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PubMed2000

Trends in sickness benefits in Great Britain and the contribution of mental disorders.

BACKGROUND: Government benefits paid to those unfit for work or the work market as a result of ill health have been rising dramatically in Great Britain, in parallel with increases throughout Europe and North America. Psychological conditions are known to be an important cause of sickness absence. This study set out to examine trends in government sickness and invalidity benefits in Britain between April 1984 and April 1995. The importance of mental disorders as a cause of 'incapacity' (the condition for which benefits are paid) was examined. METHODS: Data from the Department of Social Security were used to chart trends in incapacity according to gender, age group, employment category and cause. An exploratory ecological analysis of associations between regional rates of incapacity and socio-economic and health indices was also undertaken using correlation analysis and multiple regression. RESULTS: Steadily increasing rates of incapacity were observed, primarily reflecting increases in the longer-term 'invalidity' benefit. The non-employed made up a rising proportion of recipients. Regional incapacity rate was most strongly associated with socio-economic factors, particularly social class. Mental disorders were the second most numerous causal category and consisted mainly of milder conditions, namely depressive and neurotic disorders. CONCLUSION: The dramatic increase in incapacity benefits is unlikely to be attributable to changes in population size or structure. It contrasts with improvements in the objective health status of the population. Mental disorders, and particularly milder conditions, account for a substantial and increasing amount of incapacity. The data are consistent with the hypothesis that sickness benefits increasingly represent disguised unemployment.

Absenteeism↗
PubMed1996

Incidence of mental disorders in the Finnish UKKI Study.

BACKGROUND: The aim was to give estimates of the incidence of different mental disorders from a Finnish prospective epidemiological follow-up study, the UKKI Study. METHOD: The original probability sample consisted of 1000 persons, aged 15-64 years. The baseline survey took place in 1969-71, and follow-up surveys were conducted 5 and 16 years after the baseline survey. The research methods included a personal psychiatric interview and data collection from different registers. The diagnostic system was based on the ICD-8 classification. RESULTS: The estimated annual incidence of all mental disorders was close to 15 per 1000 both between baseline and the 5-year follow-up as well as between the 5-year and the 16-year follow-up. During the entire 16-year follow-up period the annual incidence of all disorders was 14 per 1000 in men and 17 per 1000 in women. The annual income of neurotic disorders was 10 per 1000 in men and 14 per 1000 in women, and that of psychotic disorders 2 per 1000. CONCLUSIONS: In the literature, there are huge differences in the results concerning incidence of mental disorders. The results of the present study were rather close to those of the Swedish Lundby Study, but nowhere near the results of the American ECA Study.

Adolescent↗
PubMed1993

Effects of a community mental health service on the practice and attitudes of general practitioners.

Recent years have seen closer links developing between general practitioners and mental health specialists. A study was undertaken in Manchester to determine the effects of a new community mental health service on the practice and attitudes of general practitioners. Ten doctors had access to the community based psychiatric team over a three year period while another 10 doctors continued to use hospital services. Those with access to the team were significantly more satisfied with the specialist support services, and were more likely to give high priority to community psychiatric nurses and psychiatric social workers working as part of a primary health care team than those without access to the service. Those with access were more willing than those without access to share with psychiatrists the care of patients with chronic neurotic disorders. The community mental health team was considered particularly helpful in reducing the burden posed by patients with neurotic and psychosocial problems, but this resulted in the general practitioners doing less counselling themselves. The study did not find that the new service had an effect on the general practitioners' ability to detect or manage psychiatric illness.

Community Mental Health Services↗
PubMed2001

[Obsessive-compulsive disorder in children induced by streptococcal infection].

FROM OBSESSIVE-COMPULSIVE DISORDER TO PANDAS: Obsessive-compulsive disorder (OCD) represents a potentially severe and handicapping disorder that affects several hundreds of thousands of children in France. OCD has, for many years, been considered as a neurosis resulting from mental conflicts. It is currently seen as a neurobiological disorder, the etiological substratum of which is more organic than mental. Recently a sub-type of OCD was isolated in children following infection by Group A b-hemolytic streptococci. This sub-type has been described as Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS). A NEW PHYSIOPATHOLOGICAL APPROACH: The putative dysimmune relationship between bacterial infection and neurotic disorder has led to the development of an original etiopathogenic model that may lead to new therapeutic strategies. The clinical case report of an adolescent presenting with trichotillomania associated with recurrent pharyngitis is a good illustration of this. PUBLISHED DATA: Data published in medical literature over the last 10 years indicates a 10% prevalence in the young suffering from OCD, i.e. 0.1 to 0.3% of the young population.

Adolescent↗
PubMed1993

[Psychiatric evaluation of patients with neurotic and somatoform disorders within the scope of legal disability pensions].

The problems of the psychiatric expertise of neurotic patients in the field of disability pension in the Federal Republic of Germany are described. Some main ideas for the psychiatric expert are proposed. In consideration of the therapeutic problems, preventive measures should be developed. To prevent a chronic illness, some hints for the treating physician are given. Some research problems are mentioned.

Disability Evaluation↗
PubMed1995

Is early separation anxiety a specific precursor of panic disorder-agoraphobia? A community study.

