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PubMed1991

Psychiatric disorders in persons with Down syndrome.

This study was designed to provide information on the prevalence and nature of psychiatric disorders in 497 individuals with Down syndrome. There were 261 patients under 20 years of age and 164 patients 20 years and older, with both groups followed as outpatients, and 72 residents from a state school. The overall frequency of psychiatric disorders in our study population was 22.1%. Patients under 20 years of age often displayed disruptive behaviors, anxiety disorders, and repetitive behaviors. Individuals with Down syndrome 20 years and older who were followed as outpatients more often exhibited major depressive disorders and state school residents were found to have an increased prevalence of dementia.

Adolescent↗
PubMed1990

Personality disorder and psychiatric illness in general practice.

In a one-year prevalence study of conspicuous psychiatric morbidity in two group general practices, one urban and the other rural, personality disorder was diagnosed in 5.3% by the GP and in 5.6% by the psychiatrist, but this increased to 28% when personality disorder was assessed using a structured interview. The prevalence of personality disorder was higher in the urban practice than in the rural one but there was no consistent association between personality disorder and mental state disorder, with the exception of alcohol abuse and dependence. The high rate of personality disorder found using the interview schedule is likely to be a true finding, and failure to recognise this hidden morbidity is important in both general and psychiatric practice.

England↗
PubMed2001

Prevalence of psychiatric disorders among persons convicted of driving while impaired.

BACKGROUND: Large numbers of convicted drunk drivers are entering alcohol treatment programs, yet little information is available about their need for psychiatric treatment. This study of convicted drunk drivers estimates lifetime and 12-month prevalence of DSM-III-R psychiatric disorders (alcohol and drug abuse and dependence, major depressive disorder, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder, and antisocial personality disorder) and compares rates with estimates from a US population-based survey. METHODS: Six hundred twelve women and 493 men, aged 23 to 54 years, convicted of driving while impaired, who had been referred to a screening program in Bernalillo County, New Mexico, were located and interviewed using the Diagnostic Interview Schedule between January 25, 1994, and June 30, 1997. Psychiatric diagnoses were compared with findings from the National Comorbidity Survey for the western region of the United States, conducted between September 14, 1990, and February 6, 1992. RESULTS: Eighty-five percent of female and 91% of male offenders reported a lifetime alcohol-use disorder, compared with 22% and 44%, respectively, in the National Comorbidity Survey sample. Thirty-two percent of female and 38% of male offenders had a drug-use disorder, compared with 16% and 21%, respectively, in the National Comorbidity Survey sample. For offenders with alcohol-use disorders, 50% of women and 33% of men had at least 1 additional psychiatric disorder other than drug abuse or dependence, mainly posttraumatic stress disorder or major depression. CONCLUSION: Drunk-driving offenders need assessment and treatment services not only for alcohol problems but also for drug use and the other psychiatric disorders that commonly accompany alcohol-related problems.

Adult↗
PubMed1998

Overcoming service barriers for homeless persons with serious psychiatric disorders.

OBJECTIVE: To help homeless persons with comorbid psychiatric and substance use disorders gain access to community services, in 1993 the Center for Mental Health Services implemented the five-year Access to Community Care and Effective Services, or ACCESS program, in 15 cities. One aim of the program is to encourage collaboration between agencies serving the multiple needs of this population. This study examined the extent of linkages between agencies in the 15 demonstration cities. METHODS: One respondent from each of the 1,060 community-based programs in tie 15 cities rated the extent to which his or her agency was linked with each of the other agencies in the local community in 1994 and again in 1996. Overall, there were 20,801 potential pairwise linkages. Linkages were classified into four types: a mutual tie, in which both agencies send and receive clients; a unidirectional tie, in which one agency sends and the other receives; an attempted tie, in which one agency sends but the other agency does not confirm receiving; and an unattempted tie. RESULTS: In 1994 and 1996, of the 20,801 pairs of potential service linkages, about a third were in place, while the remaining two-thirds were absent. Overall, linkages showed a slight but significant increase between 1994 and 1996. More than half of the linkages changed in type, indicating fluid service systems. CONCLUSIONS: Linkages between community agencies serving homeless persons with comorbid psychiatric and substance use disorders are not extensive. However, they increased slightly under the first two years of the ACCESS program, and there are good reasons to anticipate greater improvements in the future.

