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PubMed1996

Prevalence of psychiatric disorders in medical inpatients.

The aim of the present study was to determine the prevalence of psychiatric disorders in acutely ill medical inpatients. A total of 313 consecutively admitted patients were interviewed using a semistructured psychiatric interview. Diagnoses were made according to DSM-IV diagnostic criteria during two time periods, the 7 days following admission and the month prior to admission. The results showed that 85 patients (27.2%) received a DSM-IV diagnosis, with several patients having comorbid diagnoses. Major depressive disorder was present in 16 patients (5.1%), most of whom also had major depressive disorder in the month prior to admission. This prevalence rate is above that of the general population (1.2% to 2.8%), but less than that reported in most previous studies (20% to 40%). Forty-three patients (13.7%) had an adjustment disorder, 18 patients (5.8%) had an anxiety disorder, and 17 patients (5.4%) had either alcohol dependence or abuse. Nurses were more proficient than medical staff at identifying patients who had received a DSM-IV diagnosis, recognizing 61% of cases compared with 41% for medical staff.

Adjustment Disorders↗
PubMed1997

Serious overdosers admitted to a general hospital: comparison with nonoverdose self-injuries and medically ill patients with suicidal ideation.

There are few psychiatric studies of serious self-injury patients admitted to general hospitals. In order to better characterize patients whose overdoses are serious enough to require hospitalization on a toxicology service, we describe 207 consecutively admitted, serious overdose patients (OD), all of whom were psychiatrically evaluated. They were compared with 53 nonoverdose self-injury cases (NO) and 79 medical/surgical patients with suicidal ideation (SI) who were routinely referred for consultation during the same 2-year period. All data were contemporaneously compiled into a computerized database and analyzed. The attempters (OD and NO) were younger than the ideation patients (SI). The OD group was predominantly female (60%) and the NO and SI groups were predominantly male (72%). More OD cases were separated and more SI cases were widowed. Similar to previous reports, prior psychiatric contact was high in all groups. DSM-III-R diagnoses of depression, adjustment disorders, and substance abuse were most common in each group, without group differences. Only borderline personality disorder distinguished the groups, and the OD group had significantly more borderline patients. There were no seasonal differences for admission dates between groups, SI cases had longer hospital lengths of stay and were least likely to require further psychiatric care after discharge from the general hospital. Attempter groups were more similar to each other than the ideation patients. Clinicians should maintain a high index of suspicion for Axis I disorders in suicidal general hospital patients, though female borderline patients are particularly associated with the serious overdose method.

Adjustment Disorders↗
PubMed2006

Do patient requests for antidepressants enhance or hinder physicians' evaluation of depression? A randomized controlled trial.

OBJECTIVE: We sought to ascertain whether patients' requests for antidepressants affect visit duration or history taking by primary care physicians (PCPs) for patients with depressive symptoms and a coexisting musculoskeletal disorder and to determine whether more thorough history taking is associated with diagnostic accuracy or with provision of minimally acceptable initial care for major depression. DESIGN: This was a randomized trial using standardized patients (SPs). Six roles involved 2 conditions (major depression and adjustment disorder, both with coexisting musculoskeletal conditions) and 3 patient request types (brand-specific, general, or none). We conducted the study in 152 PCP offices in Northern California and Rochester, New York. Physicians were assigned randomly to see 2 SPs with depression/wrist pain or adjustment disorder/back pain. MAIN OUTCOME MEASURES: Physician history-taking for depression and the musculoskeletal condition; depression diagnosis in the medical record; antidepressant prescriptions/samples; referral/follow-up recommendations; visit duration; and provision of minimally acceptable initial depression care. RESULTS: General antidepressant requests were associated with more depression history-taking (Adjusted Parameter Estimate = 0.80 more questions of 10 (95% confidence interval = 0.31-1.29, P < 0.001); brand-specific requests were marginally associated with more depression history-taking (Adjusted Parameter Estimate = 0.45, 95% confidence interval = -0.04-0.93, P = 0.07). Antidepressant medication requests were not related to musculo-skeletal question asking (P > 0.3) or visit length (P > 0.8). Depression history taking was directly associated with the likelihood of a chart diagnosis of depression and the provision of minimally acceptable initial depression care. CONCLUSION: General antidepressant requests increase depression history taking, including screening for suicide. Patients' requests for medication do not appear to short-circuit history taking for depression or distract the physician's attention from coexisting musculoskeletal conditions.

