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PubMed1983

Liaison psychiatry in a general hospital.

An analysis of referrals to the psychiatric liaison service, Auckland Hospital showed that 1.56% of hospital admissions were referred. Females were referred more frequently as were separated, divorced, widowed and unemployed people. Adjustment disorder and affective disorder were the more common diagnoses, but a wide range of diagnostic types were seen. The service dealt with two-thirds of cases without recourse to other psychiatric resources.

Adjustment Disorders↗
PubMed2006

Evaluation of family therapy.

Because children of mentally disordered parents have an increased risk of becoming subjects of mental disorder and psychological problems, adult psychiatry has increasingly paid attention to the patients' parental skills. This study includes 31 families with children younger than 18 years of age where the parents were admitted to family therapy in an open psychiatric ward. The average number of sessions was seven, and the diagnoses of severe stress and of adjustment disorder were the most common. The aim of the study was to measure changes in the family climate during the period of therapy. The instrument used was the Family Environment Scale (FES), a self-rating questionnaire that measures the parents' experience of family environment. The change of family environment is related to its influence on children's well-being and development. The study finds that family therapy has resulted in positive changes of the parents' experience of the family climate.

Adjustment Disorders↗
PubMed1994

Can treatment research inform decision makers? Nonexperimental method issues and examples among older outpatients.

Outcome research does not seem to have informed policymakers, decision makers, or practitioners. It is proposed that reporting of improvement-deterioration rates and greater use of single-sample, pretreatment-posttreatment designs in community clinic settings will facilitate communication and, perhaps, mitigate the external validity problem of psychotherapy experiments. The Edwards-Nunnally method (D. C. Speer, 1992) was used to investigate change rates from a single cohort of older adult outpatients (N = 92). The cohort improvement rate was 51%, and the deterioration rate was 5%. However, improvement rates for clients with major depression and adjustment disorders were greater than 70%. Change rates of student and staff therapists and of clients treated in the clinic and in their homes were not significantly different. Deteriorated clients are briefly described.

Adjustment Disorders↗
PubMed1998

[Prevalence and follow-up of psychiatric diseases in internal medicine departments].

While several surveys have shown that psychiatric disorders are common in non-psychiatric hospital departments, information on the course of psychiatric morbidity during the hospital stay is still lacking. Therefore, in two medical hospital departments in Austria we investigated the course of illness in 265 patients staying in the hospital for more than four weeks. Patients were interviewed using the Clinical Interview Schedule. At admission, prevalence of all psychiatric disorders was 46.0%. During the four weeks after admission, mentally well were discharged from hospital more frequently than mentally ill. Among those staying in the hospital after four weeks, prevalence was 51.4%. In the intervening period, the incidence (9.5%) was slightly lower than the rate of remission (12.4%). At both assessments, organic mental illness was the most frequent diagnosis followed by neurotic and adjustment disorders. Thus, in spite of the slightly higher rate of remission than incidence, the overall psychiatric prevalence increased during the first four weeks after admission because of the earlier discharges of the mentally well. In conclusion, our results show that point-prevalence surveys not regarding disease course give an incomplete impression of psychiatric morbidity in non-psychiatric hospital departments.

Adjustment Disorders↗
PubMed1992

Relationships between the MAPI and the MMPI in the assessment of adolescent psychopathology.

Although the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Adolescent Personality Inventory (MAPI) are both widely used in the clinical assessment of adolescents, no research has examined the interrelationship between these two instruments. We investigated MMPI and MAPI responses from 199 adolescents assessed at entrance to inpatient or outpatient psychiatric programs in Florida and Virginia. Univariate correlation analyses identified areas of significant associations between these measures, with coefficients ranging widely from -.70 to .72. Substantial diagnostic differences were found between these instruments. The MAPI, for example, yielded no depression-related diagnoses, but produced many more adjustment disorder and personality disorder diagnoses than the MMPI. The rates of diagnostic assignment agreements between diagnoses produced by clinical judgment, MMPI findings, and MAPI interpretive reports were typically quite low.

Adjustment Disorders↗
PubMed2006

Preventing depression among early adolescents in the primary care setting: a randomized controlled study of the Penn Resiliency Program.

