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PubMed1990

Outpatient medical management of postpartum psychiatric disorders.

Many psychiatric treatment modalities may be used in treating postpartum psychiatric disorders. A structured psychiatric interview specifically designed to elicit symptoms of postpartum depression and psychosis can be very useful in diagnosing the type and severity of the disorder. Once the diagnosis has been made, a combination of education, individual and group psychotherapy, and psychopharmacologic interventions can relieve the symptoms and help restore the new mother to her previous level of functioning.

Ambulatory Care↗
PubMed2002

Prevalence of psychiatric disorder and the need for psychiatric care in Northern Ireland. Population study in the District of Derry.

BACKGROUND: This is the first report on the epidemiology of psychiatric disorders and needs for psychiatric treatment in the District of Derry, Northern Ireland. AIMS: To assess the prevalence of psychiatric disorder and the needs for treatment in the general population of Derry. METHOD: The sample was drawn at random with a two-phase design using the General Health Questionnaire (GHQ-28) during the first phase, and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) with the Needs for Care Assessment (NFCAS-C) in the second phase. RESULTS: The second phase (n=307) gave a weighted 1-month prevalence of hierarchically ordered ICD-10 psychiatric disorders of 7.5% and a 1-year prevalence of 12.2%. The equivalent prevalences for depressive disorders were 2.4% and 6.0%, respectively, and those for anxiety states were 3.5% and 3.7%. Only a quarter of needs for treatment were met, with the situation being better for depression than for anxiety. CONCLUSIONS: The rates of psychiatric disorder in Derry were even higher than those reported by a similar survey in inner London. This almost certainly reflects the very high levels of social deprivation in the District. Needs for treatment were often unmet.

Adolescent↗
PubMedDate not supplied

Comorbidity of substance abuse and other psychiatric disorders in acute general psychiatric admissions: a study from Lebanon.

This is the first published study from an Arab Near Eastern country to examine the comorbidity of substance abuse with other psychiatric disorders. All inpatients with substance abuse/dependence (present or past) admitted to the psychiatry unit at St. George Hospital (Lebanon) between 1979 and 1992 (N = 222) constituted the study sample. Of these, 64.9% were found to have comorbid psychiatric disorders with specific relations between individual substances and psychiatric diagnoses identified such as cocaine and bipolar disorder (42.1%), and cannabis and schizophrenia (44.8%). Patients with no axis I disorder were predominantly heroin users, most of them having antisocial personality disorder. Polydrug abuse was found among 44.9% of patients, and most of the benzodiazepine abusers belonged to this category. The pattern of comorbidity of psychiatric and substance use disorders in this Near East inpatient population compares well with findings from the Western hemisphere: cultural factors (including war) do not seem to have much of an effect on the different forms of dual diagnoses. This adds weight to the already existing literature on the need for careful psychiatric assessment in the treatment of substance abuse.

Adult↗
PubMed2002

Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study.

BACKGROUND: While numerous studies have documented the high comorbidity of major depressive disorder (MDD) with individual mental disorders, no published study has reported overall current comorbidity with all Axis I and II disorders among psychiatric patients with MDD, nor systematically investigated variations in current comorbidity by sociodemographic factors, inpatient versus outpatient status, and number of lifetime depressive episodes. METHOD: Psychiatric outpatients and inpatients in Vantaa, Finland, were prospectively screened for an episode of DSM-IV MDD, and 269 patients with a new episode of MDD were enrolled in the Vantaa Depression MDD Cohort Study. Axis I and II comorbidity was assessed via semistructured Schedules for Clinical Assessment in Neuropsychiatry, version 2.0, and Structured Clinical Interview for DSM-II-R personality disorders interviews. RESULTS: The great majority (79%) of patients with MDD suffered from 1 or more current comorbid mental disorders, including anxiety disorder (57%), alcohol use disorder (25%), and personality disorder (44%). Several anxiety disorders were associated with specific Axis II clusters, and panic disorder with agoraphobia was associated with inpatient status. The prevalence of personality disorders varied with inpatient versus outpatient status, number of lifetime depressive episodes, and type of residential area, and the prevalence of substance use disorders varied with gender and inpatient versus outpatient status. CONCLUSION: Most psychiatric patients with MDD have at least 1 current comorbid disorder. Comorbid disorders are associated not only with other comorbid disorders, but also with sociodemographic factors, inpatient versus outpatient status, and lifetime number of depressive episodes. The influence of these variations on current comorbidity patterns among MDD patients needs to be taken account of in treatment facilities.

Adult↗
PubMed2004

Sustained attention and visual processing speed in children and adolescents with bipolar disorder and other psychiatric disorders.