The present study aimed to examine memories of early separation anxiety symptoms in a community sample of women at heightened risk to neurotic disorder. The chief finding was that subjects with a lifetime history of panic disorder-agoraphobia (PD-Ag) returned statistically higher scores on a retrospective measure of early separation anxiety compared to subjects with either generalized anxiety or other phobic disorders, a result which was not accounted for by differences in neuroticism or General Health Questionnaire scores. Although limited by its retrospective design and the problem of co-morbidity in subclassifying the anxiety disorders, the present study does provide added support for the hypothesis--endorsed by DSM-III-R--that there is a developmental link between early separation anxiety and panic disorder.

Adult↗
PubMedDate not supplied

[Characteristics of motor activity disorders in patients with vertebrogenic lumbosacral pain syndrome].

The study is based on clinical examination of movement disorder in 126 patients (men--103, women--23) with lumbosacral pain syndrome. The authors revealed how statico-dynamic and neurotic disorders had been formed depending on structural peculiarities of primary pathologic process and thus determining different clinical forms. Mechanisms of syndromologic manifestation of suffering in every case were substantiated; own approaches to anatomico-topical diagnostics and objectification of pathology course in dynamic were suggested.

Adult↗
PubMed2001

General practice consultation rates for psychiatric disorders in patients aged 65 and over: prospective cohort study.

OBJECTIVE: To examine consultation rates for psychiatric disorder in general practice among patients aged 65 years and over; and to examine the effect of sociodemographic factors (gender, age, social class and accommodation) on consultation rates. DESIGN: Prospective cohort study. The fourth national survey of morbidity in general practice carried out between September 1991 and August 1992. Sixty volunteer practices in England and Wales took part; study population comprised a 1% sample of the population (502,493 patients). GPs recorded the reasons for all consultations and these were converted into an ICD9 code. Trained fieldworkers collected sociodemographic data on the patients in the survey. METHOD: Psychiatric disorders were categorised by compiling the appropriate ICD9 codes. Annual consultation rates (per 1000 patients) according to psychiatric disorder and sociodemographic factors were calculated after adjustment for differing length of follow-up. RESULTS: Only 4.4% of all consultations were for psychiatric disorders. Women had consultation rates 75% higher than men. Social class had no effects on rates. Consultation rates were highest for neurotic disorders and depression. Those living alone had highest rates for depression, whilst those living in residential and nursing homes had substantially higher consultation rates for dementia and bipolar affective disorder. CONCLUSION: Consultation rates were significantly lower than expected from previous epidemiological studies. This indicates that there is considerable hidden morbidity that is being untreated in primary care. Social class appears to have no effect on consultations for psychiatric disorder in the elderly. The increasing age of the population may result in a significant increase in consultations for dementia, but not for depression or neurosis.

Aged↗
PubMed2005

[Psychiatric disorders and the prognosis for criminal recidivism].

The risk for criminal recidivism of mentally ill offenders is, unlike the general risk of delinquency, not well established. The relationship between psychiatric diagnosis and criminal recidivism was examined in the context of the Munich project on risk assessment. A total of 185 offenders had been examined on the question of culpability between 1992 and 1993. Re-offenses committed before the end of 2001 were recorded according to the Federal Registry of court sentences (Bundeszentralregister); 38.8% of the total group recidivated. High rates of recidivism were observed for individuals with substance abuse (45.5%) and with personality disorders (46.6%). The combination of the two illnesses increased the rate for recidivism to 50%. For individuals with organic, affective and neurotic disorders the rates for recidivism were below the average. Rates of recidivism for schizophrenic offenders were slightly higher, if re-offenses in the state of inculpability were included. The HCR-20 predicted recidivism equally well for offenders with and without a psychiatric diagnosis. In both groups, individuals with HCR-20 scores above the mean recidivated more often and after shorter periods of time.

Crime↗
PubMedDate not supplied

[Psychotherapeutic process in a day hospital: results of a survey and importance of qualitative data].

This survey was carried out in a psychiatric day hospital over three years on all patients admitted. The aim was to assess the patients' state at discharge, and to identify the factors to explain the clinical changes, in particular to evaluate the impact of the various types of therapy proposed. The patients were evaluated when they entered the hospital and at discharge using mainly validated translated English-language questionnaires ("Health Sickness Rating Scale" of Luborsky, "Helping Alliance questionnaire" of Luborsky), but also two instruments developed and validated by our team: "Clinical Evaluation Profile", and the "Commitment Scale". The results provide not only a good description of the patients' state at arrival but also of their evolution. The factors found to be important in the evaluation were similar to those identified in most of previous studies, i.e. the initial severity, and quality of the therapeutic relationship, but we also found that the degree of commitment of the patients to the various therapies offered was important. In addition, we found that, when using the commitment scale in homogeneous subgroups of patients (identified using the CIM 9 diagnostic scale) were examined, the favourable outcome of a given psychotherapeutic approach was dependent on the type of the pathology. Thus, patients with personality disorders and high scores at the commitment scale benefited above all from group therapy. The reverse was found for patients with neurotic disorders. For patients suffering from schizophrenia the most important factor was the commitment to the background milieu of the hospital. These observations are in contradiction with some of the main conclusions (known as the equivalence paradox) from english and american studies over the last 40 years of Psychotherapy Research, which state that all psychotherapies are equivalent, and that the reason why some give successful results, and other do not can, only be by non specific factors (i.e. the quality of the therapeutic bond, patients' motivations, etc.). From our results, if homogeneous subgroups of patients are considered and if we use subjective (commitment to the therapy) instead of hard data (as for example having this type of therapy or an other one, or the length of therapy, ect.), we can distinguish the effect of the various psychotherapeutic approaches at least in a psychiatric institution.

