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PubMed2000

Use of the Beck Depression Inventory-II with depressed geriatric inpatients.

To provide information about the clinical utility of the Beck Depression Inventory-II (BDI-II) [Beck, A.T., Steer, R.A., & Brown, G.K. (1996b). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation] with geriatric inpatients, the BDI-II was administered to 130 psychiatric inpatients who were 55 years old or above and who were diagnosed with principal DSM-IV major depressive disorders (MDD) (N = 85, 65%) or adjustment disorders with depressed mood (N = 45, 35%). The internal consistency of the BDI-II was high (coefficient alpha = 0.90), and its total score was not significantly related to sex, age, or ethnicity. An iterated maximum-likelihood factor analysis found the Cognitive and Noncognitive dimensions which have been reported for the BDI-II by Steer and co-workers (Steer R.A., Ball R., Ranieri W.F., & Beck A.T. (1999). Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. Journal of Psychopathology and Behavioral Assessment, 55, 117-128) in a younger sample of clinically depressed psychiatric outpatients. The mean BDI-II total score of the 85 geriatric inpatients with MDD was also comparable to that of 42 younger (< or = 54 years old) inpatients with MDD. The results were discussed as supporting the use of the BDI-II with clinically depressed geriatric inpatients.

Acute Disease↗
PubMedDate not supplied

DSM-III-R classification of psychiatric symptoms in systemic lupus erythematosus.

DSM-III-R criteria applied in the evaluation of 88 systemic lupus erythematosus patients revealed a point prevalence rate of 18.2% for psychiatric disorders, the most common diagnosis being adjustment disorder (11.4%). No patients had disorders compatible with a functional psychosis. Psychiatric morbidity was not associated with increased disease activity, corticosteroid use, brain magnetic resonance imaging abnormalities, or electroencephalogram abnormalities. High scores on a life event scale were associated with psychiatric disorders, suggesting that psychosocial stress is etiologically important. Cognitive testing showed that poor performance on the Stroop Colour-Word Inference Test was associated with psychiatric disorders.

Adolescent↗
PubMed2000

An overview of generalized anxiety disorder: disease state--appropriate therapy.

OBJECTIVE: This article reviews the prevalence, diagnosis, and treatment of generalized anxiety disorder (GAD). BACKGROUND: Patients with GAD often present to primary care physicians; frequently the disorder manifests with somatic symptoms that have no identifiable physiologic foundation. Accurate diagnosis and treatment often prove elusive, and health care resources are inappropriately consumed in the management of a wide array of complaints, including headache, noncardiac angina, fatigue, insomnia, or abdominal discomfort. Early diagnosis and intervention are critical; GAD is frequently associated with other anxiety and mood disorders, major depressive disorder among them. The differential diagnosis of GAD is complex, including medication side effects and substance-related dependence or withdrawal phenomena, as well as endocrine, neurologic, cardiorespiratory, and autoimmune disorders. CONCLUSIONS: GAD is differentiated from adjustment disorder with anxiety because only GAD can manifest without identifiable emotional stressors; it is differentiated from panic disorder largely on the basis of the chronicity of GAD and the episodic, abrupt nature of panic attacks, with the involvement of at least 4 autonomic, cardiopulmonary, neurologic, or other symptoms. In addition to psychotherapy, education, lifestyle modifications, and social support, several pharmacologic agents may be appropriate therapy for GAD. Given the chronic, nonremitting, relapsing character of GAD, use of benzodiazepines, which confer short-term relief, is usually ill-advised in long-term treatment because these agents can impair cognitive and psychomotor function, interact with various central nervous system depressants (eg, alcohol), and exhibit substantial potential for abuse, tolerance, dependence, and withdrawal effects. Buspirone and certain antidepressants, including the dual noradrenergic-serotonergic reuptake inhibitor venlafaxine, represent first-line therapy for GAD.

Adolescent↗
PubMed2002

Psychopathological dimensions of depression: a factor study of the 17-item Hamilton depression rating scale in unipolar depressed outpatients.

