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PubMed1993

The problem of coping as a reason for psychiatric consultation.

To examine those patients referred to psychiatry for the "problem of coping," a structured clinical databased management system--MICRO-CARES--was employed to identify the frequency, demographic characteristics, psychiatric diagnoses, psychosocial interventions, use of psychopharmacology, number of follow-up visits, and discharge placement of these referrals. Consultations totaling 1,157 from July 1, 1988 through January 1, 1990 were divided into two groups and compared: "Not coping" (N = 456, 28.5%) and "others" (N = 701, 61%). Those with a "problem in coping" more often had no Axis I diagnosis (p = 0.001), or were described as adjustment disorders (p = 0.0001). Fewer recommendations were made for those with a coping problem, although lag time (admission date to request for consultation), number of follow-ups, and discharge placement were not significantly different between the two groups. Stepwise logistic regression analyses revealed that the aged had lesser risk for being referred with a coping problem; those who were white, had their own income, experienced greater stress prior to hospitalization (Axis IV), and had higher functioning during the last year (Axis V) were at greater risk.

Adaptation, Psychological↗
PubMed1989

A survey of deliberate self-poisoning.

Over a 12-month period in 1985-1986, 325 cases of deliberate self-poisoning were admitted to the Princess Alexandra Hospital in Brisbane. This survey confirms that deliberate self-poisoning remains common, accounting for 19.6% of all admissions to the intensive-care unit, and 5.4% of all medical-ward admissions. In 232 (71.4%) cases formal psychiatric consultation occurred, and some form of follow-up was organized in 227 (69.8%) cases. In the total group, the female-to-male ratio was 1.5 to one. In the 325 cases, a total of 489 substances was consumed. Benzodiazepine agents were consumed the most often (39.5% of all substances), followed by antidepressant drugs (11.7% of substances) and paracetamol (7.2% of substances). Barbiturate drugs, which previously have been shown to be prominent in deliberate self-poisoning, accounted for only 1.6% of the substances that were used in this survey. Alcohol was consumed in almost one-third (31.1%) of cases. The diagnosis of adjustment disorder with depressed mood was the most-frequent primary diagnosis (64.8% of diagnosed cases), followed by personality disorder (16.7% of diagnosed cases), schizophrenia (5.5% of diagnosed cases) and major depression (3.7% of diagnosed cases). Nearly one-half (46.8%) of all cases involved a past history of deliberate self-poisoning. Comparison of the results of this survey with those of past surveys shows that the profile of deliberate self-poisoning is changing. Barbiturate usage has declined markedly with a reciprocal increase in benzodiazepine usage. A review of the prescribing pattern of antidepressant agents in groups of individuals who are at high risk of deliberate self-poisoning is suggested in the light of the frequency of this phenomenon.

Adjustment Disorders↗
PubMed1989

First admission young adult patients to a state hospital: relative risk for rapid readmission.

High readmission rates by young adult patients to state hospitals represents a major service utilization problem for the public mental health system. By identifying those patients who have an increase risk for rapid readmission, effective community-based services could be developed to help reduce utilization of costly hospital services. A nonconcurrent prospective study of 210 first admission young adult patients admitted to a state hospital was conducted to ascertain the incidence of readmission within 180 days of discharge from the index admission (rapid readmission), and to establish relative risk for rapid readmission based on demographic, hospital utilization, and diagnostic variables. The cohort was partitioned into two subgroups: patients with no prior hospitalization, (NPH; N = 119), and patients with prior hospitalization, (PH; N = 91). Group comparisons revealed NPH patients had a lower readmission rate, had shorter hospital lengths of stay, and had a higher proportion on patients with personality or adjustment disorders. The relative risk for rapid readmission in the NPH patient group was greatest for nonwhite female patients (3.30) and for patients who had hospital length of stays between 4-15 days (1.76). In the PH patient group, the relative risk for rapid readmission was greatest for those patients with hospital length of stay less than 15 days (2.15). In both groups, patients with major mental illness were more likely to get readmitted. An association between hospital occupancy rate, the time of discharge from the index admission and readmission to the hospital, hospital length of stay, sex, race, or diagnostic category was not found.