Adult↗
PubMed1993

Clinicians' information habits, patients' knowledge of diagnoses and etiological concepts in four different clinical samples.

A total of 230 psychiatric inpatients and their physicians in charge took part in semistandardized interviews. Patients suffering from schizophrenia received information less frequently and less comprehensively than other patients. The label of schizophrenia was often paraphrased or not communicated at all; patients knew their diagnosis less exactly than other subgroups. Asked to indicate the most important cause of their disorder, neurotics tended to name their living conditions (60%), and addicts preferred to blame themselves (73%). Only 26% of the patients with affective disorders or schizophrenia accepted the idea of their disorders as diseases in a medical sense, whereas the psychiatrists favored a biological concept in more than 90% of the cases. The findings stress the need to improve communication between patients and psychiatrists as regards information on illness and treatment.

Adult↗
PubMed2001

[Prevalence and structure of borderline mental disorders in adolescent groups].

328 schoolchildren and students of 13-17 years of age were examined by clinical epidemiological method. Point prevalence of borderline mental disorders and of their separate clinical forms were compared in two groups: pupils of secondary schools (148 cases) and students of the professional technical schools (PTS) (180 individuals). General prevalence of the borderline mental disorders was equal to 58.2%. It was higher in the group of pupils of secondary schools (66.7%) as compared with PTS students (49.3%). Neurotic disorders were more frequently found in pupils, while pathology of the personality--in PTS students. As the adolescent were of the same age and were under the influence of the same biologic factors (puberty period), the conclusion is made that the main factors in the formation of these differences were related to the social and cultural conditions.

Adaptation, Psychological↗
PubMed1992

Helping patients to think better: cognitive therapy for individuals and couples.

A system of psychotherapy called cognitive therapy, emphasising that mood disorders are affected by distortions in thinking about self, the future and the world, has been found useful in the treatment of diverse neurotic disorders. Helping the patient restructure his thinking by examining such distortions and correcting them would be a vital process in the prevention or recovery of mood disturbances. Applications of cognitive therapy in depression, panic disorder, hypochondriasis and marital distress are described in this article.

Cognitive Behavioral Therapy↗
PubMed1996

Obsessive compulsive disorder--a neuropsychiatric illness.

Until recently, obsessive compulsive disorder (OCD) was thought to be a rare condition. Once viewed predominantly as a manifestation of psychodynamic conflict, OCD is now considered a model neuropsychiatric disorder. While clear differences exist between OCD patients and normal controls, there are more similarities between OCD and Tourette's Syndrome than most other neurotic disorders in neurological signs, electrophysiology and neuropsychology. These include a lack of laterality, bilateral or dominant (left) frontal lobe dysfunction, shortened REM latency in sleep electroencephalogram, shortened latency of N200 and P300 components in visual evoked potentials, abnormal glucose metabolism in the caudate nucleus, and greater ventricle to brain ratios in OCD patients. Neuropharmacological and neuroendocrinological researches have increasingly shown that serotonin plays an important role in the complex aetiology in OCD. Finally, psychopharmacological trials have consistently demonstrated the effectiveness of the selective serotonin reuptake inhibitors in the treatment of OCD.

Diagnosis, Differential↗
PubMed1993

[The characteristics of the social psychological status of patients with chronic ischemic heart disease].

The multifactorial rating scale, interpersonal relation test and methods for examining lifestyle were used to study the psychosocial status of 168 patients with chronic coronary heart disease. As compared with normal psychoemotional persons, the patients with these disorders were found to show a significantly higher degree of their dissatisfaction with occupational and financial status, working conditions, extra-familiar relations. With progressive neurotic disorders, their dissatisfaction with relations at home and work significantly increased and their work motivation decreased. Moreover, psychoemotional disorders were accompanied by higher conflicts with all those present and lower lifestyle.

Affective Symptoms↗
PubMed2002

First-time hospitalisation for depressive and/or anxiety disorders and severe life events.

BACKGROUND: It has been suggested that the impact of antecedent life events differs between first and subsequent episodes of depressive or anxiety disorders. METHOD: We used the Bedford College methodology to determine the presence of severe events and/or major difficulties in two different groups of patients hospitalised for neurotic disorders, and in a control group of healthy subjects from the general population. RESULTS: The experience of severe events and/or major difficulties was significantly higher in patients being hospitalised for the first time than in patients who had been hospitalised several times, or in the control group. This difference was observed for female patients only. CONCLUSIONS: Two hypotheses are put forward as an explanation of these results.

Adult↗