BACKGROUND: Agreement on the factor structure of the Hamilton Depression Rating Scale (HDRS) has not been consistent among studies, and some investigators argued that the scale's factor structure is not reliable. This study aimed at shedding more light on this debated issue. METHODS: We studied 186 adults with unipolar depression (Major Depressive Disorder, n=80; Dysthymic Disorder, n=71; Depressive Disorder Not Otherwise Specified, n=25; Adjustment Disorder, n=10). They had no comorbid DSM-IV axis I or axis II disorders, and had received no treatment with antidepressant drugs in the previous 2 months. The factor structure of the scale was studied using the principal factor method, followed by oblique rotation. Factor scores were computed for each subject using the regression method. RESULTS: Using the scree-test criterion for factor extraction, we obtained a four-factor solution, explaining 43.8% of total variance. The four factors extracted were identified as (1) somatic anxiety/somatization factor; (2) a psychic anxiety dimension; (3) a pure depressive dimension; and (4) anorexia factor. Patients with Major Depressive Disorder scored significantly higher than patients with other diagnoses on the pure depressive dimension. LIMITATIONS: These results need to be replicated in different cultures, using analogous factoring techniques. CONCLUSIONS: Though not exhibiting factorial invariance in the stricter sense of the term, the 17-item HDRS did exhibit a relatively reliable factor structure. Our analysis provides further evidence that the scale is multidimensional. However, as long as the multidimensional character of the scale is taken into account the scale should be able to play a useful role in clinical research.

Adult↗
PubMed2006

Characteristics of adolescent suicide attempters admitted to an acute psychiatric ward in Taiwan.

BACKGROUND: To investigate the characteristics of adolescent suicide attempters in Taiwan, compare with Western reports and provide reference for suicide preventive interventions in adolescence. METHODS: During a 3-year period, the charts of 109 adolescent psychiatric inpatients were retrospectively reviewed. Twenty-eight adolescents admitted to an acute psychiatric ward as a result of recent suicide attempts were investigated to unravel factors related to suicide. Fifty-five adolescents with at least 1 suicide attempt recently or in the past were analyzed for risk factors of suicidal behavior compared to others. RESULTS: Of the 109 adolescents admitted, 28 (25.6%) patients had been admitted due to recent suicide attempt. The most common diagnosis was depressive disorder (50%), followed by bipolar disorder (14.3%), schizophrenia (14.3%), and finally adjustment disorder (10.7%). There were significantly more girls than boys who attempted suicide. Suicide attempts increased with age, but this trend was not statistically significant. The most common precipitating factors were school stress (46%), parent-child conflict (25%), and psychopathology (25%) including feeling of hopelessness and psychotic symptoms. Adolescents with substance abuse or panic symptoms comprised a higher risk group for suicide. After discharge, 34.9% (38/109) of patients were lost to follow-up, and 15.5% (11/71) of the follow-up patients continued to manifest suicidal behavior. CONCLUSION: Our study confirms some previous Western reports that adolescents with depressive disorders commonly manifest suicide attempts. There are, however, some cultural differences in risk factors. School-related problems play an important role in Taiwan among the adolescent suicides, and prior suicide attempts predict future suicidal behavior. Enhancing school-based screening for adolescents with suicide risk and transferring them to psychiatric professionals for intervention is important. We should focus suicide prevention resources mainly on the adolescent population with psychiatric illness, prior suicide attempts, and with high risk factors.

Adolescent↗
PubMed2002

Psychiatric morbidity in first time stroke patients in Hong Kong: a pilot study in a rehabilitation unit.

OBJECTIVE: There is a paucity of data on post-stroke psychiatric morbidity in Chinese populations. We examined the frequency of post-stroke psychiatric morbidity in Chinese first time stroke patients, including depressive and anxiety disorders, mania, and psychosis. METHODS: One hundred and fifty-seven patients following their first stroke, who were consecutively admitted to a rehabilitation unit, participated in this prospective, cross-sectional study. All subjects were interviewed by a qualified psychiatrist using the SCID-DSM-III-R. Subjects' cognitive function, neurological status, and level of functioning were also measured. Twenty-five (92.6%) of the subjects with the diagnosis of depression were followed up 6.0 +/- 3.9 months after the initial assessment. RESULTS: The frequency of all depressive disorders was 17.2%. Major depressive episodes, adjustment disorder with depressed mood, dysthymia, and generalized anxiety disorder were diagnosed in 7.6%, 8.2%, 1.3% and 0.6% of the subjects, respectively. No cases of other anxiety disorders, mania or psychosis were found. The majority of depressed subjects were in remission at the follow-up assessment. CONCLUSION: The low morbidity of affective disorders and their relatively favourable short-term outcome in Chinese first time stroke patients warrants further investigation.

Adult↗
PubMed1997

Comparability of telephone and face-to-face interviews in assessing axis I and II disorders.