Community Mental Health Services↗
PubMed2005

Association of antisocial personality disorder with psychiatric morbidity among patients with substance use disorder.

OBJECTIVES: The aims were to determine among patients with Substance Use Disorder (SUD) whether patients with Antisocial Personality Disorder (ASPD) manifest less, the same, or more of the following: (1) psychiatric symptoms, (2) family history of psychiatric disorder, (3) psychiatric disorders and morbidity, and (4) psychiatric treatment, as compared to patients without ASPD. DESIGN & DEFINITION: Scheduled interview using DSM-III-R criteria for ASPD, with blinded interviewers making the ASPD classification vs. other assessments. SETTINGS: Alcohol-drug treatment programs located in two university medical centers. SUBJECTS: Six hundred and six voluntary patients aged 18 and older meeting diagnostic criteria for SUD. RESULTS: SUD patients with ASPD reported more family history of non-SUD psychiatric diagnoses and endorsed more hostility symptoms. Demographic characteristics, psychiatric disorder, and past psychiatric treatment did not differ in association with ASPD.

Adolescent↗
PubMed1996

Comment on "Personality disorders and psychiatric symptoms in psoriasis": a critical analysis.

In 1995 Rubino, et al. reported that a cluster analysis provided evidence for four different personalities in patients with psoriasis. Because they did not include controls with other disfiguring chronic dermatologic conditions, did not relate severity of disfigurement or chronicity of the psoriasis with personality dysfunction, and did not assess pre- and post-onset of psoriasis personality structure, we do not think it is prudent at this time to draw conclusions about personality and psoriasis.

Adaptation, Psychological↗
PubMed2000

Prevalence of subthreshold forms of psychiatric disorders in persons making suicide attempts in Hungary.

BACKGROUND: Suicide and suicide attempts have been associated to psychiatric illnesses; however, little is known about the role in suicide risk of those symptoms that do not meet the full criteria for a DSM-IV disorder. The aim of this study was to examine the prevalence of subthreshold psychiatric disorders among suicide attempters in Hungary. METHODS: Using a modified structured interview (Mini International Neuropsychiatric Interview) determining 16 Axis I psychiatric diagnoses and their subthreshold forms defined by the DSM-IV and a semistructured interview collecting background information, the authors examined 140 consecutive suicide attempters, aged 18-65 years. RESULTS: Eighty-three-point-six percent of the attempters had one or more current threshold diagnoses on Axis I and in addition more than three-quarters (78.6%) of the subjects had at least one subthreshold diagnosis. Six-point-four percent of the subjects (N = 9) had neither subthreshold nor threshold diagnoses at the time of their suicide attempts. Ten percent of the subjects (N = 14), not meeting the full criteria for any DSM-IV diagnoses, had at least one subthreshold diagnosis. In 68.6% of the subjects (N = 96), both subthreshold and threshold disorders were diagnosed at the time of their suicide attempts. The number of subthreshold and threshold diagnoses were positively and significantly related (chi2 = 5.12, df = 1, P < 0.05). Sixty-three-point-six percent of the individuals received two or more current threshold diagnoses on Axis I and 44.3% of the individuals (N = 62) had two or more subthreshold diagnoses at the time of their suicide attempts. LIMITATIONS: The subthreshold definitions in this study included only those forms of the disorders which required the same duration as the criteria DSM-IV disorder with fewer symptoms. Conclusions - Suicide attempts showed a very high prevalence of subthreshold disorders besides psychiatric disorders meeting the full criteria required according to the DSM-IV. Subthreshold forms of mental disorders need to be taken into account in suicide prevention.

Adolescent↗
PubMed1987

Legal issues in the care of mentally impaired elderly persons: competence, surrogate management, and protection of rights. Working Group on Legal Issues, Committee on Guidelines for Comprehensive Services to Elderly Persons with Psychiatric Disorders.

