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PubMed1993

Stability of diagnoses in various psychiatric disorders: a study of long-term course.

The frequency of diagnostic shift was investigated in 267 patients diagnosed with various psychiatric disorders according to the 9th revision of the International Classification of Diseases (ICD-9). Forty-six patients fulfilled the diagnostic criteria for schizophrenic psychosis, 71 for affective psychosis, 66 for neurotic disorder, 24 for personality disorder, and 40 for psychogenic reaction. The remaining 20 patients were diagnosed with heterogenous disorders. The mean follow-up time was 12.5 years. Every episode of inpatient treatment was diagnosed cross-sectionally. Patients with an initial episode of schizophrenic psychosis showed by far the greatest stability (93%). A high stability was found in patients diagnosed with neurotic disorders (79%). Forty-two patients with an index diagnosis of affective psychosis suffered more than one type of episode during the course of disease. The lowest stability was noted in patients with a psychogenic reaction (10%). Eleven percent of patients with a final diagnosis of schizophrenia had an index diagnosis of psychogenic reaction. Our findings demonstrate that the course of disease should be considered in making the final diagnosis.

Adult↗
PubMedDate not supplied

[Study of compatibility of psychiatric diagnoses with ICD-10 diagnostic criteria using the SCAN questionnaire].

AIM: Authors aimed at testing whether psychiatrists in their diagnostic process obeyed strict ICD-10 diagnostic criteria. Diagnoses made by psychiatrists at discharge were compared with those of SCAN ver.2.1 on admission. METHODS: Diagnoses obtained by SCAN I-Shell program were compared with clinical diagnoses obtained by psychiatrists in the psychiatric wards according to ICD-10 criteria on 3 levels: diagnostic group (Fc), diagnostic class (Fcc), and diagnostic category (Fcc.c). Validity assessment was obtained with Cohen's Kappa coefficient, sensitivity, specificity and Yule's Y coefficient. RESULTS: On the diagnostic group level, Cohen's kappa was 0.14-0.65, Yule's Y 0.57-0.71. Sensitivity 0.69-0.95 and specificity 0.41-0.94. In psychotic disorders group F2 kappa was 0.65, Yule's Y 0.71, sensitivity 0.69, specificity 0.94. In affective disorders group F3 kappa was 0.31, Yule's Y 0.57, sensitivity 0.95, specificity 0.41. In neurotic disorders group F4 kappa was low 0.14, Yule's Y 0.62, sensitivity 0.95, specificity 0.50. CONCLUSIONS: The study showed a higher level of agreement between SCAN and clinical diagnoses in the group of psychotic disorders with exception of schizoaffective disorders, and lower agreement rates in the group of affective and neurotic disorders where the number of SCAN diagnoses outweighed that of the clinical ones. It could be the result of systematic faults in the coding of diagnoses.

Adult↗
PubMed1996

Long-term outcome of patients with neurotic illness in general practice.

OBJECTIVE: To determine the 11 year outcome of neurotic disorder in general practice. DESIGN: Cohort study over 11 years. SETTING: Two general practices in Warwickshire England. SUBJECTS: 100 patients selected to be representative of those identified nationally by general practitioners as having neurotic disorders. MAIN OUTCOME MEASURES: Mortality, morbidity, and use of health services. RESULTS: At 11 years 87 subjects were traced. The 11 year standardised mortality ratio was 173 (95% confidence interval 164 to 200). 47 were cases on the general health questionnaire, 32 had a relapsing or chronic psychiatric course, and 49 a relapsing or chronic physical course. Treatment for psychiatric illness was mainly drugs. The mean number of consultations per year was 10.8 (median 8.7). A persistent psychiatric diagnosis at one year follow up was associated with high attendance ( > 12 visits a year for 11 years) at follow up after age, sex, and physical illness were adjusted for. Severity of psychiatric illness (general health questionnaire score) at outset predicted general health questionnaire score at 11 year follow up, course of psychiatric illness, and high consultation rate. CONCLUSION: These data support the view that a neurotic illness can become chronic and is associated with raised mortality from all causes and high use of services. Such patients need effective intervention, particularly those with a more severe illness who do not recover within one year.

Aged↗
PubMed2001

A1 Ain Community Psychiatric Survey. I. Prevalence and socio-demographic correlates.