OBJECTIVE: The present study examined the comparability of data obtained by telephone and face-to-face interviews for diagnosing axis I and II disorders. METHOD: Sixty young adults from the community were interviewed face-to-face and over the telephone regarding axis I disorders; another 60 subjects were interviewed twice regarding axis II disorders. The order of interviews was counterbalanced, and subjects with a history of disorder were oversampled. Agreement between telephone and face-to-face interviews was contrasted with interrater values, which were obtained by having a second interviewer rate a recording of the original interview. RESULTS: Interrater reliability was excellent. Agreement between telephone and face-to-face assessment was excellent for anxiety disorders and very good for major depressive disorder and alcohol and substance use disorders; agreement was problematic, however, for adjustment disorder with depressed mood. Strong support was shown for the validity of the axis II telephone assessment format. Small but consistent trends were noted for lower rates of psychopathology reported in the second interview. CONCLUSIONS: This is the first study in which telephone and face-to-face assessments of axis I and II psychopathology were conducted with the same subjects assigned to conditions in a counterbalanced manner. The present findings provide qualified justification for the use of telephone interviews to collect axis I and II data. The apparent concerns do not appear sufficient to override the economic and logistic advantages of telephone interviewing.

Adolescent↗
PubMed1984

Identifying common errors in the use of DSM-III through diagnostic supervision.

The authors describe the use of diagnostic supervision to identify common errors made by trainees in the application of DSM-III to multiaxial evaluations in an outpatient clinic. Errors on all five axes were due primarily to misapplications of diagnostic criteria and conventions. Errors on axes I, IV, and V were most frequent. Axis I errors were commonly due to confusion about the relationship of dysthymic disorder to major depression, neglect of substance use disorder diagnoses, and misuse of the adjustment disorder and V-code categories. On axis IV, the severity of psychosocial stressors was frequently overrated, based on several misconceptions. Axis V ratings were often erroneously overestimated because they were individualized rather than made on a uniform scale. No differences were found in the error rates of psychiatric residents compared with psychology interns except on axis I, where interns made more errors. The authors discuss the implications of these errors for training residents and psychology interns in the use of DSM-III.

Adult↗
PubMedDate not supplied

[Clinical and epidemiological characteristics of severe poisoning in an adult population admitted to an intensive care unit].

OBJECTIVE: To describe the clinical and epidemiological features of severe acute poisonings in an adult population. DESIGN: Retrospective analysis of clinical cases. PATIENTS AND METHODS: Analysis of the clinical charts, risk factors and main outcomes of 55 acute poisoned patients admitted to an intensive care unit (ICU). RESULTS: Of the 55 clinical charts reviewed, female prevailed over male gender with a relation of 1.5:1, the average age was 32 years (16-83 years), the major etiologic factor for the acute poisonings were drugs in 35 cases (64%), and home or work chemicals in 20 cases (36%). The mechanisms of intoxication/poisoning were: attempted or successful suicide in 51 cases (93%), accidental poisoning in three cases (5%), and iatrogenic in one case (2%). Precipitating factors were major depressive disorder in 29 cases (53%), dysthymic disorder in 12 cases (22%) and adjustment disorder with depressive mood or impulsive act in nine cases (16%). Associated feature comorbid conditions were: homosexuality, schizophrenia, drug addiction, AIDS, other chronic diseases, and previous suicide attempts. Outcomes were 33 (60%) patients discharged from the ICU without sequela, seven (13%) with permanent severe sequela and 15 (27%) deaths. CONCLUSIONS: There was a high rate of suicides related with depressive disorders in a predominantly female population. Drug products were used more frequently than home or work chemicals. Although advanced life support and antidotal treatments were available, mortality was high. Areas where injury prevention efforts might have an influence on adult poisoning morbidity and mortality include management of depression as well suitable control of drugs and chemicals.

Acute Disease↗
PubMed1996

Epidemiology and psychopharmacology of anxiety in medical patients.

A wide variety of comorbid anxiety disorders have been described in patients with medical disorders, with the most common being adjustment disorder with anxiety, panic disorder, and generalized anxiety disorder. This article briefly reviews representative studies of the prevalence of anxiety disorders in several medical conditions, placing emphasis on cardiovascular, pulmonary, cerebrovascular, and dermatologic disease. Psychotropic medications appropriate for the treatment of anxiety disorders in these medical-psychiatric populations (benzodiazepines, cyclic antidepressants, and buspirone) as well as beta-adrenergic blocking agents and antihistamines are discussed with an emphasis on pharmacokinetic and drug interactions of major clinical importance for the medically ill patient.

Adrenergic beta-Antagonists↗
PubMed2006

Screening for depression in terminally ill cancer patients in Japan.

