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PubMed2001

[Nonorganic hypersomnia: epidemiology, diagnosis, and therapy].

Daytime tiredness and daytime sleepiness are frequent complaints occurring in 29% and 14% of the Austrian population. Epidemiological studies demonstrate a high comorbidity between nonorganic hypersomnia and mental disorders. Especially comorbidity with affective disorders increases steadily from the general population over primary to tertiary care settings. Diagnostic criteria of nonorganic hypersomnia have been described in the International Classification of Diseases (ICD-10). Nonorganic hypersomnia can be primary or associated with a number of psychiatric disorders such as reaction to severe stress or adjustment disorders, affective disorders, other functional disorders, tolerance to or withdrawal of CNS-stimulating substances and chronic use of CNS-sedating substances. Diagnostic procedures comprise case history and symptom evaluation, sleep-specific and supplementary investigations. Concerning the latter, this article will focus on sleep questionnaires, vigilance and psychological tests as well as CNS investigations. Therapy of nonorganic hypersomnia rests on 3 pillars: psychological, somatic and pharmacological treatment. In view of the wide variety of psychiatric causes, resulting in a number of therapeutic options, it seems desirable that apart from subjective clinical assessment also objective methods be used in diagnosis and treatment. On the neurophysiological level objective measures can be obtained by means of EEG mapping during the day and polysomnography at night. Different mental disorder patients show different brain activity patterns as compared with normal controls and different classes of psychotropic substances cause different changes in neurophysiological variables. The fact that the changes in electrophysiological brain activity caused by mental disorders are exactly opposite to those induced by the psychotropic drugs used for their treatment suggests a key-lock principle in the diagnosis and treatment of nonorganic hypersomnia.

Austria↗
PubMedDate not supplied

The psychopathology inventory for mentally retarded adults: factor structure and comparisons between subjects with or without dual diagnosis.

Whether the Psychopathology Inventory for Mentally Retarded Adults (PIMRA) could detect specific psychopathological disorders was investigated in 652 subjects with different levels of mental retardation living in the community or in residential facilities. An exploratory factor analysis was carried out to check the scale organization of PIMRA. The Anxiety, Adjustment Disorder, Somatoform Disorder, and Soundness Scales were confirmed by 4 corresponding factors; the Psychosexual Disorder Scale was replaced by a factor specific to gender identity problems, and the Schizophrenia Scale by two factors concerning isolation and bizarre behaviors, respectively. The items of the Depression Scale were distributed over the three factors concerning anxiety, adjustment, and psychosomatic disorders, while the items of the Personality Disorder Scale were scattered over almost all the factors. Moreover, 55 subjects with anxiety disorders and 49 with depression were compared to 50 control subjects of the same age, intelligence level, and gender ratio but without dual diagnosis and obtained significantly higher factorial scores both on the overall scale and on the factors specifically related to their disorders. PIMRA has been found to show good construct validity. These results could be considered particularly valid as they were obtained from a large sample comprising different levels of mental retardation and thus showing all possible psychopathological behaviors.

Adolescent↗
PubMed2006

Familial autoimmune thyroid disease as a risk factor for regression in children with Autism Spectrum Disorder: a CPEA Study.

A multicenter study of 308 children with Autism Spectrum Disorder (ASD) was conducted through the Collaborative Programs of Excellence in Autism (CPEA), sponsored by the National Institute of Child Health and Human Development, to compare the family history of autoimmune disorders in children with ASD with and without a history of regression. A history of regression was determined from the results of the Autism Diagnostic Interview-Revised (ADI-R). Family history of autoimmune disorders was obtained by telephone interview. Regression was significantly associated with a family history of autoimmune disorders (adjusted OR=1.89; 95% CI: 1.17, 3.10). The only specific autoimmune disorder found to be associated with regression was autoimmune thyroid disease (adjusted OR=2.09; 95% CI: 1.28, 3.41).

Autistic Disorder↗
PubMed1983

The prevalence of psychiatric disorders among cancer patients.