This article identifies a number of areas of concern in the care of mentally impaired elderly persons, focusing on the need for improved criteria, definitions and procedures in the following areas: the determination of competence or incompetence; the initiation, implementation and monitoring of measures for surrogate management (power of attorney, trusteeship, guardianship); standards of care; and advocacy in defence of the rights of elderly persons. The large and growing number of elderly persons in need of care--the very old, the frail, those without relatives and, in particular, the mentally impaired--has many legal implications. The critical issue is how effectively the law can protect and maintain the rights of people who are unable to do so themselves.

Aged↗
PubMed2002

Dual diagnosis in offenders with intellectual disability: setting research priorities: a review of research findings concerning psychiatric disorder (excluding personality disorder) among offenders with intellectual disability.

Studies of so-called 'dual diagnosis', i.e. intellectual disability (ID) with an additional psychiatric disorder, are reviewed with particular reference to offending behaviour. Because of the paucity of studies of psychopathology in offenders with ID, the present paper opens with studies of broader issues of psychopathology among people with ID, notably those with depression, schizophrenia, mild depressive disorder, other major psychotic disorders, anxiety/neurotic disorder, autistic spectrum disorders and attention deficit hyperactivity disorder. There follows a review of the most established and commonly used measurement scales for dual diagnosis in ID. The review then focuses directly on those studies which have looked at the issues of dual diagnosis among offenders with ID. In keeping with other reviews in this series, the latter studies are classified according to the same criteria. Based on this review, it is apparent that there are high-priority research questions which concern the extent and nature of psychopathology among offenders with ID, most notably those with autistic spectrum disorders.

Comorbidity↗
PubMed1995

Personality disorders and psychiatric symptoms in psoriasis.

Two groups of psoriatic outpatients (ns = 192 and 119) were given, respectively, the Million Clinical Multiaxial Inventory-II and Foulds' Delusions-Symptoms-States Inventory. They were compared with dental (n = 192) and with general surgical (n = 190) patients. The psoriatic group presented clearly higher mean scores and frequencies on most of the personality disorder scales. On Foulds' inventory, psoriatic patients showed higher frequencies of neurotic and psychotic class allocations. A cluster analysis of personality scores provided evidence for 4 different personality clusters of patients with psoriasis: (a) Avoidant, Dependent, Schizoid, and Self-defeating (32.2%), (b) Compulsive, Narcissistic, and Aggressive (30.7%), (c) no personality disorder (18.2%), (d) Borderline, Paranoid, and Schizotypal, etc. (18.8%).

Adolescent↗
PubMed1999

Including children and adolescents with schizophrenia in medication-free research.

OBJECTIVE: There has been an increasing focus on the ethical issues raised by studies requiring the withdrawal of effective medication in schizophrenic adults. This article examines the risks and benefits of a medication-free period for pediatric patients with treatment-refractory schizophrenia who are participating in an ongoing study. METHOD: Between April 1993 and March 1998, 31 children and adolescents were admitted with a diagnosis of treatment-resistant, childhood-onset schizophrenia. Parental consent was obtained so that patients could participate in a medication-free research period. Patients were evaluated at screening, at the end of a 4-week washout, at the completion of a 6- to 8-week atypical neuroleptic trial, and at a 2- to 4-year follow-up. RESULTS: At the completion of a 4-week drug-free period, seven patients (23%) were diagnosed with another disorder on the basis of data gained from the drug-free period and their lack of schizophrenic symptoms. Their revised diagnoses were posttraumatic stress disorder (N = 1), an atypical psychosis labeled "multidimensionally impaired" (N = 4), and personality disorder (N = 2). At follow-up, three of these patients remained free of neuroleptic therapy. For eight patients (26%), the washout was curtailed because of rapid and severe deterioration of their schizophrenic symptoms. CONCLUSIONS: For children and adolescents with treatment-refractory schizophrenia, a medication-free period can be conducted safely for at least 4 weeks for inpatients. Such trials are useful on clinical grounds and for providing homogeneous patient groups for research. This study also highlights the necessity of having access to hospitalization to observe children and adolescents with psychotic symptoms while medication free.

Adolescent↗