This study attempted to assess the performance of several screening instruments for adjustment disorders (ADs) and major depression (MD) among terminally ill Japanese cancer patients. Two hundred and nine consecutive patients were assessed for ADs and MD using a structured clinical interview at the time of their registration with a palliative care unit, and two single-item interviews ("Are you depressed?" and "Have you lost interest?") and the Hospital Anxiety and Depression Scale (HADS) were administered. Screening performance was investigated by calculating sensitivity, specificity, the positive predictive value, negative predictive value, likelihood ratio, and stratum-specific likelihood ratios. When the screening target included both an AD and MD, the HADS is a more useful screening method than the single-item interviews. Regarding screening for MD, both single-item interviews and the HADS possess useful screening performance. Different screening instruments may be recommended depending on the depressive disorders and specific populations.

Adjustment Disorders↗
PubMed1997

Clinicians' predictions of length of psychotherapy.

The study examined therapists' accuracy in predicting the length of individual outpatient psychotherapy for 109 clients and attempted to identify variables associated with predicted and actual treatment lengths. The mean predicted treatment length (9.7 months) was significantly longer than the mean length of actual treatment (6.6 months). Therapists correctly predicted treatment length to the nearest month in 26 percent of the cases. Predictions were more accurate for older clients. Treatment tended to be shorter for clients with less than a high school education. Therapists more often predicted shorter treatments for clients with an adjustment disorder and those with less education. Predicting treatment length appears to be difficult.

Adjustment Disorders↗
PubMed1998

Antidepressant prescribing practices of outpatient psychiatrists.

BACKGROUND: The authors examined recent changes in the number and proportion of patients prescribed antidepressants by psychiatrists in outpatient private practice and characterized antidepressant prescription patterns by patient age, sex, race, payment source, and clinical diagnosis. METHODS: The authors analyzed physician-reported data from the 1985 and 1993-1994 National Ambulatory Medical Care Survey, focusing on visits to physicians specializing in psychiatry. Logistic regressions were used to examine associations between survey year and antidepressant prescription, adjusting for the presence of other variables. RESULTS: The proportion of outpatient psychiatric visits in which an antidepressant was prescribed increased from 23.1% (95% confidence interval [CI], 19.7%-26.5%) in 1985 to 48.6% (95% CI, 47.5%-49.7%) in 1993-1994. After controlling for several patient variables, psychiatric patients were approximately 2.3 (95% CI, 1.8-2.9) times more likely to receive an antidepressant in 1993-1994 than in 1985. In 1993-1994, selective serotonin reuptake inhibitors accounted for approximately half of the psychiatric visits with an antidepressant prescription. Increases in the rate of antidepressant prescription were particularly evident for children and young adults; whites; new patients; and patients with adjustment disorders, personality disorders, depression not otherwise specified or dysthymia, and some anxiety disorders. CONCLUSIONS: During the late 1980s and early 1990s, there was a significant increase in the prescription of antidepressants by office-based psychiatrists. This increase was greatest for patients with less severe psychiatric disorders.

Adjustment Disorders↗
PubMed2006

Prevalence of youth-reported DSM-IV psychiatric disorders among African, European, and Mexican American adolescents.

OBJECTIVE: The authors present prevalence data for adolescents in a large metropolitan area and examine the association of DSM-IV diagnoses with functional impairment and selected demographic correlates among European Americans (EA), African Americans (AA), and Mexican (MA) Americans. METHOD: The authors sampled 4,175 youths ages 11 to 17 years whose households were enrolled in large health maintenance organizations. Data were collected using questionnaires, the Diagnostic Interview Schedule for Children-IV and the Children's Global Assessment Scale. The data were collected in the Houston Metropolitan area in 1998-2000. Data on psychiatric disorders were derived from interviews with youths only. RESULTS: AA had a lower prevalence of mood disorders, substance use disorders, and any disorders adjusted for Diagnostic Interview Schedule for Children-IV impairment or Children's Global Assessment Scale score than did others. EA had greatest prevalence of substance use disorders, whereas AA were lowest. After adjusting for covariates, EA had a higher risk for some disorders than AA. Effects of gender, age, parent education, family income, and marital status were not consistent across groups. Family income was protective only for EA. CONCLUSIONS: There appear to be few systematic differences between majority and minority adolescents at risk for psychiatric disorders. MA are not at increased risk contrasted to EA. AA had lower risk for some disorders, but adjusting for impairment and covariates eliminated most differences. Thus, multivariate analyses support the hypothesis that initial ethnic differences appear to be a function of factors associated with disadvantaged minority status rather than to distinctive ethnic culture. A noteworthy finding was that disadvantaged social status did not appear to increase the risk for disorders among minority youths.