To investigate the cognitive functioning of children and adolescents with bipolar illness, 112 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital were administered the Wechsler Intelligence Scale for Children-III (WISC-III) as part of an admission psychological assessment. There were 22 patients with Bipolar Disorder and 90 with other psychiatric disorders; all were between 8 and 17 years of age. The patients with Bipolar Disorder had a mean age of 14 yr., a mean Verbal IQ of 78, a mean Performance IQ of 76, and a mean Full Scale IQ of 75. When their WISC-III scores were compared with those who had Schizophrenia Spectrum disorders (Schizophrenia and Schizoaffective Disorder), Psychosis Not Otherwise Specified, Attention Deficit Hyperactivity Disorder, and Conduct Disorder and Oppositional Defiant Disorder, there were no significant between-group mean differences for Verbal IQ, but patients with Bipolar Disorder had a significantly lower mean Performance IQ than those with ADHD and those with Conduct Disorder and Oppositional Defiant Disorder. Contrary to the expectation that the patients with Bipolar Disorder might have better sustained attention (higher Digit Span scores) than those with Schizophrenia Spectrum disorders and worse visual processing speed (lower Coding scores) than the other diagnostic groups, the bipolar patients' Digit Span and Coding scores did not differ significantly from those of the other groups. The patients with Psychosis, Not Otherwise Specified had significantly lower mean Performance IQ, Full Scale IQ, and Coding than the ADHD and the Conduct Disorder and Oppositional Disorder groups.

Adolescent↗
PubMed2005

Treatment of co-occurring alcohol, drug, and psychiatric disorders.

Comorbid psychiatric disorders and drug use disorders (DUDs) are common among adolescents with alcohol use disorders (AUDs). These comorbid disorders have a large potential significance on the clinical course of the AUDs among adolescents, and can predict a shorter time to relapse of alcohol use. The use of medication for treatment of the various comorbid adolescent populations has increased dramatically in recent years, despite the lack of double-blind, placebo-controlled studies that demonstrate their safety and efficacy. Consequently, to date, no empirically proven treatment exists for most of these comorbid disorders. This chapter reviews the state of the art regarding the treatment of comorbid adolescents. This chapter also identifies gaps in knowledge regarding the treatment of comorbid adolescents, and outlines directions for future research in this field.

Adolescent↗
PubMed2005

Dementia associated with psychiatric disorders.

Functional psychiatric disorders are associated with a variety of cognitive deficits and, in some instances, severe cognitive impairment. This paper reviews the cognitive profile of patients with schizophrenia, depression, bipolar and anxiety disorders, as well as the longitudinal course and clinical outcome of the cognitive impairment associated with these conditions. The paper also discusses some of the mechanisms that may contribute to the expression of the cognitive deficits in these disorders and their potential relationship with common causes of dementia.

Atrophy↗
PubMed1975

Viral infection and psychiatric disorders.

A psychiatric population of 94 inpatients and 12 outpatients was investigated on referral to a psychiatric unit in a general hospital for serum antibody titres to several viruses by a complement fixation technique. Of the total population studied, only eight were considered to have antibody titres of possible significance. This result would appear to indicate that viral infection does not play a major part in the causation or precipitation of psychiatric disorders.

Adenoviridae↗
PubMed1982

Computed tomography in schizophreniform disorder and other acute psychiatric disorders.

To assess whether computed tomographic findings are present at the onset of schizophrenia, we evaluated CT scans of 35 patients with first-episode schizophreniform disorder, 17 with chronic schizophrenia, 23 with affective disorders, 27 with other psychiatric disorders, and 26 controls. Both the schizophreniform and the chronic schizophrenic patients had significantly larger cerebral ventricles than did the other psychiatric or control subjects. Ventricular size in the patients with affective disorder was not significantly different than in any of the other groups. Twenty percent of the schizophreniform patients had enlarged ventricles, (ventricular-brain ratio, greater than 10). The only other subjects outside this limit were four chronic schizophrenic patients (24%). Five schizophreniform patients and three with affective disorder had evidence of mild cortical atrophy. The results suggest that, in some schizophrenic patients, ventricular enlargement and less frequently cortical atrophy predate the onset of psychoses and are not a result of psychiatric treatment.

Adolescent↗
PubMed2006

Genetic analysis of psychiatric disorders in humans.

Psychiatric disorders place a large burden not only on affected individuals and their families but also on societies and health services. Current treatment is only effective in a proportion of the patients, so considerable effort has been put into the development of new medications. The susceptibility to all major psychiatric disorders is, at least in part, genetic. Knowledge of the genes that underlie this susceptibility may lead to the identification of new drug targets and the development of more effective treatments. Therefore, numerous genetic studies in search for the genes involved in psychiatric disorders have been performed. Although results of both linkage and association studies have been inconsistent, several promising gene regions and candidate genes have been identified recently. In this article, we will review the strategies that proved to be successful in detecting genes for psychiatric disorders and we will provide some recommendations to increase the probability of detecting susceptibility genes in genetic studies of different designs.

