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PubMed1994

The midlife transition: crisis or chimera.

The construct of the midlife crisis is examined on definitional, developmental, psychoanalytic, and existential dimensions, and the literature reviewed. The DSM-III-R criteria for Adjustment Disorder appear to subsume the midlife crisis paradigm, and only a small percentage of people high in neuroticism are prone to developmental crises. It is argued that the crisis model is a contemporary social construct that has outlived its usefulness.

Adjustment Disorders↗
PubMed2002

[Gerontopsychiatric consultation service].

In the discussion of the increasing costs of health care in Germany the frequent and often times long inpatient treatments of elderly patients are pointed out. Since these patients also suffer from psychiatric disorders very frequently, a psychiatric consultation is required rather often. This study was aimed to evaluate the requirements of a consultation service for elder inpatients. For this purpose all 9363 consultation reports from 1994 to 1998 were evaluated retrospectively. 2152 (31.4 %) of the patients visited by the psychiatric consultation service were over 64 years old. The most frequent diagnoses were organic brain syndrome (ICD-10: F0), particularly senile dementia (ICD-10: F00 - 03), adjustment disorder (ICD-10: F43) and affective disorders, particularly depressive disorders (ICD-10: F3). In 139 patients (6,5 %) a consultation was requested because of a suicidal attempt prior to admission. Our results suggest that in a gerontopsychiatric consultation service predominantly old patients with internal diseases and with the need of psychosocial help are visited and that the specific knowledge of psychopharmacological treatment in multimorbid patients as well as the psychosocial help and legal advice is requested. These aspects should therefore be a special focus in educational programs for a gerontopsychiatric consultation service.

Adjustment Disorders↗
PubMed1992

DSM-III-R brief reactive psychosis among Air Force recruits.

BACKGROUND: Clinical characteristics of patients diagnosed with brief reactive psychosis based on DSM-III-R criteria and the incidence of this disorder in a defined population have not been sufficiently studied. Some military recruits who are subjected to relatively uniform levels of stress in a monitored environment over a specified time period develop transient, severe psychotic symptoms consistent with a diagnosis of brief reactive psychosis. METHOD: We retrospectively reviewed all cases of brief reactive psychosis that occurred among 139,360 Air Force recruits during 6-week basic training experiences over a 3-year period. Brief case descriptions, including clinical courses, are provided. RESULTS: Six cases were found among 557 consecutive psychiatric admissions between January 1, 1988, and January 1, 1991 (annual incidence = 1.43 cases per 100,000 recruits). An apparent temporal relationship was found between the onset of the stressor (basic military training) and the development of psychosis. Paranoid symptomatology, including persecutory delusions, was present in all cases. Adjustment disorders were the most common diagnoses in patients admitted from the training environment (N = 464). CONCLUSION: Brief reactive psychosis is a rare discharge diagnosis in this large population of young Air Force recruits. Prospective studies are warranted to evaluate the usefulness of DSM-III-R criteria for this disorder and to determine the longitudinal course of patients who have received this diagnosis.

Adjustment Disorders↗
PubMed2001

Major depression and demoralization in cancer patients: diagnostic and treatment considerations.

Major depression and demoralization are very common in patients with cancer. A discussion of the diagnostic specificity of major depression and demoralization (also known as adjustment disorder) is presented here, followed by a review of some effects of comorbid depression and cancer. Finally, there are a brief review of studies of antidepressant pharmacotherapy in cancer patients, a treatment algorithm for antidepressant therapy, and suggestions for treatment of demoralization.

Adjustment Disorders↗
PubMed2002

Psychiatric morbidity in vitiligo: prevalence and correlates in India.

BACKGROUND: Vitiligo, a common pigmentary disorder, is recognized to be associated with a high psychiatric morbidity, yet compared to other dermatological disorders like leprosy, psoriasis, etc., it has not been subjected to detailed evaluation of its psychological consequences. The data from the developing countries on this aspect in particular is meager. METHODS: One hundred and thirteen cases with vitiligo were evaluated along with 55 healthy controls comparable for sociodemographic profile and matched on attitude to appearance scale. Clinical details, impact of illness, associated dysfunction and psychological morbidity were additionally assessed. RESULTS: Twenty-eight patients with vitiligo were found to have psychiatric morbidity, a clinic prevalence rate of 25% (95% confidence interval 20.3-29.3%). The majority of the cases had a diagnosis of adjustment disorder. Psychiatric morbidity was significantly correlated with dysfunction arising out of illness. CONCLUSIONS: Vitiligo is associated with high psychiatric morbidity. There is a need to develop cross-cultural database on psychosocial aspects and psychiatric morbidity associated with vitiligo.

Adjustment Disorders↗
PubMedDate not supplied

Diagnosing demoralization in consultation psychiatry.