Adjustment Disorders↗
PubMed1998

Psychiatric disorders and gynecological oncology: a review of the literature.

It is likely that patients with gynecological cancers are at risk for psychiatric disorders such as major depression and anxiety disorders. However, relatively little attention has been focused on studying these women. We review here papers that report rates and treatment of psychiatric illness in women with gynecological cancer. This small literature suggests that depression, anxiety, and adjustment disorders do occur with heightened frequency, and appear to worsen over the course of treatment persisting well after the initial diagnosis and therapy. Antidepressants are reported to be effective but compliance is often a problem. Limitations in this literature include a paucity of research specific to gynecological cancers, small sample sizes in reports that do exist, and minimal differentiation between the specific cancers and their rates of depression and anxiety. There is a clear need for more clinical and research attention to this at-risk population.

Adjustment Disorders↗
PubMed1998

A comparison of psychotic and nonpsychotic substance users in the psychiatric emergency room.

Current illicit drug and alcohol users were identified by laboratory evaluation of urine samples from nonpsychotic patients without a primary clinical diagnosis of a substance use disorder seen in a psychiatric emergency room. Urine screens revealed that 32 of 93 nonpsychotic patients (34 percent) had used a substance just before visiting the emergency room. Compared with nonusers, users were more often Caucasian females with adjustment disorders who admitted their previous substance use. The prevalence of concurrent use among nonpsychotic patients was higher than among psychotic patients. Nonpsychotic and psychotic users differed in gender, marital status, level of suicidality, self-report of use, the clinician's suspicion of use, use of seclusion during the visit, admitting status, level of care, and disposition.

Adjustment Disorders↗
PubMed2006

[Treatment of depression: what do women need?].

OBJECTIVES: To answer the question of adequate treatment of depression in women from a scientific point of view, it is necessary to investigate the aetiology of depressive disorders as they relate to bio-genetic, mental and social factors. METHODS: For a comprehensive understanding of depressive disorders in women three factors are analysed: (1) the severity of a depression, (2) the phenomenological description, and (3) the factors of the development of depression in the female life cycle. RESULTS: Different treatment strategies for women can be developed on the basis of these phenomenological and psychodynamic considerations. A case study of a female patient suffering from depressive adjustment disorder who had a background history of sexual reproductive problems is presented to demonstrate characteristic factors in women which may serve as indicators for psychoanalytic focal psychotherapy. DISCUSSION: In our opinion, psychoanalytic theory in its complexity, working with unconscious phantasies, fears concerning body integrity and relationships to others, is the most appropriate method to determine specific factors behind the pathogenesis and the persistence of depressive disorders in women.

Adjustment Disorders↗
PubMed1997

Physicians' decisions to prescribe benzodiazepines for nervousness and insomnia.

OBJECTIVE: To assess the effects of particular clinical cues on decisions about prescribing benzodiazepines. DESIGN: A factorial survey based on social judgment theory. SETTING: A midwestern U.S. medical school. PARTICIPANTS: Physicians (n = 115) recruited from the staff by invitation and interview. MEASUREMENTS AND MAIN RESULTS: Physicians indicated their level of agreement with prescribing a benzodiazepine for 24 hypothetical cases of nervousness and insomnia. The cases stemmed from the same scenario but varied systematically with regard to psychiatric diagnosis, recent ability to work, and long-term social stability. A fourth cue, called "health status," covertly depicted the presence or absence of three common alcohol-related medical problems. One fourth of the physicians agreed with prescribing for 15 or more cases, and 15% disagreed for all of them. Agreement was cumulative and least common for major depression, more common for adjustment disorder, and most common for generalized anxiety. Agreement with prescribing for cases with alcohol-related medical problems was 14% less than that for cases without them. Over half the physicians agreed with prescribing for 4 or more of the 12 cases with alcohol-related medical problems. CONCLUSIONS: Prescribing decisions varied widely. Some physicians avoided benzodiazepines unnecessarily for some cases, while others agreed with prescribing for patients with a high probability of alcohol abuse. Blanket calls for more or less prescribing are overly simplistic; physicians should be able to recognize substance use disorders among anxious patients and make prescribing decisions based on relevant literature and clinical cues.

Adjustment Disorders↗
PubMed1998

Depressive disorders among somatizing patients in primary health care.

