiatric condition. A proposal for DSM-IV.

A new diagnostic category, "Physical Factors Affecting Psychiatric Condition," is proposed for inclusion in the DSM-IV. In addition, there should be a new category called "Chronic Adjustment Disorder." Psychiatric syndromes meeting Axis I or Axis II criteria that arise as an emotional reaction to a chronic or episodic physical illness or disability should be subsumed under the diagnosis of "Physical Factors Affecting Psychiatric Condition--Specific Axis I or II syndrome." Psychiatric symptoms that do not meet other Axis I or Axis II criteria should be diagnosed as "Chronic Adjustment Disorder." These categories will be especially useful in consultation-liaison settings.

Adams-Stokes Syndrome↗
PubMed1998

Screening for psychological distress in Japanese cancer patients.

BACKGROUND: Psychological distress is frequently observed, however, it is underestimated in cancer patients. The aim of this study is to develop a simple battery for screening for psychological distress, adjustment disorder and major depressive disorder in Japanese cancer patients. METHODS: One hundred and twenty-eight cancer patients were interviewed by psychiatrists and tested using the Hospital Anxiety and Depression Scale (HADS), a 14-item self-assessment questionnaire. Psychiatric diagnoses were performed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised. RESULTS: Cronbach alpha values of the Japanese version of the scale were 0.77 for the subscale for anxiety and 0.79 for depression. By a receiver operating characteristic analysis, we determined that an optimal cut-off point for screening for adjustment disorder and major depressive disorder was 10/11, which gave high enough sensitivity and specificity (91.5 and 65.4%, respectively). To screen for major depressive disorder alone, 19/20 was an optimal cut-off point with 82.4% sensitivity and 96.3% specificity. The subscales of HADS (anxiety and depression) also had high screening performance. CONCLUSIONS: The Japanese version of HADS is a sensitive and specific tool for screening for psychological distress in Japanese cancer patients. This scale can be used for an early detection of patients' psychological distress which may be followed by psychiatric interventions.

Adaptation, Psychological↗
PubMed2005

Smoking and the risk of suicidal behavior: a prospective study of a community sample.

BACKGROUND: A link between cigarette smoking and suicidal behavior has been reported in clinical and epidemiological studies. OBJECTIVE: To examine the association between smoking and suicidal thoughts or attempt in a longitudinal study, in which proximate status of smoking and psychiatric disorders in relation to timing of suicidal behaviors is taken into account. DESIGN: A longitudinal study of young adults interviewed initially in 1989, with repeated assessments over a 10-year follow-up. SETTING AND PARTICIPANTS: The sample was selected from a large health maintenance organization representing the geographic area, except for the extremes of the socioeconomic range. The response rate at each follow-up (3, 5, and 10 years after baseline) exceeded 91%. MAIN OUTCOME MEASURES: Relative risk of occurrence of suicidal behaviors during follow-up intervals by status of smoking and psychiatric disorders at the start of the interval, estimated by generalized estimating equations with repeated measures. The National Institute of Mental Health Diagnostic Interview Schedule was used at baseline and at each reassessment. RESULTS: Current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, independent of prior depression and substance use disorders (adjusted odds ratio, 1.82; 95% confidence interval, 1.22-2.69). Additionally, current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, adjusting for suicidal predisposition, indicated by prior suicidality, and controlling for prior psychiatric disorders (adjusted odds ratio, 1.74; 95% confidence interval, 1.17-2.54). CONCLUSIONS: The biological explanation of the finding that current smoking is associated with subsequent suicidal behavior is unclear. Recent observations of lower monoamine oxidase activity (which may play a role in central nervous system serotonin metabolism) in current smokers but not ex-smokers might provide clues, but interpretations should proceed cautiously.

Adult↗