Demoralization, a normal response to adversity, is commonly seen in medical and surgical patients referred for psychiatric consultation. Demoralization should be distinguished from adjustment disorders and other pathological conditions--a process that would be facilitated if demoralization, like grief, were given a V code in DSM. Although the primary responsibility for treating demoralization rests with the patient's physician, the consulting psychiatrist must make an accurate diagnosis and begin the process of supportive psychotherapy.

Adaptation, Psychological↗
PubMed1997

Overdose among youth in Bahrain: psycho-social characteristics, contact with helping agencies and problems.

A one year cohort of 67 overdose attempts among youth (15-24 years) was examined as part of a case control study. The prevalence rate of 105 per 100,000 population is lower than reported rates in the West but higher than those for the region. The majority of attempters were females and nationals who used paracetamol, and their suicide intent was low. Thirteen percent visited a helping agency in the previous week and 18% in the previous month. The most common difficulties preceding the overdoses were problems with parents, school or work, social isolation and problems with boyfriends, or girlfriends respectively. Adjustment disorder was the most common diagnosis followed by depression. A seasonal variation was noted with 46% of the cases occurring in the summer months. The implications of these findings with respect to future policy making and prevention were discussed.

Acetaminophen↗
PubMed2007

Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study.

This study aimed at the identification of acute and post-traumatic stress responses, and comorbid mental disorders in breast cancer patients. Structured clinical interviews for DSM-IV (SCID) were conducted post-surgery with 127 patients (t1). Screening measures were used to assess post-traumatic stress responses, anxiety, and depression at t1 and at 6 months follow-up (t2). Based on the SCID, prevalence rates were 2.4% for both, cancer-related ASD and PTSD. Experiences most frequently described as traumatic were the cancer diagnosis itself and subsequent feelings of uncertainty. Patients with lifetime PTSD (8.7%) were more likely to meet the criteria for cancer-related ASD or PTSD (OR=14.1). Prevalence estimates were 7.1% for Adjustment Disorder, 4.7% for Major Depression, 3.1% for Dysthymic Disorder and 6.3% for Generalized Anxiety Disorder. Using the screening instruments, IES-R, PCL-C and HADS, we found PTSD in 18.5% at t1 and 11.2-16.3% at t2. The estimates of anxiety and depression reveal rates of 39.6% (t1) and 32.7% (t2) for anxiety, as well as 16.0% (t1) and 13.3% (t2) for depression (t1) (cut-off> or =8). The diagnosis of a life-threatening illness has been included as a potential trauma in the DSM-IV. However, it has to be critically evaluated whether subjective feelings of uncertainty like fears of treatment count among traumatic stressors, and thus, whether the diagnosis of PTSD is appropriate in this group of cancer patients. However, a large number of women with emotional distress illustrate the need for psychosocial counseling and support in this early treatment phase.

Acute Disease↗
PubMed1996

Symptom profile, Axis II comorbidity and suicidal behaviour in young males with DSM-III-R depressive illnesses.

We assessed the descriptive validity of DSM-III-R major depression (MDD), dysthymia (DD) and adjustment disorder with depressed mood (ADDM) by comparing the clinical profiles of 176 young male patients. The severity of depression increased progressively across the three diagnostic groups (ADDM < DD < MDD). Symptom presentation did not distinguish clearly between the diagnostic groups, even though somatic symptoms were more frequent among MDD patients. The prevalence of personality disorders was much higher (43%) among DD patients than among MDD (22%) and ADDM (15%) patients. The lifetime prevalence of suicide attempts differed in the three diagnostic groups (MDD 27%, DD 17%, ADDM 4%). Assessment of Axis II comorbidity and suicidal behavior can improve the diagnostic distinction between these DSM-III-R depressive illnesses.

Adjustment Disorders↗
PubMedDate not supplied

Neuropsychiatric complications of AIDS: a literature review.

Acquired immune deficiency syndrome (AIDS) has become a major public health problem with over 12,000 cases and 6,000 deaths reported to date. Although there has been an explosion of knowledge in the virology, immunology and pathology of AIDS, relatively little has been written on the neuropsychiatric aspects. This report reviews the existing literature on the neuropsychiatric complications of AIDS. As many as 40 percent of patients with AIDS have neurologic complications at some point in their illness. These complications include either focal deficits attributable to opportunistic organisms infecting the CNS or diffuse encephalopathy caused by viral infection or lymphoma infiltration. Psychiatric complications include major depression, adjustment disorder with depressed mood, and organic brain syndrome with affective, delusional or demented features. Inpatient and consulting psychiatrists must be alert to these complications of AIDS so as to make accurate diagnoses and deliver appropriate therapy. Further studies, integrating both psychiatric and neurologic perspectives, are needed to better elucidate the neuropsychiatric complications of AIDS and help plan appropriate therapeutic interventions.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Caught in the act? Prevalence, predictors, and consequences of physician detection of unannounced standardized patients.