BACKGROUND: Psychiatric community studies are essential for the planning and development of psychiatric services, as well as being helpful in examining the socio-demographic correlates of mental disorders in a given community. Few such studies have been carried out to date in the Arabian peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in A1 Ain in the United Arab Emirates. The findings regarding lifetime prevalence and psychiatric morbidity are reported. METHODS: A total of 1394 (n = 1394) adults systematically sampled from Al Ain community were assessed with a modified version of the Composite International Diagnostic Interview (CIDI) as well with other instruments: the new screening psychiatric instrument, Self-Reporting Questionnaire (SRQ-20), and the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID) screening module. Lifetime prevalence and 1-week prevalence rates of mental distress as measured by screening instruments were estimated as well as the lifetime prevalence rate of CIDI ICD-10 psychiatric disorders. The sensitivity of the CIDI interview to correctly pick up distressed subjects, as well as those who had undergone previous treatment for a psychiatric disorder, was also calculated. Associations between socio-demographic risk factors and ICD-10 psychiatric disorder as well as with mental distress were also examined by bivariate and multivariate analyses. RESULTS: Overall lifetime prevalence of ICD-10 psychiatric disorder was found to be 8.2% (95% CI: 6.7-9.7), while the 1-week prevalence rate of mental distress as measured by the SRQ-20 was 15.6% (95% CI: 11.8-19.5) and the lifetime prevalence rate of mental distress as measured by the new screening instrument was 18.9% (95% CI: 11.5-25.9). The CIDI interview correctly picked up 42% of subjects who had received previous psychiatric treatment and 51% of the distressed. Mood disorders and anxiety (neurotic) disorders were more common in women and alcohol and substance use disorders were exclusively confined to men. Female sex, young age, quality of marital relationship, life events over past year, chronic life difficulties, physical illness, family history of psychiatric disorders and past history of psychiatric treatment were found to be significantly associated with ICD-10 psychiatric disorder. Multivariate analysis revealed that age, sex, exposure to chronic difficulties and past history of psychiatric treatment were the most significant predictors of ICD-10 psychiatric disorders, and exposure to chronic difficulties, past history of psychiatric treatment and educational attainment were the significant predictors of lifetime ever and current mental distress. CONCLUSION: The pattern and trend of psychiatric morbidity found in this survey is in line with those reported by other surveys that utilized similar assessment instruments. Differences in rates are explained by different methodologies used.

Adult↗
PubMed2006

Somatoform disorders in the workplace in Japan.

The literature related to somatoform disorders in the workplace is very limited, and these disorders need more attention from mental health professionals in the workplace as well as from employers. Over the last decade, major changes have taken place in the work environment in Japan. More stress and less support from supervisors or colleagues in the workplace have made employees stressed out. The number of employees with mental disorders, including somatoform disorders, taking sick leave has significantly increased. In our multi-centre collaborative study, somatoform disorders were the third most prevalent psychiatric disorder in employees, after mood and schizophrenic disorders. Employees with neurotic disorders manifested physical symptoms more frequently than those without. Young employees frequently reported somatic symptoms such as general malaise, nausea, constipation, diarrhoea, headache, stiff shoulder, and dizziness. A rational new approach is needed to tackle this important psychopathology increasingly seen among employees.

Adult↗
PubMed1997

The use of a case register to evaluate the costs of psychiatric care.

The aim of this study was to show the usefulness of adding cost information to a routine data collection provided by a case register for analysing the association between patients' characteristics and the direct costs of the psychiatric care actually provided. All patients (n = 706) who in 1992 had at least one contact with services which report to the South Verona psychiatric case register and who received an ICD-10 diagnosis were included in the study. The costs of specialist psychiatric care provided during the 365 days following the first contact in 1992 were calculated using a unit cost list. A bespoke software, linked to the case register, was designed to produce the individual information on costs directly. For each patient, costs were categorized as in-patient costs, sheltered accommodation costs, day-care costs, out-patient costs and community costs. All costs, grouped by service type, were found to differ significantly (P < 0.01) between diagnostic groups (affective disorders, neurotic and somatoform disorders, schizophrenia and related disorders, and other diagnoses). The multivariate analyses showed that costs are significantly higher for patients with a diagnosis of schizophrenia and related disorders than for patients belonging to the other diagnostic groups. However, only 6% of the variation could be explained by diagnostic group alone. On the other hand, between 40 and 50% of the costs of mental health care was predicted by patients' personal characteristics and other measures recorded on the case register. The results of the present study show that, where service use is monitored regularly, the base from which decisions on community provision and placement are made can be informed by careful analysis of routinely or easily available data on direct costs.

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↗
PubMed1995

Background factors predicting non-response in a health survey of northern Finnish young men.