Two hundred fifteen randomly accessed cancer patients who were new admissions to three collaborating cancer centers were examined for the presence of formal psychiatric disorder. Each patient was assessed in a common protocol via a psychiatric interview and standardized psychological tests. The American Psychiatric Association's DSM-III diagnostic system was used in making the diagnoses. Results indicated that 47% of the patients received a DSM-III diagnosis, with 44% being diagnosed as manifesting a clinical syndrome and 3% with personality disorders. Approximately 68% of the psychiatric diagnoses consisted of adjustment disorders, with 13% representing major affective disorders (depression). The remaining diagnoses were split among organic mental disorders (8%), personality disorders (7%), and anxiety disorders (4%). Approximately 85% of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom. The large majority of conditions were judged to represent highly treatable disorders.

Adaptation, Psychological↗
PubMed2004

Attenders of a university hospital psychiatric emergency service in Belgium - general characteristics and gender differences.

OBJECTIVE: The aim of this study was to provide a clinical and epidemiological profile of patients consulting the psychiatric emergency team (PET) of an emergency service of a Belgian university hospital. METHOD: Of all PET patients (N = 1050), demographic characteristics, axis I diagnosis, any axis II diagnosis, presenting problems, psychiatric antecedents, and patterns of referral were assessed. RESULTS: Male patients presented more with hostility or violence towards others (10%) and substance abuse (23%); female patients presented more with suicidality (31%) and depressed mood (24%). Male patients had more psychoactive substance use disorders (21%); female patients had more mood (21%) and adjustment disorders (19%). About 50% of the patients were unemployed and had sought psychiatric help in the past. Female patients were more often referred by the emergency physician (35%) and health care professionals (29 %); male patients were more often self-referred (23%) and referred by the police (9%). CONCLUSION: A PET could overcome the discrepancy between the need of treatment and the effective use of mental health services. Male and female PET patients presented different complaints and were given different axis I diagnoses; they also had different pathways to care.

Adolescent↗
PubMed1991

Psychiatric morbidity following implantation of the automatic implantable cardioverter defibrillator.

The automatic implantable cardioverter defibrillator (AICD) has found a place in the treatment of sustained ventricular tachycardia and in survivors of sudden arrhythmic death. However, little is known about the psychological impact of this device on patients and their families. In a group of 20 AICD recipients, examined between 3 and 21 months post-implantation, the prevalence of psychiatric disorder was 50%. Following implantation, six patients suffered from adjustment disorder; three suffered from major depression; and one developed panic disorder. Psychiatric morbidity in patients was associated with psychopathology in family members, peri-operative AICD shocks, and social support that was perceived to be inadequate.

Adaptation, Psychological↗
PubMed1990

ARIMA modelling of chronospsychometric self-evaluation of drive and mood.

The expanding study of biological rhythms requires the use of refined methods of time series analysis. We propose the use of ARIMA (Autoregressive Integrated Moving Averages) model, a powerful statistical tool of relatively recent development. A group of 5 patients with Affective Disorders (2 bipolars, 3 unipolars) and 1 patient with Adjustment Disorder self-assessed their AS every 8 hours for about a month. The affective state (AS) was estimated for 4 indicators: the two main constructs (Mood and Drive) of the segmented Visual Scale ESTA III and two bipolar items (Anxiety and Drowsiness). Mood and Drive are continuous variables, while Anxiety and Drowsiness are ordinal ones. Strictly speaking, ARIMA modelling is not valid with ordinal data. However, comparison of models of the two kinds of variables reveals no significant differences. This points out to a certain robustness of the method. Most of the series were non-stationary but could be transformed taking no more than two differences. The models made a very good fit of the data. Statistically significant coefficients on different lags may indicate the presence of circadian and infradian periodicities in the series. Further applications of ARIMA models to biological and psychological rhythmometry may be quite useful.

Adult↗
PubMedDate not supplied

Use of health services, mental illness, and self-rated disability and health in medical inpatients.