Adjustment Disorders↗
PubMed1997

[Violence in partnership of immigrant women from Turkey].

Forty-one female immigrants from Turkey, who were victims of violence in their relationships and diagnosed with "reaction to severe stress and adjustment disorders" (F43, ICD-10) were compared with a controle-group of the same origin, sex, age and diagnosis who had not suffered from such violence. The frequency of emergency treatment and suicide attempts (in the last month before the first consultation) of the victims of violence were higher than in the controle-group. The victims of violence less frequently live in large families and were more often employed than the controle-group. The duration of time until the immigration of the partner was significantly higher in the group of victims than in the controle-group. The results are discussed with regard to studies concerning other ethnic groups and specific aspects of psychodynamics and migration.

Adjustment Disorders↗
PubMedDate not supplied

Screening for depressive symptoms in the acute phase of stroke.

Depressive symptoms can often be observed after stroke. We prospectively evaluated patients at a stroke unit in order to determine the occurrence and severity of depressive symptoms in the acute phase of stroke in 82 patients 7 +/- 2 days after admission to the stroke unit. Severity of stroke was evaluated by the Scandinavian and Orgogozo scales and the Barthel index. Severity of depressive symptoms was measured by the 13-item Beck scale. Mean age of the patients was 65.8 years. No gender difference was observed in the severity of stroke or depressive symptoms. DSM-IV criteria of adjustment disorder with depressed mood were fulfilled by 27% of the patients. In this group, stroke was significantly more severe by the Barthel, Orgogozo, and Scandinavian scales (p < 0.001). Whereas Beck score was at least 10 in 19.5%, severe depressive symptoms (Beck score > or = 15) occurred in less than 5% of patients with acute stroke. Those who could not walk by themselves or who were aphasic had significantly higher mean Beck scores (6.3 +/- 5.1 vs 2.4 +/- 3.1, p < 0.001, and 7.0 +/- 5.8 vs 3.4 +/- 3.9, p = 0.002). Significant correlation was found between the severity of stroke and that of the depressive symptoms (r = -0.56, -0.58, and -0.54 for the Scandinavian, Orgogozo, and Barthel scales, p < 0.001).

Activities of Daily Living↗
PubMed2005

Remote psychotherapy for terminally ill cancer patients.

We conducted a feasibility study of remote psychotherapy in 10 terminally ill cancer patients with diagnoses of adjustment disorder or major depression. Subjects received six sessions of individual cognitive therapy with the same therapist. Sessions alternated between face-to-face sessions and remote sessions delivered by analogue videophone. After each therapy session, a brief questionnaire was used to evaluate the subjects' level of satisfaction with the session, sense of connectedness to the therapist and overall progress being made in the therapy. Nine patients completed the study. Of 53 completed therapy sessions, 21 were by videophone and 32 were conducted face to face. Participants reported strong positive perceptions and acceptance after almost all therapy sessions, regardless of service delivery mode. The study suggests that there may be a role for the delivery of psychotherapy using low-bandwidth videophones.

Adjustment Disorders↗
PubMed1984

Thyroid stimulation test in healthy subjects and psychiatric patients.

Fifteen healthy women and 64 female psychiatric inpatients (major depression: 17, schizophrenia: 24, alcohol dependence: 9, and adjustment disorder: 14 cases) without identifiable thyroid dysfunction were investigated with the TRH test under comparable circumstances. Although all patient groups showed some tendency toward lower baseline TSH and smaller TRH-induced TSH responses, only patients with major depression demonstrated marked, statistically significant differences from controls in both variables. Women with alcohol dependence (in the early withdrawal period) showed significantly decreased TSH responses to TRH but only a weak tendency to lower basal TSH levels. Intergroup differences in the TSH response remained significant after correction for basal TSH by analysis of covariance. Neither variables correlated significantly with age, weight or body height, but baseline TSH correlated with body surface. The TRH test, using only 0.2 mg TRH for stimulation, seemed to be useful for identifying major depression and showed that early withdrawal from alcohol may be a factor to be considered in similar studies.