Genetic Determinism↗
PubMed2005

Techniques for the identification of genes involved in psychiatric disorders.

OBJECTIVE: Most psychiatric disorders are complex genetic traits involving both genetic and environmental risk factors. This paper aims to review the gene identification strategies being applied by molecular geneticists in their efforts to elucidate the genetic and molecular basis of psychiatric disorders. Future strategies will also be canvassed. METHOD: The psychiatric genetic literature was reviewed to identify current strategies applied to gene identification, with examples provided where available. The future strategies and applications that will arise from genome projects, including the International Haplotype Mapping Project, are also discussed. RESULTS: Many advances in the techniques of gene discovery, and the increasing resources available, are rapidly being adopted by researchers and applied to the complex problem of identifying susceptibility genes for mental illnesses. Perhaps the single most important advance to date is the Human Genome Project and all that has stemmed from the vast quantity of information that this endeavour has provided. With these technological advances and the massive increase of publicly available genetic resources, several genes have recently been implicated in the susceptibility to psychiatric illnesses including schizophrenia and depression. After many years of fruitless endeavours, these recent reports indicate that the labours of researchers in psychiatric genetics are beginning to show exciting results. CONCLUSIONS: Identification of these susceptibility genes holds great promise, with the unravelling of the molecular and biochemical basis of some conditions now being a more realistic and tangible goal. The increasing number of genes being identified augers well for the future treatment of psychiatric disorders. The genes identified, and the pathways of genes and proteins that they implicate, will provide potential novel targets for new therapeutic drugs. Psychiatric genetics appears to be poised for significant advances in our knowledge and understanding of the molecular genetic basis of mental illness.

Chromosome Mapping↗
PubMed2004

Using the Strengths and Difficulties Questionnaire (SDQ) multi-informant algorithm to screen looked-after children for psychiatric disorders.

BACKGROUND: Child psychiatric disorders are common among children in foster and residential care, but often go undetected and therefore untreated. AIMS: To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community. METHOD: SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 1,028 looked-after 5-17 year olds from a nationwide English survey. RESULTS: Multi-informant SDQs (parents, teachers, older children) identified individuals with a psychiatric diagnosis with a specificity of 80 % and a sensitivity of 85%. The SDQ prediction works best when SDQs have been completed by both carers and teachers. When it is only possible to have one adult informant, carers and teachers provide information of roughly equal predictive value. By contrast, self-reports by 11-17 year olds provide little extra information when there is already an adult informant. CONCLUSION: Using multi-informant SDQs as a regular screening measure for looked-after children could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.

Adolescent↗
PubMed1989

Erythrocyte sodium pump activity in bipolar affective disorder and other psychiatric disorders.

Erythrocyte ouabain-inhibitable sodium pump activity, a measure of NaK-ATPase activity, was studied in 6 diagnostic groups of psychiatric subjects: bipolar affective disorder, unipolar depressive disorder, neurotic depression, chronic alcohol abuse, schizoaffective disorder, and schizophrenia, and in sex- and age-matched normal controls. In the bipolar manic-depressive group, which was restricted to lithium-free subjects, values for sodium pump activity were significantly lower than in the controls (-11.4%, n = 53, p less than 0.001); subgrouping of the bipolar group by sex or age showed a significantly lower sodium pump activity in each of the groups. In the unipolar depressive group, values for sodium pump activity were significantly higher than in the controls (+13.7%, n = 12, p less than 0.01). The difference in direction of changed sodium pump activity between the bipolar and the unipolar groups was also observed in the values for subgroups of subjects in the two categories who were in a depressed state at the time the blood sample was taken. In the chronic alcohol abuse group, values for sodium pump activity were significantly higher than those for the control group (+13.5%, n = 20, p less than 0.05). In the neurotic depression (n = 24), schizoaffective (n = 12), and schizophrenia (n = 35) groups, there were no significant differences in sodium pump activity between the group of psychiatric subjects and their matched controls. These observations indicate that there is a trait-dependent deficiency of NaK-ATPase activity in bipolar affective disorder.

Adolescent↗
PubMed2004

Impact of psychiatric disorders in the general population: satisfaction with life and the influence of comorbidity and disorder duration.