OBJECTIVE: The primary objective of this study was to investigate if among medical inpatients their health service use was associated with 1) presence and type of mental disorders, 2) emotional distress and somatization, 3) self-rated physical disability and health. METHOD: Health service use (number of admissions to nonpsychiatric departments and reimbursement of primary care services) as well as psychological distress (SCL-8D) and somatization (Whiteley-7) was assessed for 294 consecutive medical inpatients. Patients rated their own health and physical functioning, and medical consultants assessed them for chronic and life-threatening diseases. A subsample of 157 patients was assessed for ICD-10 psychiatric diagnoses by means of an extensive semistructured interview (SCAN). RESULTS: High use (above 80th percentile) of inpatient admissions was statistically significantly associated to mental disorders (adjusted OR = 3.6 [95%CI, 1.3-9.7]), to anxiety and/or depression, somatoform disorders, chronic and life-threatening physical disease, severe (self-rated) physical disability, and SCL-8 and Whiteley-7 scores. High use of primary care was statistically significantly associated to mental disorders (OR = 3.4 [95%CI, 1.5-8.0]), to anxiety and/or depression, somatoform disorders, moderate or severe (self-rated) physical disability, fair, poor or very poor (self-rated) health, and the Whiteley-7 score. The SCL-8D score was significant in men only. CONCLUSION: Mentally disordered medical inpatients use health care more heavily than patients without, also after adjustment for medical disease severity. Use is closely associated to the Whiteley-7 and the SCL-8D.

Adolescent↗
PubMed1995

Is treatment in groups a useful alternative for psychiatry in low-income countries? An evaluation of a psychiatric outpatient unit in Nicaragua.

Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight-oriented group psychotherapy, psycho-educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1-year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM-III-R plus the Structural Clinical Interview for DSM-III Disorders. A 1-year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive-compulsive, passive-aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.

Activities of Daily Living↗
PubMed2004

Patient satisfaction with outpatient psychiatric treatment: the role of diagnosis, pharmacotherapy, and perceived therapeutic change.

OBJECTIVE: To investigate the influence of diagnosis, type of treatment, and perceived therapeutic change on patient satisfaction following psychiatric treatment for nonpsychotic, nonsubstance-related disorders. METHOD: We mailed questionnaires, including Larsen's Client Satisfaction Questionnaire and Grawe's Bern Inventory of Treatment Goals, to outpatients who had undergone 8 or more therapy sessions 1 year following treatment. RESULTS: Patients with somatoform, eating, and personality disorders were less satisfied than patients with affective, anxiety, and adjustment disorders. Symptom reduction and changes in the interpersonal domain were important outcomes associated with patient satisfaction. Although pharmacotherapy itself was not related to patient satisfaction, patients who perceived improvements in pharmacotherapy as one of the most important treatment outcomes were less satisfied than others. Preliminary evidence shows that coping with specific problems and symptoms is associated with satisfaction among male patients, whereas changes in the interpersonal domain seem to produce satisfaction among female patients. CONCLUSION: Patient-reported change and diagnostic category appear to play a relevant role in generating patient satisfaction. Further research is needed to clarify the interactions between sex, perceived outcome, and satisfaction.

Adult↗
PubMed2004

Depression and its 6-month course in untreated hemodialysis patients: a preliminary prospective follow-up study in Turkey.

The major goal of this study is to assess the frequency of psychiatric disorders in end-stage renal disease (ESRD) patients, who were on hemodialysis (HD) treatment in Turkey. Additionally, it aims to determine whether depression, anxiety, and functional and occupational levels of patients who did not receive any psychiatric treatments change at the end of 6 months. We conducted Structured Clinical Interview for the DSM-IV, Clinical Version on 50 HD patients, and 16 (32%) fulfilled the criteria for a psychiatric disorder. Depressive disorder, not otherwise specified, was observed in 12 (24%) patients. Adjustment disorder with depressed mood and dysthymic disorder were observed in 8% of our population. Fourteen patients were followed up for 6 months. All patients were assessed with Hamilton Depression (HDRS), Anxiety Rating Scale (HARS), and Global Assessment of Functioning (GAF) at baseline and at 6 months. The comparisons of baseline and 6 months HDRS, HARS, and GAF scale scores did not reveal any statistically significant differences in 14 depressed patients. The level of depression, anxiety, and functional and occupational impairment did not remit spontaneously in our untreated depressed HD patients. We believe that further studies regarding categorization, prognosis, and treatment of these patients are needed to better understand what to do when we encounter depressive ESRD patients.