Adjustment Disorders↗
PubMed1997

The orofacial cancer patient's support from the general practitioner, hospital teams, family, and friends.

BACKGROUND: After the diagnosis of cancer, about a third of patients have adjustment disorders. Of recently diagnosed patients, 5 to 15% experience serious psychological disturbances, but their distress is often undetected and untreated. Little attention has been directed to the patients' sources of support and their adequacy. METHODS: This study assessed a defined group (n = 49) of cancer patients' ratings of the support they received from general practitioners, hospital teams, family, and friends. Additional information was collected on the patients' interest in receiving further hospital services and their psychological morbidity (i.e., anxiety and depression). RESULTS: The results show wide variation in patients' perceptions of the helpfulness of the primary and secondary care teams, raising concern about the levels of help and support available to some cancer patients. CONCLUSIONS: Although this sample rated the help received from the hospital very highly, those patients who requested more information from the hospital sector showed little evidence of having had their general anxiety "buffered" by involvement of family members.

Adjustment Disorders↗
PubMed1985

TRH-induced hormonal responses: the effect of pizotifene and naloxone.

We examined the effects of the serotonin antagonist pizotifene (4 mg daily for 3 days orally), and the opiate antagonist naloxone-HCI (0.8 mg intravenously) on the TRH-induced thyrotropin (TSH), growth hormone (GH), and prolactin (PRL) response in female psychiatric inpatients with adjustment disorder or alcohol abuse. All the patients were free from interfering endocrine and metabolic illness and had not received major psychotropic medication before the investigation. Pizotifene caused a small but significant decrease of the TRH-induced TSH response in 8 patients, two of them changed their responses from normal (i.e. above 5 mU/l) to blunted. Neither GH nor PRL changed significantly after pizotifene. Naloxone-HCI, 30 min before the TRH challenge, did not produce any significant change in the TSH, GH or PRL responses, nor did it cause any significant change in the plasma level of these hormones by itself. The hormonal responses to TRH remained unaltered in ten other patients who had repeated tests without any drug treatment between the two occasions. The results suggest that serotonin deficiency may play a role in the blunted TSH response to TRH, while opiate mechanisms do not appear to have a primary influence on these endocrine effects of TRH.

Adjustment Disorders↗
PubMed1990

Loss, stress, and mental health.

1. The loss of an attachment to a loved person or of some other significant attachment leads to a prolonged period of distress and disability. 2. The upset feelings are usually associated with reduction in cognitive effectiveness and problem-solving capacity, the magnitude of which is dependent on the intensity and duration of emotional arousal. There is a reduced capacity for collecting and processing information and for access to relevant memories that associate significant meaning to perceptions. There is also a deterioration in the clarity of the person's self-concept and in his capacity to assess his ability to persevere in the face of discomfort, which weakens his will to struggle. 3. The disability following loss of an attachment is the product of three interlocking factors: (a) the pain of the rupture in the bond and the agony of coming to terms with this reality, (b) the handicapping privation of the missing assets previously derived from the lost person or resource, and (c) the cognitive erosion and reduction in problem-solving capacities and of the will to persevere. 4. These factors may lead to poor mental health in the form of an acute adjustment disorder, or else of chronic psychopathology if the individual uses maladaptive ways of trying to escape his burdens through alienation from reality or through the irrational mechanisms of psychoneurotic symptoms, or if prolonged emotional tension leads to malfunctioning of a bodily system. On the other hand, if the individual masters his problems by working out ways of effective coping, he may emerge from the experience with increased competence and resilience. 5. Eventual mastery of the burdensome experience involves reorganization of the individual's "assumptive world," namely of his intrapsychic maps of external reality and his internal system for guiding and motivating his behavior, which have been disorganized by the loss of their anchorage in the ruptured attachment. 6. This reorganization is helped by the following: a. The maintenance of hope of eventual personal mastery that provides a basis for continued striving. b. Regular activity through adhering to a daily schedule of work and social interaction, even though this initially provides little emotional satisfaction and seems empty and meaningless. c. Seeking support from other people in compensating for current deficits and in helping lower the intensity of emotional arousal. d. Repeatedly remembering the values and guidance the person used to derive from the old attachments.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed1982

[Studies on the occupational maladjustment syndrome. With reference to the survey of examinations, etiological factors and treatment].