The study addresses the characteristics potentially predictive of non-response to a health survey among 2500 24-year-old males, on whom a notable amount of other data was available. The overall non-response rate was 40%, part of which was due to the unreachability of some subjects: 4% of the questionnaires were returned because of unknown addresses. Some (n = 39) of the respondents had concealed the identification number in the questionnaire, which made it impossible to link these data to those collected before in their cases. We were therefore able to use effectively the data on 1450 (58%) responding subjects in this paper. Failure to respond was more common among the subjects who had lived in towns in their youth, had not grown up in a complete family, whose socioeconomic status of the family was unknown, and whose mother was young and had a low educational level. Poorer-than-average school performance at elementary school was also predictive of a high non-response rate. Non-response was heavily associated with previous non-response to a health inquiry. Some aspects of health and behaviour in adolescense, such as smoking at the age of 14, were related to non-response to this survey, too. The non-response was higher than average among those subjects who had suffered from mental disorders (serious mental disorders, less serious mental disorders such as neurotic disorders, adjustment reactions, and psychosomatic disorders and mental retardation). The young men who were employed, were students or were doing military service at the age 24 responded better than those who were unemployed or at disability pension.

Achievement↗
PubMed1985

[Epilepsy, anticonvulsive treatment and child psychiatric conspicuousness].

Seventy-nine children suffering from epileptic seizures who were seen at a clinic for child and adolescent psychiatry for behavior disorders were compared with a control group from the same clinic matched by age, sex and IQ. Significant differences were found between the two groups in the percentages diagnosed as having "no psychiatric disorder", "neurotic or emotional disorder" and "specific disorder following brain damage". Neither the type nor the frequency of epileptic seizures was found to have an influence on the type of psychiatric disturbance. Only a small proportion of the children with epilepsy (12%) had psychiatric symptoms, which if present were compatible with the diagnosis "organic psychosyndrome". No abnormal psychosocial situations were found to be specific for epilepsy, but the type of medication (especially barbiturates) had a significant influence on the incidence of conduct disorders.

Adolescent↗
PubMed1997

[The effect of phototherapy on psychoautonomic disorders of a neurotic nature].

Bright white light therapy was applied to 51 patients with syndrome of autonomic dysfunction of neurotic origin (1 hour of light exposure every day in the morning, during 2 weeks, 60 sm from the lamp, 3300 lux). Improvement occurred in 52% of the patients (responders--group 1, nonresponders--2). Changes occurred in nearly all symptoms: neuroendocrine, motivation, psychoautonomic, pain, psychopathologic. After the treatment in group 1 there was an increase of power of EEG spectrum, intensification of manifestations of the slow activity and decrease of the fast one from the two sides, an approach of the coefficient of asymmetry to the control levels as well as elevation of the urine excretion of metabolites of both catecholamines and serotonin. Initially higher power of EEG spectrum in group 2, became still more increased due to intensification of manifestations of theta and beta-2 rhythms from the two sides. Meanwhile coefficient of asymmetry was sharply decreased as well as general secretory activity inhibited. There were such symptoms and indices which had changed either negatively or positively under the influence of phototherapy.

Adult↗
PubMed1998

[A family study of obsessive-compulsive disorder].

OBJECTIVE: To explore the genetic etiology of obsessive-compulsive disorder (OCD) and genetic association between OCD and tic disorder. METHODS: The mental disorders in the first degree and second degree relatives of 90 probands with OCD were investigated and compared with those of 100 healthy families by the method of family genetic study. RESULTS: Compared to the control, the prevalence rates of schizophrenia, affective disorder, minor depression, subclinical OCD, general anxiety disorder and tic disorder in the first degree relatives of OCD were elevated, except that of OCD. The prevalence rates of OCD and subclinical OCD, general anxiety disorder, and other neurotic disorders in the first degree relatives of patients with pure obsession were 47.6%, 35.7% and 23.8%, respectively; compared to 10.8%, 3.6% and 0 in those of the control (P<0.01). The prevalence rates of schizophrenia,affective disorder,and tic disorder in the first degree relatives of OCD with tic were 52.0%, 26.0% and 90.9%, respectively; compared to 0, 3.6% and 7.2% in those of the control (P<0.01). CONCLUSION: The etiology of OCD is related to heredity. There was evidence to show genetic association between OCD and tic disorder,The elevation of prevalence rates of various mental disorders in the first degree relatives of OCD might suggest the genetic basis of various subtypes of OCD.

Adolescent↗
PubMed1999

Splitting: an empirical study.

In this study, the Rorschach scoring system for splitting developed by Lerner, Sugarman, and Gaughran (1981) was applied to the Holtzman Inkblot Technique (HIT). Normal individuals (n = 30), patients with neurotic disorders (n = 30), patients with borderline personality disorder (n = 30), patients with acute schizophrenia (n = 25), and patients with chronic schizophrenia (n = 25) were studied with respect to their use of splitting. Sufficient interrater reliability was demonstrated for the scoring of splitting in the HIT. Significant differences between borderline patients, acute schizophrenic patients, and chronic schizophrenic patients, on the one hand, and patients with neurotic disorders, on the other hand, were demonstrated. Furthermore, it was shown that the indicators of splitting were associated with measures of identity diffusion, primitive defense mechanisms, and other measures of psychopathology. The Lerner indicator of splitting proved to be multidimensional. Different forms of splitting seem to be characteristic of borderline patients and schizophrenic patients. The application of the Lerner criteria of primitive defenses to the HIT appears to be promising.