This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events. PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to previous PRP studies and research on the dissemination of psychological interventions.

Analysis of Variance↗
PubMedDate not supplied

Consultation-liaison psychiatrists management of depression.

Prospective data on 1,360 consecutive inpatients referred to the consultation-liaison psychiatry service of 2 metropolitan general teaching hospitals and diagnoses as having a Depressive Illness Spectrum Disorder were collected by using the MICRO-CARES clinical database system. The distribution of DSM-III-R diagnoses was major depression (MD) 49%; dysthymia (DYS) 15%; organic or substance-induced mood disorder or depressive disorder not otherwise specified (ORG/NOS) 14%; and adjustment disorder with depressed mood (AD) 29%s. Antidepressants were prescribed in 59% of the MD cases, 40% of the DYS cases, 36% of the ORG/NOS cases, and 17% of the AD cases. In confirmed MD, antidepressants were prescribed in 69%, and significantly more often in those who were older, female, had a prior history of physical illness, had a neoplasm or a disorder of the nervous or musculoskeletal systems, had higher Axis IV scores, or were referred because of pain or terminal illness. The patients with confirmed MD prescribed antidepressants had a longer length of stay and were referred later than those not prescribed antidepressants. The results illustrate the importance of all the forms of depression in consultation-liaison psychiatry and the vigor with which all forms are treated.

Adult↗
PubMed1989

Risk factors for maladjustment in Puerto Rican children.

Data are presented on risk factors for childhood psychopathology derived from a study of an island-wide probability sample of children in Puerto Rico aged 4 through 16 years. Analyses estimated the effects of 12 demographic, health, and family variables on the probability of being a "case," using two different operational definitions of caseness, as well as on the probability of receiving the diagnoses of oppositional disorder, attention deficit disorder, separation anxiety, depression, functional enuresis, and adjustment disorder. When compared to other findings, the results from these analyses indicate that the relationship between maladjustment and the risk factors evaluated does not appear to be culturally specific.

Adolescent↗
PubMedDate not supplied

Decreased bone mineral density in medicated psychiatric patients.

Osteoporosis is a common problem in postmenopausal women. It has been linked to estrogen deficiency, other neuroendocrine processes such as hypercortisolemia and male hypogonadism, nutritional deficiencies, and other mechanisms. Some of these changes have been also reported in male and female patients with mental disorders, especially those receiving psychotropic medications. Therefore, bone mineral density was measured by dual-photon absorptiometry in the lumbar spine and in the femoral neck of 33 female and 35 male consenting psychiatric inpatients admitted consecutively. Patients were diagnosed as having major depressive disorder (N = 21), schizophrenia (N = 33), schizoaffective disorder (N = 7), mania (N = 2), and adjustment disorder (N = 5). Plasma levels of prolactin, estrogen, cortisol, and testosterone were also measured in a subgroup of these patients. It is reported that female patients, but especially male patients, had a highly significant decrease in bone mineral density when compared with age- and sex-matched normal data. It is suggested that psychiatric patients treated with antidepressants or neuroleptics might have decreased bone mineral density than is normal for their age and sex, and may be at an increased risk for fractures. These results may be related to low levels of gonadal hormones, especially in male subjects. Data should be confirmed with a larger number of patients with and without medications to distinguish between diagnosis-related and treatment-related effects.

Adult↗
PubMed2005

Diagnostic stability in depressive disorder as according to ICD-10 in clinical practice.

BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of depressive disorder has not been investigated in clinical practice. SAMPLING AND METHODS: All patients who were diagnosed with depressive disorder at least once in a period from 1994 to 2002 in psychiatric out- or inpatient settings in Denmark were identified in a nationwide register. RESULTS: A total of 39,741 patients were diagnosed with depressive disorder at least once; among these, 81% were diagnosed at the first contact. In approximately 56% of patients, the initial diagnosis of depressive disorder eventually changed during follow-up mainly to the schizophrenic spectrum (16%), but also to personality disorders (9%), neurotic, stress-related and somatoform disorders (8%) and to bipolar disorder (8%). Among the 18% of patients who were later diagnosed with depressive disorder, 23% initially had a diagnosis of adjustment disorder. CONCLUSIONS: When the ICD-10 diagnoses are used in clinical practice, the diagnosis of depressive disorder has a low stability over time. These findings emphasize the need for a longitudinally based diagnostic process in the diagnostic systems.