A survey of medical examinations has been made on occupational maladjustment syndrome (O.M.A.S.). We have examined and treated on 358 patients with O.M.A.S. during the past 10-15 years at two clinics; one was a company's clinic (this company has 15,000 employees) and the other was the clinic at the Dept. of Mental Health, Osaka Prefectural Institute of Public Health during the past 15 years. Discussions have been made on 150 patients whom we directly treated. Our 358 subjects having O.M.A.S. do not include those with secondary O.M.A. resulting from psychosis, depression, neurosis and physical impairment. From that reason, our subjects are categorized in a narrow sense, in a category which may be called as "adjustment disorder." The results are summarized as follows. 1. The patients with O.M.A.S. were found almost in males and most commonly found among patients in the twenties. 2. The average rate of patients with O.M.A.S. among all the patients who visited two clinics, was 4.1% at our clinic and 16.7% at the company's clinic. 3. At our clinic, the number of patients with O.M.A.S. was followed by the number of those with neurosis, schizophrenia and manic-depressive psychotic zone. This trend was also the same at the company's clinic. 4. As the cause of O.M.A.S., we found the following occupational factors; firstly, transposition by selective promotion, secondly, complication of job-quality, and thirdly, promotion to middle management position. As to personal factors, i.e. as to characteristic individual personality we found mostly rigid and serious trait, next immaturity and egotism, and timidity and nervousness. 5. The relation between the occupational and individual factors was examined from the psychodynamic point of view. From the result, O.M.A.S. was classified into 5 groups which consisted of the core group, dropout group, special job maladjustment group, transient reaction group and others. 6. In conclusion of the above mentioned data, the authors emphasize that it is important to explain and advise by the therapists not only for patients and their families, but also for their colleagues or superiors in their working place.

Adjustment Disorders↗
PubMed1997

Test-retest reliability of maternal reports of lifetime mental disorders in their children.

This study examined the test-retest reliability of maternal reports of lifetime psychopathology using DSM-III-R criteria in nonreferred offspring. Sixty-three mothers reported on 79 children, ages 6 to 18 years. Retest intervals were between one and 12 months. The results indicated acceptable reliability for all supraordinate categories (any disorder, any anxiety disorder, any disruptive disorder, externalizing disorders, internalizing disorders) as well as for most individual diagnoses (separation anxiety disorder, simple phobias, oppositional defiant disorder, attention deficit disorder with and without hyperactivity, simple phobias, and adjustment disorder). Maternal reports for any diagnosis were significantly better for intervals under 6 months than for longer retest intervals. Reliability of maternal reports was not significantly affected by child's age or gender. This study supports the expectation that a history of psychiatric disturbance in children can be obtained reliably from mothers.

Adolescent↗
PubMedDate not supplied

Psychiatric disorders among parents of children suffering from acute lymphoblastic leukemia.

The aim of the study was to assess the frequency and likely associations of psychiatric disorders in parents of children suffering from acute lymphoblastic leukemia (ALL). One parent each of 30 consecutive ALL patients who achieved their first remission were interviewed and rated on the Comprehensive Psychopathological Rating Scale. Ratings were also made on the Hamilton Depression Rating Scale and the State Trait Anxiety Inventory. Fifty percent (n = 15) of the parents had psychiatric disorders, namely neurotic depression (n = 11, 36.7%) and adjustment disorder with depressed mood (n = 4, 13.3%). These disorders were of mild to moderate severity and were perceived to be highly treatable. Psychiatric morbidity was associated with women and unemployment. A score of 14 on the Hamilton Depression Rating Scale provided a reliable cutoff for selection of subjects for referral.

Adult↗
PubMed2005

Hospital admission in adolescents with acute psychiatric disorder: how long should it be?