Acute Disease↗
PubMed1980

Prevalence rates for the neuroses: pitfalls in the evaluation of familiality.

A survey was made of studies reporting population prevalence rates for the different types of neurotic disorders in order to determine the utility of these rates for familial and genetic research. Rates varied considerably among studies both for all neuroses and for particular types of neuroses, even among studies using similar methods examining similar populations. The method of case ascertainment (personal interview versus record searches) and the threshold for defining an individual as affected are important contributors to variation. The use of the published prevalence rates for quantifying familial and genetic effects on the neurotic disorders would be premature.

Actuarial Analysis↗
PubMed1990

The prognosis in early adulthood of child psychiatric patients: a case register study in Denmark.

A register-based study of 485 children (0-15 years of age) admitted to a child psychiatric hospital from January 1, 1970 to December 31, 1972 who were followed up on December 31, 1986 showed higher rates of admission to psychiatric hospital in late adolescence or young adulthood (i.e. greater than or equal to 16 years of age) than found in an age-standardized general population. Patients with the childhood diagnosis neurosis (ICD-8 300 + 308.00) were found to have higher rates of admission with personality disorders (ICD-8 301.09-301.39 + 301.82-301.99) but not of other diagnoses including neurotic disorders. Patients with the childhood diagnosis of conduct disorder (ICD-8 301.09-301.99 + 308.01) had a higher risk of admission in adulthood with the diagnosis of personality disorders and drug or alcohol abuse. Girls with adjustment disorder (ICD-8 307 + 308.02-308.06) had higher risks of admission in young adulthood with diagnosis of personality disorders and psychosis. No connection was found between the age at first referral and the incidence of admission after the age of 15 years.

Adolescent↗
PubMed1996

Diagnostic anomalies in social phobia.

Social phobia has been recognized only recently as a clinical entity, and there is considerable overlap in diagnosis between agoraphobia, panic disorder, stress disorder and avoidant (anxious) personality disorder. In more severe cases there may also be some difficulty in differentiating the condition from schizophrenia. In reaching a correct diagnosis of social phobia it appears that the two essential elements of a phobic diagnosis, situational fear and avoidance, should be present prominently and that a distinction from agoraphobia can be made by paying close attention to the nature of the situations in which fear is shown. If this policy is followed, social phobia can be readily defined and is fairly easily distinguished from other neurotic disorders. There is considerable overlap with the anxious and fearful group of personality disorders, particularly avoidant (anxious) personality disorder and this is almost impossible to distinguish from chronic persisting social phobia. Data are presented on the incidence of primary and secondary social phobia occurring prospectively in patients with the most common neurotic disorders (dysthymia, panic and generalized anxiety disorder) seen over a 2-year period. Twelve per cent of the patients had secondary social phobia initially, but over the 2-year period 9% of the patients had social phobia as a primary or single psychiatric diagnosis on at least one occasion. This was most likely in those patients allocated to a benzodiazepine, diazepam, in the first phase of treatment (p < 0.05).

Adolescent↗
PubMed1990

[The automated detection of patients with neurotic disturbances in conducting mass prophylactic examinations].

The theory of image recognition was used to design clinico-statistical models of patients with neurotic disorders and healthy persons. 535 patients with neuroses and 204 mentally healthy persons were used as material for investigation. Based on a complex of anamnestic, psychological and clinical characteristics the assessment function developed makes it possible to distribute the examined into groups of a high risk for the disease development and of healthy persons. The diagnostic algorithm ensures proper recognition of patients with neurotic disorders (in 93-95% of cases). The use of the diagnostic algorithm for automated screening of neuroses enables the increased demonstration of the pathology and reduction of expenses for conduction of mass prophylactic screenings.

Algorithms↗
PubMed1984

Growth hormone secretion in prepubertal children with major depression. II. Sleep-related plasma concentrations during a depressive episode.

Plasma growth hormone (GH) concentrations were determined every 20 minutes during sleep in 71 prepubertal children: 22 had endogenous major depressive disorder, 20 had nonendogenous major depressive disorder, 21 had nondepressed neurotic disorders, and eight were normal. Both depressive groups secreted significantly more GH during sleep than did controls. Measures included maximal GH plasma peak and area under the curve (AUC) during the total sleep period, during the first three hours after sleep onset, and during the first five hours after sleep onset. An AUC cutoff of 2,000 ng X min/mL identified positively half the prepubertal children with major depression; with a specificity of 78% (v neurotics) and 100% (v normal children). Increased GH secretion during sleep may be a marker of illness, a past episode, or trait for prepubertal major depression regardless of endogenicity.

Affective Symptoms↗