Activities of Daily Living↗
PubMed1990

Underdiagnosis of psychoactive-substance-induced organic mental disorders in emergency psychiatry.

The tendency of emergency psychiatrists to make alcohol- and drug-related diagnoses was examined before and after the addition of a standardized psychoactive substance use questionnaire. The addition of the questionnaire resulted in a significant increase in the number of psychoactive-substance-induced organic mental disorder (substance-induced disorder) diagnoses. The questionnaire selectively increased the recognition of nonalcoholic substance-induced disorders while not significantly increasing the diagnoses of alcohol-induced disorders when alcohol was used alone. This suggests that nonalcoholic substance-induced disorders are underdiagnosed in emergency psychiatry. With the increase in the diagnoses of substance-induced disorders, there was a significant decrease in the frequency of psychotic disorder diagnoses and a significant increase in the frequency of adjustment disorder diagnoses. The clinical impact of underdiagnosing and misdiagnosing substance-induced disorders is discussed. Overall, the findings suggest that an increased awareness of substance use history, by the use of a standardized questionnaire, is an effective means of increasing the diagnostic yield of substance-induced disorders in the psychiatric emergency room. Follow-up studies using urine drug screening are recommended.

Diagnosis, Differential↗
PubMedDate not supplied

Inpatient child and adolescent psychiatric referrals in Saudi Arabia: clinical profiles and treatment.

A retrospective review was made of the case records of inpatients referred to the psychiatric consultation-liaison service of King Khalid University Hospital, Saudi Arabia over a 6-year period. For the 109 patients under 18 years old, the study noted both the medical or surgical diseases diagnosed as well as psychiatric disorders and the treatment approaches used by psychiatrists. Depressive and adjustment disorders were the most often diagnosed psychiatric illnesses. The most common medical diagnoses were epilepsy, drug overdose, ambiguous genitalia, orthopaedic injuries and diabetes mellitus. Young people with these medical problems are in real need of psychological assessment and intervention.

Adolescent↗
PubMed1999

Variations in CSF monoamine metabolites according to the season of birth.

The cerebrospinal fluid (CSF) concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) as well as their ratios and correlations were analyzed in relation to the season of birth. The sample consisted of 241 drug-free patients participating in psychobiological programs and comprising the DSM-III-R diagnoses of mood, anxiety and adjustment disorders. Significant season-of-birth variations were found even after adjusting for sex, age, height, the diagnostic category and the month of lumbar puncture. Those born during February to April had significantly lower values of 5-HIAA. Values of HVA and of the ratios HVA/5-HIAA and HVA/MHPG were significantly higher for those born during October to January. Correlation coefficients also showed season-of-birth variations. These results may provide an important link for the season-of-birth variations reported for several neuropsychiatric disorders.

Adult↗
PubMed2006

How do we interpret the answer "Neither" when physicians ask patients with cancer "Are you depressed or not?".

OBJECTIVES: The aim of this study was to clarify how physicians should interpret the answer "neither" to the single-question interview, "Are you depressed or not?" PATIENTS AND METHODS: Two hundred fifty-one patients with cancer were studied. The patients were directly interviewed, choosing one answer among these three: "Yes, I am depressed"; "No, I am not depressed"; or "Neither." After this, the patients completed the Hospital Anxiety and Depression Scale (HADS). The threshold of 11 or greater on HADS was used for adjustment disorder and major depressive disorder. RESULTS: All patients could reply to the single question, but 10 patients did not complete HADS. Among 83, 81 and 77 patients who answered "yes," "neither," and "no," respectively, 75 (90%), 43 (65%), and 9 (12%) patients scored 11 or more on HADS. The mean score of HADS was 12.2 in patients who answered "neither," significantly higher than that of the "no" group (p < 0.0001) and significantly lower than that of the "yes" group (p < 0.0001). CONCLUSION: Patients who answered "neither" frequently scored in a high enough range to warrant further investigation for adjustment or depressive disorder.

