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PubMed1994

Elevated plasma monoamine metabolites in eating disorders.

Mean fasting plasma homovanillic acid (HVA) levels were elevated in females hospitalized with eating disorders (both anorexia and bulimia nervosa) compared with females hospitalized with adjustment disorder. Fasting plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) was elevated in anorectic patients only. Five patients with eating disorder and psychosis had higher values for HVA and MHPG than the remainder of the patients with eating disorder.

Adolescent↗
PubMed2004

Psychosocial distress and need for psychotherapeutic treatment in cancer patients undergoing radiotherapy.

BACKGROUND AND PURPOSE: Empirical investigations examining the need for psychotherapeutic treatment of inpatients in radio-oncology departments are rare. We, therefore, assessed the degree of psychosocial distress of radio-oncology inpatients and their need for psychotherapeutic interventions. PATIENTS AND METHODS: Eighty-seven patients from two radio-oncology wards underwent psychodiagnostic interviews and completed self-rating instruments to determine mental disorders, psychosocial distress, coping strategies and quality of life. Need for psychotherapeutic interventions and treatment motivation were estimated by patients and by a professional. RESULTS: Using ICD-10 criteria, mental and behavioral disorders were diagnosed in 51% of the patients, most of them adjustment disorders. The professional regarded 32.2% of patients as needing psychotherapeutic treatment, compared with 43% of the patients who were motivated to accept at least one of the psychotherapeutic treatments offered. There was a marked discrepancy between the points of view of the patient and the professional, in that, while the professional regarded anxiety as a highly significant predictor of the need for treatment, psychosocial distress played no role in the patients' estimation. CONCLUSIONS: In determining the indication for psychotherapeutic treatment, both objectified psychosocial distress and a patients' subjective treatment expectations should be considered. There is a need to develop screening instruments that integrate both aspects.

Adult↗
PubMed2001

Has there been a decrease in the prevalence of mood disorders in HIV-seropositive individuals since the introduction of combination therapy?

PURPOSE: The aim of this study was to assess the prevalence of current mood disorders in HIV-seropositive patients treated with combined antiretroviral drug therapy including or not protease inhibitors. SUBJECTS AND METHODS: A random sample of 90 subjects consecutively attending, between February 1 and July 31, 1998, the outpatient unit of the Second Department of Infectious Diseases of the 'L. Sacco' Hospital in Milan was assessed by means of the Structured Clinical Interview for DSMIII-R (SCID) and the Zung Self-Rating Depression Scale (ZSDS). RESULTS: Twenty-three-point-three percent of the subjects were classified in CDC stage A, 32.3% in CDC stage B and 44.4% in CDC stage C. A DSMIII-R psychiatric diagnosis of current mood disorder was found in 4.4% of the recruited sample (dysthymia: 2.2%; adjustment disorder with depressed mood: 2.2%). CONCLUSIONS: Direct and indirect effect of new combination therapies, epidemiological changes in social groups affected by HIV and possible modifications in social perception of people with HIV infection may explain, at least in part, the decreased prevalence of current mood disorders observed in our study as compared to prevalence rates reported in the pre-HAART era.

Adult↗
PubMed2002

Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations.

We examined the relationship between comorbidity and first return to work after episodes of work-disabling, nonspecific low back pain (NSLBP). An inception cohort of workers with new episodes of NSLBP was identified from administratively maintained occupational health records. We compared 6-month return-to-work rates between workers with one or more comorbid conditions with those without documented comorbidity. Workers with comorbidity were 1.31 times more likely to remain work disabled than those with uncomplicated NSLBP, after adjusting for age, gender, lifting demands, and company membership (adjusted hazards ratio [HR] = 1.31; 95% confidence interval [CI] 1.12 to 1.52). Concurrent injury (i.e., sprains or strains of the neck, upper extremity, and lower extremity; contusions; and lacerations) had the strongest association (adjusted HR = 1.49; 95% CI, 1.21 to 1.83), followed by musculoskeletal disorders (adjusted HR = 1.13; 95% CI, 0.77 to 1.66). Comorbidities should be routinely evaluated at first visit by occupational health professionals to better manage disability associated with LBP.

Adolescent↗
PubMed2005

National trends in hospitalization of youth with intentional self-inflicted injuries.

OBJECTIVE: The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries. METHOD: Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N=10,831) with a diagnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring inpatient treatment. Overall population-based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, inpatient costs, method of injury, and associated mental disorder diagnoses. RESULTS: The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were increases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%). There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and nonmental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000. CONCLUSIONS: Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders.

Adolescent↗
PubMed1994

[The most frequent depressive disorders. Diagnosis, classification, symptoms and prognosis].