Unrecognized, untreated and undertreated depressive disorders incur inordinate human and economic costs, despite the availability of an exclusive array of clinical interventions. The aim of this study was to identify cases of masked depression in primary health care, employing a two-stage design. In the first stage, involving a study of 442 patients, the prevalence of recognized depression was 1.8%. In the second step, 62 patients from stage 1 were investigated further because of their high score on somatization tendency. In total, 41 of the 62 patients were found to have a mood disorder according to DSM-III-R, i.e. a major depressive disorder or dysthymia. Two patients were found to have already had a diagnosis of major depression assigned to them in stage 1, but they were joined by 13 more patients. A further 26 patients were found to be suffering from dysthymia, nine had adjustment disorders with depressed mood, and 12 patients showed no signs of depressed mood. For the group suffering from a current episode of major depression or dysthymia, the prevalence rate increased to 11.7% in the initial total population after stage 2. The diagnostic category with the highest rate of depressed patients was 'musculoskeletal diseases'. Patients with masked depression had higher scores for alexithymia and psychasthenia than depressed patients who were directly diagnosed.

Adjustment Disorders↗
PubMed2003

Asthma and panic attacks among youth in the community.

OBJECTIVE: To determine the association between asthma and panic attacks among youth in the community. METHOD: Data were drawn from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study (n = 1285), a community-based sample of youth age 9-17 in the United States. Multivariate logistic regression analyses were used to determine the association between asthma and both panic attacks and panic disorder, adjusting for differences in sociodemographic characteristics and comorbid mental disorders. RESULTS: Asthma was associated with a significantly increased likelihood of panic attacks [OR= 1.5 (1.01, 2.2)]. This effect was specific and persisted after adjusting for differences in demographics and psychiatric comorbidity. Severe asthma was associated with an even greater likelihood of panic attacks [OR = 2.2 (1.3, 4.0)]. There was a dose-response relationship between number of panic symptoms during a panic attack and the likelihood of asthma [OR = 1.2 (1.1, 1.3)] and severe asthma [OR = 1.3 (1.1, 1.4)], which remained significant after adjusting for differences in sociodemographic characteristics and comorbid mental disorders. CONCLUSIONS: These data suggest a significant association between asthma, severe asthma, and panic attacks among youth in the community. Replication of these findings is needed, as are future studies that investigate the nature of these links. In light of the increasing prevalence of asthma and hospitalization for asthma among youth in the United States and worldwide, these associations may be worthwhile to consider in future investigations.

Adolescent↗
PubMed1994

Psychological and endocrine abnormalities in refugees from East Germany: Part I. Prolonged stress, psychopathology, and hypothalamic-pituitary-thyroid axis activity.

The influence of prolonged psychological stress on hormonal secretion was investigated in 84 East Germany refugees suffering from psychiatric disorders within 6 weeks of their arrival in West Berlin shortly before or after the fall of the Berlin Wall. Before leaving the German Democratic Republic, these patients had already experienced prolonged stress, which continued after migration. In most cases, the diagnosis was anxious-depressive syndrome with vegetative complaints and symptoms of increased arousal. Their formal DSM-III-R diagnoses (American Psychiatric Association, 1987) included adjustment disorders, depressive disorders, and anxiety disorders (the latter including posttraumatic stress disorder). Serum levels of thyroid stimulating hormone (TSH) and thyroid hormones (thyroxine, free thyroxine, triiodothyronine, and reverse triiodothyronine) were measured and compared with those of 20 healthy control subjects. TSH and all thyroid hormone concentrations were significantly reduced in the patient group. Fifty-two of the patients (62%) were in the hypothyroid range but did not show any clinical signs of hypothyroidism. These disturbances in hormonal secretion were not correlated to any psychiatric diagnosis or to the severity of acute or chronic stress. The marked abnormalities in the hypothalamic-pituitary-thyroid axis seen in these refugees differ from those reported in depression and would seem to reflect severe chronic stress rather than specific psychiatric disorders. The underlying neurochemical mechanisms remain to be investigated.

Adjustment Disorders↗
PubMedDate not supplied

Comparison of psychiatric ICD-10 diagnoses in Denmark and Germany.

A dataset of psychiatric ICD-10 diagnoses from the Danish case register concerning psychiatric hospitals was compared with a sample of psychiatric diagnoses from 27 psychiatric hospitals in Germany. The comparison shows a higher proportion of F1 diagnoses in the German dataset and a difference in the coding of alcohol dependence and harmful use. Some further differences in the groups F0-F6 are demonstrated and some of them are discussed. The most frequent diagnoses found in both datasets but in different sequence are alcohol dependence syndrome and paranoid schizophrenia and, in third place, adjustment disorder. Various aspects of the problem of rarely used diagnoses are discussed.