Adult↗
PubMed1993

Personality disorders diagnosed at intake at a public psychiatric facility.

OBJECTIVE: The purpose of the study was to determine the prevalence of personality disorders among a large population of persons seeking treatment in a public psychiatric facility and to examine the role of personality disorders in the clinical conditions of persons frequenting such facilities. METHODS: Clinical and demographic data were retrospectively examined for 18,179 adults who visited a walk-in clinic of a public psychiatric facility between 1983 and 1989. Patients who received a diagnosis of personality disorder were compared with those who did not. RESULTS: A total of 2,344 patients (12.9 percent) were diagnosed as having a personality disorder, a lower prevalence rate than generally found in treatment populations. The most frequent diagnoses were atypical, antisocial, and borderline personality disorders. Compared with other subjects, those with a personality disorder were significantly more likely to be men, to be 35 years old or younger, to have a higher level of social impairment, and to have more symptoms and more severe symptoms. CONCLUSIONS: The relatively low prevalence rate was attributed in part to underdiagnosis, largely due to the need for making rapid assessments in a public intake setting. The authors conclude that clinicians in such facilities may be likely to diagnose personality disorders when patients with certain axis I disorders such as substance use, affective, and adjustment disorders present with an overall greater level of symptomatology and social impairment.

Adult↗
PubMedDate not supplied

Screening a skilled nursing home population for depression.

The population resident in the skilled nursing home of a Veterans Administration Hospital on the 27th of June 1988 was screened for the presence of depression. Only 74% of the patients (59 of 80) were able to complete most of the screening battery: the Folstein Mini-Mental State Examination, the 15-item Geriatric Depression Scale, and the Hamilton Depression Scale. Thirty-four percent of the sample (20 of 59) met the criteria for a DSM-III-R psychiatric diagnosis; 22% (13 patients) had a major depressive disorder, and 12% (seven patients) had an adjustment disorder with depressed mood. The 15-item version of the Geriatric Depression Scale was more effective than the Hamilton Depression Scale as a screening instrument in this population of frail elderly veterans who had multiple and severe medical problems (end-stage cardiac disease, progressive myasthenia gravis, terminal pulmonary disease, and multiple cerebrovascular accidents) that limited verbal and nonverbal communication, as well as physical endurance.

Adult↗
PubMed2006

Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India.

Patients' accounts complement psychiatric assessment of deliberate self-harm (DSH). In this study we examined psychiatric disorders, and sociocultural and cross-cultural features of DSH. SCID diagnostic interviews and a locally adapted EMIC interview were used to study 196 patients after DSH at a general hospital in Mumbai, India. Major depression was the most common diagnosis (38.8%), followed by substance use disorders (16.8%), but 44.4% of patients did not meet criteria for an enduring Axis-I disorder (no diagnosis, V-code, or adjustment disorder). Psychache arising from patient-identified sociocultural contexts and stressors complements, but does not necessarily fulfill, criteria for explanatory psychiatric disorders.

Adolescent↗
PubMed1991

Psychological distress and psychiatric morbidity in women prisoners.

The population of a women's prison (n = 92) was screened for psychological distress and psychiatric morbidity with the 12-item General Health Questionnaire, the Hamilton Depression Rating Scale, a Recent Stressful Life Events questionnaire and the Structured Clinical Interview for DSM-III-R. High levels of symptoms of psychological distress were recorded. Distress was correlated with recent stressful life events and was more severe in women awaiting trial. Fifty-three per cent of the prisoners were diagnosed as current cases of a psychiatric disorder and the most frequent diagnoses were adjustment disorder with depressed mood and personality disorders. Lifetime prevalence of psychoactive substance use disorders was 54 per cent. Aboriginal women were over-represented in this prison population. A follow-up survey after 4 months showed no fall in the prevalence of psychological distress and psychiatric morbidity.