The most frequent depressive disorders--anxiety and panic syndrome, dysthymic (neurotic) illnesses and reactive depressive adjustment disorders--were classified according to the new international codes. It was also explained that theoretical aetiological assessment principles had to be replaced by duration and symptomatology as operational criteria. Further, a table was elaborated for diagnosing depressive syndromes from an intrapsychic, social and somatic standpoint. Epidemiological aspects of both German and international studies were discussed and prognostic factors highlighted.

Cross-Sectional Studies↗
PubMed1993

Anxiety in the older patient: differential diagnosis and treatment.

Anxiety in older patients is more often a symptom of an underlying mental or physical disorder than a primary diagnosis. Its various forms include situational anxiety, adjustment disorder, and phobias. A search for underlying organic causes is important, as age-related diseases, drug side effects, and substance abuse/withdrawal may have etiologic significance. Anxiety may also mask primary psychiatric disorders such as depression or delirium. Therapy requires treating any underlying psychiatric illness and seeking psychosocial intervention for functional causes. If medical therapy is indicated, short-acting benzodiazepines are the first choice, but patients should be followed closely for possible side effects.

Age Factors↗
PubMed2000

[Quality of life of the mentally ill].

Object of this research project was to study the subjective quality of life of psychiatric patients. The vulnerability of 424 out- and inpatients was assessed. The Vulnerability Index, composed of: marital status, income, health, life conditions, occupation, and risk factors in childhood was used. According to their vulnerability, two groups of patients were differentiated: patients with high and low vulnerability. We compared these objective criteria of vulnerability with the subjective quality of life (Q-LES-Q). Quality of life was also compared with diagnosis, severity of illness, and treatment (first contact/long-term contacts). Quality of life of 250 patients was analysed after one year follow up. Patients with a low vulnerability score are more satisfied with 'social relations' than patients with a high vulnerability score. In-patients are more satisfied with 'social relations' than out-patients. Out-patients are more satisfied with their 'physical health', 'subjective feelings', 'leisure time activities', and 'overall life satisfaction' than in-patients. Patients with a mild affective disorder have a better 'life satisfaction' than patients with severe affective disorder. Quality of life of schizophrenics and of patients with anxiety and adjustment disorders has improved significantly after one year.

Adaptation, Psychological↗
PubMed1988

Current status of beta-blocking drugs in the treatment of anxiety disorders.

beta-Adrenoceptor blocking drugs have been used for the treatment of acute stress reactions, adjustment disorders, generalised anxiety, panic disorder and agoraphobia. In general they are effective in these disorders if somatic or autonomic symptoms are prominent but not extreme in degree. Thus, they are of more value for the relatively mild tremor of the anxious violinist in public performance than in the severe shaking noticed during a panic attack. It is most likely that beta-blockers act primarily by blocking peripheral adrenergic beta-receptors; symptoms that are mediated through beta-stimulation, such as tremor and palpitations, are helped most. Improvement is noted within 1 to 2 hours and with relatively low doses (e.g. propranolol 40 mg/day). Some recent studies, however, have suggested that when longer treatment using higher doses (e.g. propranolol 160 mg/day) is given, improvement in other forms of anxiety is noted after several weeks of treatment. beta-blocking drugs are useful adjuncts to existing treatments for anxiety and are likely to enjoy wider use now that benzodiazepines are being avoided due to their dependence risks.

Adrenergic beta-Antagonists↗
PubMed2007

Trends in the inpatient mental health treatment of children and adolescents in US community hospitals between 1990 and 2000.

CONTEXT: Previous work has demonstrated marked changes in inpatient mental health service use by children and adolescents in the 1980s and early 1990s, but more recent, comprehensive, nationally representative data have not been reported. OBJECTIVE: To describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000. DESIGN AND SETTING: Analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationally representative sample of discharges from US community hospitals sponsored by the Agency for Healthcare Research and Quality. PATIENTS: Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder. MAIN OUTCOME MEASURES: Changes in the number and population-based rate of discharges, total inpatient days and average length of stay, charges, diagnoses, dispositions, and patient demographic and hospital characteristics. RESULTS: Although the total number of discharges, population-based discharge rate, and daily charges did not significantly change between 1990 and 2000, the total number of inpatient days and mean charges per visit each fell by approximately one half. Median length of stay declined 63% over the decade from 12.2 days to 4.5 days. Declines in median and mean lengths of stay were observed for most diagnostic categories and remained significant after controlling for changes in background patient and hospital characteristics. Discharge rates for psychotic and mood disorders as well as intentional self-injuries increased while rates for adjustment disorders fell. Discharges to short-term, nursing, and other inpatient facilities declined. CONCLUSIONS: The period between 1990 and 2000 was characterized by a transformation in the length of inpatient mental health treatment for young people. Community hospitals evaluated, treated, and discharged mentally ill children and adolescents far more quickly than 10 years earlier despite higher apparent rates of serious illness and self-harm and fewer transfers to intermediate and inpatient care.