Adjustment Disorders↗
PubMed1995

Brief psychiatric hospitalization: preliminary experience with an urban short-stay unit.

OBJECTIVE: To present data from the recently implemented psychiatric short-stay units (SSUs) in metro Halifax. There are few data describing SSUs and factors associated with successful outcome. METHODS: A 4-month retrospective chart review of 124 patients. RESULTS: Patients tended to be single, unemployed young adults, with a past history of psychiatric admission. Most patients were admitted voluntarily. There was an equal sex ratio. Mean length of stay for all patients was 2.5 days. Adjustment disorder was the diagnosis most responsible for admission. CONCLUSION: Many psychiatric inpatients may benefit from brief hospitalization. Brief hospitalization results in reduced health care costs.

Adjustment Disorders↗
PubMed1987

Depression in intensive care units.

There is thought to be a high incidence of depression in intensive care units (ICUs), both as a result of the psychological toll of serious illness and threat to life as well as the physiologic derangements caused by illnesses and treatments. The authors outline a strategy to classify ICU depressions into major depressive illness, adjustment disorders, dysthymic disorder, or organic affective syndrome. Other psychiatric disturbances which may simulate depression are also discussed. A summary of environmental, behavioral, psychotherapeutic, and psychopharmacologic treatments for these disorders and their special application in the ICU setting is presented. The limitations and precautions with antidepressant drugs in this clinical site are reviewed.

Adjustment Disorders↗
PubMed1990

Maladaptive denial of physical illness: a proposal for DSM-IV.

Denial of physical illness is a commonly encountered problem in consultation-liaison psychiatry. Although there is an extensive literature on denial, it has virtually ignored the diagnostic issues raised by the individual whose denial of physical illness is clearly maladaptive. The authors propose that DSM-IV include a subtype of adjustment disorder called "with maladaptive denial of physical disorder." They discuss this new category, its differential diagnosis, and the benefits to clinical practice of this proposed addition to diagnostic classification.

Adjustment Disorders↗
PubMed1991

The comparison of postpartum with non-postpartum depression: a rose by any other name.

A strong tradition exists in the psychiatric literature to consider postpartum depression a distinct diagnosis. However, the empirical evidence indicates that, in terms of etiology and relapse rates, postpartum depression is indistinguishable from non-postpartum depression. Symptomatically, postpartum depression seems to involve a milder disturbance, suggesting that it is best seen as an adjustment disorder. This paper summarizes the empirical evidence relevant to the distinct diagnosis question, and considers the benefits to be derived from challenging the traditional view of postpartum depression.

Adjustment Disorders↗
PubMed2003

Measuring adjustment to chronic skin disorders: validation of a self-report measure.

This article describes the development of a questionnaire that assesses problems in adapting to chronic skin disorders, the Adjustment to Chronic Skin Diseases Questionnaire. Patients (N = 442) with different skin disorders completed the original item pool. Principal-components analysis suggested a 6-factor solution that was largely replicated with 2 additional samples of 192 patients with psoriasis or atopic dermatitis and 165 patients with atopic dermatitis. Four of the subscales showed very good internal consistencies, retest reliabilities, and sufficient correlations with expert ratings: Social Anxiety/Avoidance, Itch-Scratch Cycle, Helplessness, and Anxious-Depressive Mood. Two short additional subscales, Impact on Quality of Life and Deficit in Active Coping, showed moderate internal consistencies, but good retest reliabilities. Correlations of the subscales with measures of depression, anxiety, and coping, and meaningful differences between dermatological subgroups support their construct validity. A treatment study showed that changes in some of the subscales correlated with changes in the severity of the skin condition.

Adaptation, Psychological↗
PubMedDate not supplied

[Update on the morbidity of psychiatric disorders in patients with AIDS: results of a clinical follow-up].

A follow-up study after one or two years of treatment was carried out on 107 AIDS patients who were seen by the Consultation-Liaison Psychiatry Unit of the Ramon y Cajal Hospital. The sample was reduced to 52 patients (49%) mainly due to the lack of check-ups in 43% and to the death of 8% of the cases. 36% of patients suffered from Delirium or Dementia and these had the greater mortality rate. Grade IV patients and those with a diagnosis of Adjustment Disorders came to the check-ups most frequently.

AIDS Dementia Complex↗