Objective. To examine the prevalence, predictors, and consequences of physician detection of unannounced standardized patients (SPs) in a study of the impact of direct-to-consumer advertising on treatment for depression. Data Sources. Eighteen trained SPs were randomly assigned to conduct 298 unannounced audio-recorded visits with 152 primary care physicians in three U.S. cities between May 2003 and May 2004. Study Design. Randomized controlled trial using SPs. SPs portrayed six roles, created by crossing two clinical conditions (major depression or adjustment disorder) with three medication request scripts (brand-specific request, general request for an antidepressant, or no request). Data Collection. Within 2 weeks following the visit, physicians completed a form asking whether they "suspected" conducting an office visit with an SP during the past 2 weeks; 296 (99 percent) detection forms were returned. Physicians provided contextual data, a Clinician Background Questionnaire. SPs filled in a Standardized Patient Reporting Form for each visit and returned all written prescriptions and medication samples to the laboratory. Principal Findings. Depending on the definition, detection rates ranged from 5 percent (unambiguous detection) to 23.6 percent (any degree of suspicion) of SP visits. In 12.8 percent of encounters, physicians accurately detected the SP before or during the visit but they only rarely believed their suspicions affected their clinical behavior. In random effects logistic regression analyses controlling for role, actor, physician, and practice factors, suspected visits occurred less frequently in HMO settings than in solo practice settings (p<.05). Physicians more frequently referred SPs to mental health professionals when visits aroused high suspicion (p<.05). Conclusions. Trained actors portrayed patient roles conveying mood disorders at low levels of detection. There was some evidence for differential treatment of detected standardized patients by physicians with regard to referrals but not antidepressant prescribing or follow-up recommendations. Systematic assessment of detection is recommended when SPs are used in studies of clinical process and quality of care.

Adjustment Disorders↗
PubMed1999

Psychological impact of informed consent in hospitalized cancer patients. A sequential study of anxiety and depression using the hospital anxiety and depression scale.

Patients with cancer receive an explanation of their disease and the recommended treatment when they are asked to give informed consent (IC). In the course of this process patients suffer severe distress, including anxiety and depression, but physicians tend to underestimate it. The goal of this study was to reveal the magnitude of such stress and any changes to this during the IC process by means of the Hospital Anxiety and Depression (HAD) scale, a self-assessment scale. Of 171 in-patients newly diagnosed with lung cancer, 119 were assessable for serial HAD scale scores on admission, immediately after the IC process, and at 1 and again at 2 weeks after the IC. Both anxiety and depression scores increased significantly immediately after IC. Female patients had significantly higher anxiety and depression scores than males at 1 week after the IC. The patients with poor performance status demonstrated high anxiety scores on admission and immediately after the IC, and substantial depression persisted longer in these patients. The prevalence of high scores of more than 11 (judged as adjustment disorder or more severe state) immediately after the IC was 50% for anxiety and 31% for depression. The prevalence decreased significantly within 1 or 2 weeks, but 41% and 14% of the patients still showed high anxiety and depression scores, respectively. Physicians should be aware of these facts and pay special attention to their patients' psychological distress in routine clinical practice.

Adjustment Disorders↗
PubMed1992

Massage reduces anxiety in child and adolescent psychiatric patients.

A 30-minute back massage was given daily for a 5-day period to 52 hospitalized depressed and adjustment disorder children and adolescents. Compared with a control group who viewed relaxing videotapes, the massaged subjects were less depressed and anxious and had lower saliva cortisol levels after the massage. In addition, nurses rated the subjects as being less anxious and more cooperative on the last day of the study, and nighttime sleep increased over this period. Finally, urinary cortisol and norepinephrine levels decreased, but only for the depressed subjects.

Adjustment Disorders↗
PubMedDate not supplied

Psychiatric morbidity among dermatology inpatients.