Adolescent↗
PubMed2005

The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients.

BACKGROUND: In geriatric psychiatry assessment scales are often used in clinical praxis in the diagnostic work-up of mental disorders. AIM: To assess whether the state part of the STAI is useful as a case-finding instrument of mental disorders. MATERIALS AND METHOD: Data came from 70 non demented geriatric in-patients in stable clinical condition. Mean age was 83.3 years (range 64-96), and 74.3% were women. The 20-item STAI state instrument was used to measure current anxiety symptoms. Without knowledge of the score on STAI state a psychiatrist examined all patients and set diagnosis according to DSM-IV-TR criteria, but hierarchical rules were not used. Sensitivity, specificity, Likelihood ratio and accuracy were calculated for different cut-points of the mean sumscore on the STAI state. RESULTS: 15.7% of the participants suffered from a mental disorder: GAD = 1, mixed anxiety-depression = 5, depression = 1, dysthymic = 1, adjustment disorder (mixed anxiety-depression) = 1, and personality disorder = 1. The mean STAI sumscore in this group was 56.3 compared with 39.2 in the 59 patients without any psychiatric diagnosis. The optimal cut-off score on the STAI mean sumscore corresponding to the highest accuracy of 0.87 was 55/54 with sensitivity 0.82, specificity 0.88, and LR + 6.8. CONCLUSION: The STAI state scale is a useful instrument for detecting a variety of mental disorders in older people. Further studies should be carried out in different populations.

Aged↗
PubMed1990

Psychiatric aspects of HIV-1 infection and AIDS.

The literature on the psychiatric aspects of HIV-1 infection is reviewed. The whole range of psychiatric disorders described in HIV-1 infected subjects, from HIV-1 dementia to adjustment disorders, is covered, along with the AIDS-related psychopathology which may develop in subjects without HIV-1 infection.

AIDS Dementia Complex↗
PubMed2001

Panic disorder cases in Japanese-Brazilians in Japan: their ethnic and cultural confusion.

The comparatively high salaries made in Japan are attractive to many Japanese-Brazilians. The number of individuals from this ethnic group being treated in Japanese mental hospitals has increased. We hypothesized that Japanese-Brazilian patients with panic disorders adjusted better to Japanese society and culture than those with other mental disorders. The subjects in the present study are 40 Japanese-Brazilian patients undergoing treatment at the Department of Psychiatry at Jichi Medical School, Japan, from May 1990 to September 1998. Patients were divided into a panic disorder group, a schizophrenic group, a mood disorder group and a neurosis group. Demographic data (Japanese language ability, duration of residence in Japan etc.) were collected. A comparison was made among the four groups. Patients in the panic disorder group showed a significant tendency to be fluent speakers of Japanese. Patients in the panic disorder group also had been in Japan for a significantly longer period of time than those in the other three groups. Japanese ability and length of residence in Japan rule out exacerbating factors due to a foreign living environment. Panic disorder patients usually have resolved the problems inherent in living and working in a foreign country. In general, Japanese-Brazilians are more comfortable both financially and socially in Japan than other foreign laborers because of their cultural and family background. The emotional conflict experienced by such patients may result from concern over whether to live in Brazil or Japan in the future. Their ethnic and cultural identity may be confused, fluctuating between identifying with Brazil and with Japan, and this may cause vague feelings of anxiety.

Adult↗
PubMed1993

Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation.

In this longitudinal study, the rates and correlates of suicidal ideation and suicide attempts were determined among outpatient youths with depressive disorders and youths with other psychiatric disorders. At study entry, about 66% of the subjects evidenced suicidal ideation and 9% already attempted suicide. The rate of ideation remained fairly stable over time, whereas the rate of attempts reached 24% by the average age of 17 years. Major depressive and dysthymic disorders were associated with significantly higher rates of suicidal behaviors than were adjustment disorder with depressed mood and nondepressive disorders. In the presence of affective disorders, comorbid conduct and/or substance use disorders further increased the risk of suicide attempts.

Adolescent↗
PubMed2001

Psychiatric comorbidity in pathological gamblers seeking treatment.