Adolescent↗
PubMed2006

Psychiatric problems of heart transplant candidates with left ventricular assist devices.

Most heart transplant candidates are equipped with left ventricular assist devices (LVADs). LVAD therapy is associated with characteristic psychiatric and psychosocial problems. To investigate the mental states of heart transplant candidates, psychiatric diagnosis, psychological or behavioral problems, and the need for treatment were evaluated around the time of registration to the waiting list and during follow-up. Saitama Medical University Hospital has been designated a hospital for heart transplantation since October 2002. The subjects were 14 heart transplant candidates (9 male candidates and 5 female candidates, mean age 29 years) at the hospital from September 1997 to October 2005. These 14 candidates were equipped with LVADs. The waiting periods on LVAD support were from 119 days to 1028 days, and the average waiting period was 313 days. Six candidates among the 14 had more than one DSM-IV diagnosis. Seven candidates were diagnosed with adjustment disorder, which was the most frequent diagnosis. Three candidates had depressive disorder, one had psychotic disorder, and one had dissociative disorder. Three candidates had acute cognitive dysfunction (delirium) due to their general medical condition. All three had other disorders with mainly psychological elements. Nine candidates (64%) were diagnosed with disorders with mainly psychological elements. Antipsychotics were used for the candidates in psychotic states and with delirium, and there was a need for crisis intervention. Antidepressants and antianxiety drugs were used for the candidates with depressive disorder; they needed intensive observation. Four candidates (28%) needed some attention and some antianxiety drugs or hypnotics. Psychiatric interventions were not necessary in five candidates (36%).

Adjustment Disorders↗
PubMed1983

Diagnostic and treatment considerations in depressed dialysis patients.

Depressive symptoms are common in a dialysis population. These symptoms are only infrequently part of a major depressive illness, however, and are more usually related to adjustment disorders associated with the onset of chronic dialysis treatment, or medical complications of end stage renal disease. A substantial proportion of depressive symptoms are also related to problems in living not directly associated with renal failure. Psychotherapeutic support helps the majority of patients with depressive symptomatology. Nurse-patient and physician-patient relationships are potentially powerful factors influencing patient adjustment to dialysis.

Adjustment Disorders↗
PubMed1994

Poststroke depression.

Sixty-eight patients with stroke were investigated to assess their mood state. Nearly half of them were found to be depressed; according to DSM-III-R, 6 of these were diagnosed as suffering from major depression and the rest from adjustment disorder with depressive mood. A significant relationship was found between mood state on the one hand, and daily living activities and Type A behavior pattern on the other.

Activities of Daily Living↗
PubMed1997

Psychiatric morbidity and depressive symptomatology in patients with permanent pacemakers.

Implantation of a permanent pacemaker requires a psychological effort on the patient's part for adaptation in the acute term, and chronically, it restricts activities of the patient and may cause some psychiatric disturbances. To investigate psychiatric morbidity and depressive symptomatology of the patients with permanent pacemakers, 84 pacemaker patients were diagnosed using the DSM-III-R criteria and depressive symptoms were determined by modified Hamilton Depression Rating Scale (mHDRS). Sixteen (19.1%) patients had been given a psychiatric diagnosis. The most frequent diagnoses were adjustment disorder (5.9%) and major depressive episode (4.7%). Nine patients (10.7%) were diagnosed as having clinical depression (mHDRS > or = 17). The mean score of mHDRS was 7.57 +/- 7.46, and the severity of depression was significantly higher in females. The most frequent symptoms are difficulties in work and activities (53.6%), psychic anxiety (48.8%), loss of energy (42.9%), and hypochondriasis and insomnia (39.3%). Depressed mood, psychic anxiety, loss of energy, loss of interest, insomnia, and hypochondriasis were significantly more frequent in females. Uneducated patients had a more significant loss of energy than educated patients. Depressed mood, psychic anxiety, and somatic concerns and symptoms were more frequent in patients with permanent pacemakers than in the general population. These symptoms, resembling mixed anxiety-depression disorder, were related to fears of having a permanent pacemaker, since our series were composed of uneducated patients who did not have enough knowledge about the device.

Adjustment Disorders↗