BACKGROUND: Research on psychiatric morbidity among patients with dermatological diseases generally focuses on outpatients and questionnaire-based surveys. The aim of this study was to determine the prevalence and nature of psychiatric morbidity among dermatological inpatients with diagnosis being made by psychiatric interview, and ascertain whether demographic and clinical details in dermatological inpatients with psychiatric morbidity differed from those without it. METHODS: Charts of all inpatients admitted by the dermatology department between 1 January 1991 and 31 July 1995 were analysed for socio-demographic data, clinical features, treatment and course in hospital. For those patients who were referred to a psychiatrist, all records of the psychiatric consultation were obtained and analysed. RESULTS: A total of 1073 patients were admitted during the study period. Ninety-eight patients (9%) were diagnosed to have a psychiatric illness. Patients with psychiatric illness were likely to have had more admissions and longer duration of hospital stay. The most common psychiatric diagnoses were depressive episodes (34%) and adjustment disorders (29%). The highest rates of psychiatric morbidity were found among patients with chronic urticaria, exfoliative dermatitis and sexually transmitted diseases, including human immunodeficiency virus infection. The prevalence of psychiatric disorders was significantly higher in those who had received long term (more than six weeks) treatment with high-dose steroids (more than 1 mg/kg body weight of prednisolone). CONCLUSION: Some dermatology inpatients have psychiatric morbidity, which affects the course of the dermatological condition as well as the duration of hospitalization. The availability of psychiatric consultation at dermatology clinics and regular liaison between psychiatrists and dermatologists are essential for appropriate management.

Adjustment Disorders↗
PubMed1987

The validity of the Bender-Gestalt emotional indicators.

We evaluated the concurrent validity of the revised Bender-Gestalt emotional indicators (Koppitz, 1975) among three groups of children in the 7- to 10-year age range: adjustment disorder, behavior disorder, and normal control. The concurrent validity of the emotional indicators total score was demonstrated. Notably, with the developmental level controlled, both clinical groups produced significantly more emotional indicators than the control group, although the two clinical groups could not be differentiated. Nominal-data analyses of the 13 individual emotional indicators indicated that three specific indicators (confused order, large size, boxed figures) possessed validity as pathognomonic signs. We discuss issues concerning the use of the emotional indicators in clinical practice.

Adjustment Disorders↗
PubMed1998

Deliberate exposure to motor vehicle exhaust gas: the psychosocial profile of attempted suicide.

OBJECTIVE: Deliberate exposure to motor vehicle exhaust gas has become the second most commonly used method of suicide in Australia. In an attempt to understand the factors contributing to the rise in popularity of this method, the psychosocial profiles, factors influencing method choice and circumstances of the act of self-harm were examined in a group of survivors. METHOD: A cross-sectional cohort study of 30 patients presenting for hyperbaric oxygen treatment having survived deliberate exposure to car exhaust gas was undertaken. A structured clinical interview was administered together with scales measuring depression, hopelessness and suicidal intent. Daily assessment of mental state and cognitive function was performed. RESULTS: Factors common to the majority of subjects included male gender, age group of 20-50 years, and alcohol abuse. Relationship discord was the most common precipitating factor. Reasons given for choice of this method included the availability and accessibility of motor vehicles, painlessness, awareness that the method was lethal, knowledge of another person's successful suicide by this method and awareness of the method through media portrayal. Most of the cars used did not have engines fitted with catalytic converters, substantially increasing the risk of toxicity. Regret of the attempt, denial of further suicidal ideation after the event, and the absence of a suicide note were common findings. Most denied excessive time spent planning. The most common diagnosis in this group was adjustment disorder with depressed mood. Suicide intent scores were not high, inconsistent with the majority of patients being aware of the lethality of the method. CONCLUSION: Sociodemographic findings resemble those of psychological autopsy studies of subjects completing suicide by this method. Survival in this group was due to failure of the method or unexpected discovery rather than patient factors. This population described the method as highly acceptable and accessible emphasising the urgent need for reduction of access to this means of suicide in Australia.

Adjustment Disorders↗
PubMed1986

San Diego Suicide Study. II. Substance abuse in young cases.

Fifty-three percent of 133 consecutive young suicides had a principal psychiatric diagnosis of substance abuse. Twenty-four percent had an additional principal diagnosis of atypical depression, atypical psychosis, or adjustment disorder with depression. The relationship of the substance abuse to the additional diagnosis was usually obscure, though this subgroup was similar to the group with only substance abuse on a number of factors. Typically, substance abuse was a chronic condition present for nine years. Multiple substance abuse was the norm in these cases, and marijuana, alcohol, and cocaine were the most frequently abused substances. Substance abusers without other principal diagnoses received psychiatric care less frequently than those with additional principal diagnoses.

Adjustment Disorders↗
PubMed1986

Depression in the hospitalized inpatient with various medical illnesses.

The amount of depressive symptomatology in the medical population is high. Most of the symptomatology is, however, mild and probably represents an adjustment disorder with depression as a result of illness and hospitalization. Routine screening for depression in the hospitalized medically ill patient appears to be useful, given poor physician recognition of not only mild, but severe depressive symptomatology. Affective and cognitive symptoms of depression are the most discriminating for severe depression. Patients with bone and connective tissue disease, gastrointestinal disease, neurological disease, respiratory disease, and cancer appear to be the groups of diseases at greatest risk for serious depression in a tertiary care setting in the United States.

Adjustment Disorders↗