Adolescent↗
PubMed1990

Psychiatric aspects of lung transplant. The Toronto Lung Transplant Group.

Psychiatric problems in a consecutive series of lung transplant applicants (n = 116), candidates (n = 57) and recipients (n = 42) are reported. Fifty percent of all the applicants for lung transplantation reported a history of psychiatric disorder including organic brain syndrome (19%), major depressive episode (16%), panic or anxiety disorder not otherwise specified (11%) and alcohol or substance abuse (11%). In most cases, psychiatric problems had occurred in these patients as a complication of endstage lung disease. The most common new diagnoses in candidates awaiting surgery were adjustment disorder with anxious mood and anxiety disorders. Organic brain syndromes developed in over 50% of the recipients during the first two post-operative weeks. The type and prevalence of these disorders have implications for the management of lung transplant patients and those with chronic pulmonary disease.

Adaptation, Psychological↗
PubMed2004

Asthma and depressive and anxiety disorders among young persons in the community.

BACKGROUND: The objectives of the study were to examine linkages between asthma and depressive and anxiety disorders in a birth cohort of over 1000 young persons studied to the age of 21 years. Specifically, the study aimed to ascertain the extent to which associations between asthma and depressive and anxiety disorders could be explained by non-observed fixed confounding factors. METHOD: Asthma and depressive and anxiety disorders were measured prospectively over the course of a 21-year longitudinal study. Fixed effects logistic regression models were used to determine the relationship between asthma and depressive and anxiety disorders, adjusting for potentially confounding factors. RESULTS: Asthma in adolescence and young adulthood was associated with increased likelihood of major depression (OR 1.7, 95 % CI 1.3-2.3), panic attacks (OR 1.9, 95 % CI 1.3-2.8), and any anxiety disorder (OR 1.6, 95% CI 1.2-2.2). Associations between asthma and depressive and anxiety disorders were adjusted for confounding factors using a fixed effects regression model which showed that, after control for fixed confounding factors, asthma was no longer significantly related to major depression (OR 1.1), panic attacks (OR 1.1), or any anxiety disorder (OR 1.2). Additional post hoc analyses suggested that exposure to childhood adversity or unexamined familial factors may account for some of the co-morbidity of asthma and depressive and anxiety disorders. CONCLUSIONS: These results confirm and extend previous findings by documenting elevated rates of depressive and anxiety disorders among young adults with asthma, compared with their counterparts without asthma, in the community. The weight of the evidence from this study suggests that associations between asthma and depressive and anxiety symptoms may reflect effects of common factors associated with both asthma and depressive and anxiety disorders, rather than a direct causal link. Future research is needed to identify the specific factors underlying these associations.

Adolescent↗
PubMedDate not supplied

Psychiatric sequelae following breast cancer chemotherapy: a pilot study using claims data.

Despite attention to depression and cognitive disorders, the prevalence of other mental disorders following breast cancer chemotherapy has not been well described. The authors undertook a pilot study using insurance claims data to compare the prevalence of mental disorders other than depression in a population of breast cancer surgery patients who did versus did not receive postsurgical chemotherapy treatment. Women receiving chemotherapy in addition to surgery were more likely to be diagnosed with adjustment disorders (odds ratio=2.01, 95% CI=1.04-3.87). Prevalence of depression, anxiety, cognitive, and sleep disorders were not dependent on receipt of post-surgical chemotherapy treatment. These findings support the need for heightened awareness for mental conditions following chemotherapy.

Adjustment Disorders↗
PubMedDate not supplied

[Internalizing and externalizing syndrome in reading and writing disorders].

The prevalence and comorbidity of internalizing and externalizing syndromes was investigated in a clinical sample of children (n = 77) with dyslexia. In the normoriented broadband-screening of the Child Behavior Checklist (CBCL) the rate of behavioral disorders is four times higher than in the standardisation sample. As a consequence of specific administrative prevalence the children have--in contrast to prospective studies--more internalizing than externalizing problems (according to the secondary scales of the CBCL). Psychiatric syndromes have been diagnosed in 66.2 percent: most frequently adjustment disorders, because of nonconformity to performance standards, followed by hyperkinetic disorders and anxiety. In all different diagnosis groups the scores of both secondary scales of the CBCL lie within or near the clinical range, only the priority was different. The high rate of psychiatric disorders indicates a great demand of personal or psychotherapeutic support in referred children with dyslexia, that has to be provided--besides interventions focusing on performance deficits.

Adjustment Disorders↗