OBJECTIVE: The authors' goal was to determine the frequency of psychiatric comorbidity among treatment-seeking pathological gamblers, compare the severity of gambling and psychological problems in gamblers with and without comorbid disorders, and investigate differences between gamblers with and without comorbid disorders in the dopamine D(2) receptor gene (DRD(2)). METHOD: Sixty-nine pathological gamblers who consecutively applied to a specialized outpatient treatment program were evaluated with structured interviews, self-report questionnaires, and psychological scales and were genotyped for a DRD(2) polymorphism. RESULTS: A comorbid psychiatric disorder was present in 43 (62.3%) of the gamblers. The most frequent diagnoses were personality disorders (N=29 [42.0%]), alcohol abuse or dependence (N=23 [33.3%]), and adjustment disorders (N=12 [17.4%]). Gamblers with comorbid psychiatric disorders had gambling scores and psychological scale scores indicating greater severity of gambling and psychopathology. Significant differences in DRD(2) allele distribution were found in gamblers with and without comorbid disorders. CONCLUSIONS: Psychiatric comorbidity is common among pathological gamblers and is associated with greater severity of clinical problems. The DRD(2) gene could be a liability genetic factor for psychiatric comorbidity in pathological gambling.

Comorbidity↗
PubMed2002

Psychosomatic liaison service in medicine - need for psychotherapeutic interventions and their realisation.

QUESTIONS UNDER STUDY: The aim of the study was to evaluate the need for psychotherapeutic interventions and their realisation within the framework of the psychosomatic liaison service. Apart from establishing the diagnosis of psychosocial distress and mental disorders, we assessed the motivation of the patients for psychotherapy. METHODS: 62 consecutive patients admitted to the Department of Medicine (Gastroenterology and Hepatology) Freiburg University Hospital, Freiburg, Germany, underwent standardised psychodiagnostic interviews and completed psychometric self-rating tests to identify mental disorders, psychosocial distress, and motivation for psychotherapy. In addition, the patients' need for psychotherapeutic treatment was rated by the liaison therapist. RESULTS: Using ICD 10-criteria, mental disorders were diagnosed in two thirds of the patients; most frequent were adjustment disorders, affective disorders, and disorders resulting from alcohol use. One third of the patients reported signs of psychological distress; half of them were interested in psychotherapy. A need for psychotherapeutic interventions, based on motivation of the patients and on expert estimate, was found in approximately one third of the patients. 36% received actual psychotherapy. CONCLUSIONS: Our study suggests that - in the patient population studied - the patients' motivation ought to be taken into consideration more strongly when evaluating the need for psychotherapy in clinical practice and further research.

Aged↗
PubMed2006

Self-reported psychopathology, adaptive functioning and sense of coherence, and psychiatric diagnosis among young men--a population-based study.

OBJECTIVE: To study the associations between psychiatric disorders and self-perceived problems among adolescent boys. METHOD: The study population consisted of 2348 Finnish boys born during 1981 attending obligatory military call-up (79.7% of the original sample). At military call-up in 1999, the boys filled in the Young Adult Self-Report (YASR) and Orientation of Life Questionnaire (SOC-13). Information about psychiatric disorders was obtained from the national military register during the years 1999-2004. RESULTS: Most of the psychopathology, adaptive functioning and SOC scales were associated with a variety of psychiatric disorders at follow-up. However, when the effects of scales were controlled in multivariate analysis, only YASR somatic problems and SOC-13 showed an independent association with a wide range of psychiatric disorders at follow-up. Poor SOC-13 predicted anxiety, depression, antisocial personality and substance use disorders. The YASR somatic problems scale predicted anxiety, depression, substance use, psychotic, and adjustment disorders. Self-reported delinquency and poor competence at school predicted substance use and antisocial personality disorders. CONCLUSIONS: Self-reports of poor sense of coherence and somatic complaints have a non-specific association with a wide range of psychiatric disorders. Clinical and theoretical implications of these findings are discussed.

Adaptation, Psychological↗
PubMed2002

Prevalence of insomnia in various psychiatric diagnostic categories.

Sixty percent of 536 new referrals to a psychiatric clinic at a general hospital complained of insomnia. Prevalence was high in all psychiatric categories, especially in physiologic disorders, somatoform disorders and mood disorders, followed by epilepsy. Complaints of difficulty in falling asleep were high in the physiologic and somatoform disorder groups. Complaints of nocturnal awakening were high in the anxiety and physiologic disorder groups, while complaints of early morning awakening were high in the organic and mood disorder groups. Prescription rates of hypnotics was most prevalent in the mood and adjustment disorder groups, whereas a non-pharmacological approach, including psychological education and behavioral therapy, was applied mainly to the physiologic disorder group.

Female↗