Adolescent↗
PubMed1991

Mental disorders in adolescent suicide. DSM-III-R axes I and II diagnoses in suicides among 13- to 19-year-olds in Finland.

The prevalence of mental disorders (DSM-III-R Axes I and II) among adolescent suicide victims (n = 53) was investigated in a nationwide psychological autopsy study in Finland. The data were collected comprehensively through interviews of the victims' relatives and attending health care personnel and from official records. Following independent assessment by two psychiatrists, the DSM-III-R diagnoses were assigned in consensus meetings. A large majority of the victims (94%) suffered from a mental disorder. The most prevalent disorders were depressive disorders (51%) and alcohol abuse or dependence (26%). The prevalence of adjustment disorders (21%) was higher than in most studies from other countries. Personality disorder was diagnosed in 32% of the cases. Comorbidity was found in 51% of the victims. The results indicate a strong relatedness between adolescent suicide and the presence of depression, antisocial behavior, and alcohol abuse.

Adolescent↗
PubMed1998

Persistent pain and well-being: a World Health Organization Study in Primary Care.

CONTEXT: There is little information on the extent of persistent pain across cultures. Even though pain is a common reason for seeking health care, information on the frequency and impacts of persistent pain among primary care patients is inadequate. OBJECTIVE: To assess the prevalence and impact of persistent pain among primary care patients. DESIGN AND SETTING: Survey data were collected from representative samples of primary care patients as part of the World Health Organization Collaborative Study of Psychological Problems in General Health Care, conducted in 15 centers in Asia, Africa, Europe, and the Americas. PARTICIPANTS: Consecutive primary care attendees between the age of majority (typically 18 years) and 65 years were screened (n = 25 916) and stratified random samples interviewed (n = 5438). MAIN OUTCOME MEASURES: Persistent pain, defined as pain present most of the time for a period of 6 months or more during the prior year, and psychological illness were assessed by the Composite International Diagnostic Interview. Disability was assessed by the Groningen Social Disability Schedule and by activity-limitation days in the prior month. RESULTS: Across all 15 centers, 22% of primary care patients reported persistent pain, but there was wide variation in prevalence rates across centers (range, 5.5%-33.0%). Relative to patients without persistent pain, pain sufferers were more likely to have an anxiety or depressive disorder (adjusted odds ratio [OR], 4.14; 95% confidence interval [CI], 3.52-4.86), to experience significant activity limitations (adjusted OR, 1.63; 95% CI, 1.41 -1.89), and to have unfavorable health perceptions (adjusted OR, 1.26; 95% CI, 1.07-1.49). The relationship between psychological disorder and persistent pain was observed in every center, while the relationship between disability and persistent pain was inconsistent across centers. CONCLUSIONS: Persistent pain was a commonly reported health problem among primary care patients and was consistently associated with psychological illness across centers. Large variation in frequency and the inconsistent relationship between persistent pain and disability across centers suggests caution in drawing conclusions about the role of culture in shaping responses to persistent pain when comparisons are based on patient samples drawn from a limited number of health care settings in each culture.

Adult↗
PubMed2004

[Comorbidity of mental and internal medical disorders in inpatients treated at the clinic for technical orthopedics].

Due to the severity of their clinical picture and their shattered sense of physical inviolability that almost always is associated with their condition as well as their changed physical appearance, inpatients being treated at the clinic for technical orthopedics frequently exhibit comorbid mental disorders. This article examines these mental health comorbidities. The proportion of adjustment disorders in this group was shown to be noticeably higher than in a comparative group of outpatients attending a psychosomatic/psychotherapeutic clinic. Furthermore, diabetes mellitus proved to be another statistically significant organic comorbidity in the patients treated at the clinic for technical orthopedics. This article discusses the extent to which the chronicity of this disease affects the psychosomatic diagnoses but also the course of the treatment in the clinic for technical orthopedics. In conclusion, this article emphasizes the need for close interdisciplinary management for this highly selected patient group because of the high rates of comorbidity.

Chi-Square Distribution↗