BACKGROUND: Psychiatric disorders as defined by DSM-IV are found to be highly prevalent in the general population. However, little is known about aspects defining the burden caused by different disorders. OBJECTIVES: The aim of this study was to evaluate the impact of different psychiatric disorders in the community with respect to life satisfaction taking into account the effects of comorbidity and disorder duration. METHOD: Psychiatric 12-month disorders and life satisfaction were assessed in a random sample of 4075 adults from the general population using the Composite International Diagnostic Interview and the Satisfaction With Life Scale (SWLS). Separate analyses were performed for comorbid and pure disorders. Disorder duration was defined by the time since disorder onset for participants fulfilling diagnostic criteria within the last year. RESULTS: SWLS scores were significantly lower for all diagnostic subgroups except for bipolar disorders, compared to subjects with no 12-month diagnosis. Effect sizes were medium to large. Comorbidity was significantly associated with lower satisfaction with life. Pure disorders are associated with less but still significantly reduced SWLS scores, except alcohol abuse, major depression and specific phobia. Mean duration of disorder was lowest for dysthymia (5.9 years) and highest for specific phobia (24.5 years). The only significant correlation between disorder duration and SWLS was found for major depression (r = -0.26) and no trend for the direction of the relation could be identified across disorders. CONCLUSIONS: The impact of mental disorders in the community was confirmed by using the subjective measure of life satisfaction. Comorbidity is a key factor in determining the extent of reduction in satisfaction with life. Measures of disorder persistence should be examined by refined research strategies. Comprehensive analyses of mental disorders--exceeding the prevalence or a single measure of burden--have to be considered to define the most urgent needs in the community.

Adolescent↗
PubMed1980

Psychiatric disorders in children with speech and langauge retardation. Factors associated with development.

One hundred children (mean age, 5 to 6 years) who were seen consecutively at a suburban speech and hearing clinic were systematically evaluated for speech and language disorders and psychiatric disorders. Fifty-three were found to have a psychiatric illness. The three groups were compared with the psychiatrically well group to ascertain factors associated with the presence of a psychiatric disorder. Significantly differentiating the ill group were more academic and classroom behavior problems and the presence of both speech and language problems. The two groups were not significantly different in intellectual retardation, hearing impairment, medical factors, nonlanguage development disorders, and a variety of family and demographic factors. Common in both groups were psychiatric illness in parents and first-degree relatives. The data indicate that children with speech and langauge disorders are highly at risk for the development of significant psychiatric problems, which suggests the need for proper screening and multimodal treatment planning.

Adolescent↗
PubMed1999

Dual disorders: clients suffering from psychiatric disorders and alcohol or drug abuse disorders.

If home care providers are to be diligent in assessing the total well-being of their clients, they need to assess for dual disorders (DDs), a co-occurrence (comorbidity) of psychiatric disorders and alcohol or other drug disorders (AODDs). Table 1 lists acronyms for different types of DDs. Home care clients who suffer from depression and other mental health problems are not uncommon, nor are clients who suffer from AODDs. What health professionals often do not realize, however, is that clients may be suffering from both. Failure to effectively treat clients' DDs will negatively affect their recovery. Their DD may be causing or contributing to their physical problems and affecting their judgment, motivation, and insight into their problems.

Community Health Nursing↗
PubMed1991

[Mortality of patients with organ-induced psychiatric disorders during inpatient psychiatric treatment].

In this paper data from seven psychiatric hospitals in Baden-Württemberg, which can be regarded as representative for this region, are analysed. All patients with organic mental disorders of the ICD-9 categories 290, 293, 294 and 310 were included, while patients with alcohol- or psychoactive drug-induced psychoses were excluded. During the period from 01.01.1984 to 30.06.1986, 1821 episodes of treatment were recorded. 41% of all patients were male, the mean age of the population was 72.4 +/- 15.1 years. During their stay in hospital 137 patients died from natural causes, which is to compare with an expected number of deaths of 18.3, calculated according to the age- and sex-adjusted mortality rates of the German population. With a ratio of 7.5 the mortality of the whole study population was significantly raised. In all diagnostic subgroups a correlation with raised mortality was found, the risk being highest in patients with acute organic psychosis. An inverse relationship between age and mortality could be established. The main causes of death were cardiovascular disorders and pneumonias. The data of this investigation indicate an unequivocally increased mortality risk of patients with organic mental disorder during their stay in acute psychiatric units. The causes for this phenomenon are discussed, as well as potential consequences for hospital care of patients with organic mental disorder.

Adult↗
PubMed2001

Reliability and clinical utility of DSM-IV substance-induced psychiatric disorders in acute psychiatric inpatients.

The goal of his study was to evaluate in 1,951 acute psychiatric inpatients the reliability, construct, convergent, and predictive validity of substance-induced psychiatric syndrome ratings made by clinical attending pschiatrists. The primary admitting condition for each subject was categorically rated by clinical attendings as not, mildly, moderately, or mostly substance-induced at both admission and discharge. Individual substance categories were associated with characteristic demographic, clinical treatment response, and length of stay, findings indicating good construct, predictive validity, and clinical utility. A linear dimensional approach to rating substance-induced syndromes in acute clinical populations may be preferable to the simple dichotomous approach used in DSM-IV.

Acute Disease↗