OBJECTIVE: To determine the length of stay in hospital for youth with acute psychiatric illness, and the treatment outcome. METHODS: Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) psychiatric diagnosis, clinical outcome and the length of stay were systematically gathered for admissions over an 18 month period at the Christchurch Youth Inpatient Unit (YIU). Clinical outcome data were collected at admission, 3 weeks after admission and at discharge, using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). The length of stay was determined retrospectively. Discharge was decided on clinical grounds. RESULTS: During the 18 months of the investigation, 72 subjects were admitted for the treatment of acute mental illness. The most common diagnostic category was mood disorder (n=39, 54%), followed by anxiety or adjustment disorder (n=18, 25%), and major psychosis (n=15, 21%). The mean length of admission for the whole population was 27.3 days, 23.7 days for mood disorders, 18.9 days for anxiety disorders and 46.9 days for the major psychosis diagnostic groups. According to HoNOSCA clinician ratings, the major portion of the improvement occurred during the first 3 weeks of admission. CONCLUSIONS: For the majority of youth with acute psychiatric illness, a relatively short stay in hospital is feasible, because most health gains tend to occur early during an admission.

Acute Disease↗
PubMed1998

Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit.

OBJECTIVE: To compare psychiatric diagnoses of hospitalized adolescents who (a) have made previous but no recent suicide attempts, (b) have recently made their first suicide attempt, (c) have recently made a second or subsequent attempt, or (d) have never made an attempt. METHOD: Semistructured psychiatric diagnostic interviews were used to determine psychiatric diagnoses and history of recent and previous suicidal behavior of 269 consecutively admitted adolescents to an inpatient psychiatric facility. Forty-nine previously suicidal youths, 28 first-time attempters, and 33 repeat attempters were compared with 159 nonsuicidal youths in prevalence of Axis I psychiatric disorders and psychiatric comorbidity with affective disorder. RESULTS: Previous attempters and repeat attempters both reported more affective disorders, whereas first-time attempters reported more adjustment disorders than nonsuicidal youths. Previous attempters and nonsuicidal youths reported the most externalizing disorders. CONCLUSIONS: Previous attempters on an inpatient unit have multiple psychiatric problems. Like repeat attempters, they often are depressed, but like nonsuicidal youths, they also exhibit significant externalizing behaviors. Interventions with these adolescents should focus not only on immediate presenting problems, but also on ameliorating their long-term risk of posthospitalization suicidal behavior.

Adolescent↗
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↗
PubMedDate not supplied

The impact of psychiatric diagnosis on length of stay in a university medical center in the managed care era.

Inpatient use data were examined for fiscal years 1999-2001. Patients with and without psychiatric diagnoses were compared for length of hospital stay and complexity of illness. Patients with psychiatric disorders represented 33%-35% of total cases. Substance use (9,824 cases), mood disorders (2,524 cases), and cognitive disorders (2,362 cases) were the most common psychiatric illnesses. Patients with substance use disorders or no psychiatric diagnosis had the shortest adjusted length of stay, whereas the small number with adjustment disorders (N=147) had the longest. Other psychiatric patients had lengths of stay between these extremes. Excepting substance use disorders, increased lengths of stay with psychiatric comorbidity have persisted into the managed care era.

Academic Medical Centers↗
PubMed1982

A naturalistic assessment of partial-hospital treatment.

Three hundred fifty-eight consecutive admissions to 13 partial hospitals were evaluated over an 8-month period. The design of the study focused on an unobstrusive measurement process involving clinical judgment of outcome. Analyses revealed that the clinical judgment process generated data which were both reliable and valid. The results of the study indicate that partial-hospital treatment is most effective for chronic and acute schizophrenic conditions, paranoid schizophrenia, and affective disorders and least so far patients diagnosed as adjustment disorders. Patients in the organic and neurotic diagnostic categories tended to remain stable. As in previous research, the pretreatment levels of the dependent variables were the best predictors of improvement, but the present study also reveals that progressive amounts of partial-hospital treatment lead to a greater improvement in patient functioning.

Analysis of Variance↗