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AIDS patients compared with others seen in psychiatric consultation.

To identify similarities and differences between AIDS patients and non-AIDS patients, all psychiatric consultations done in one year in a large voluntary general hospital were reviewed. A total of 93 consultations were done on 67 AIDS patients and 138 consultations were done on 121 comparably aged patients without AIDS. The most common AIDS risk factor was intravenous drug use. The AIDS patients were more likely to be Hispanic and male than were the non-AIDS patients. The AIDS group was also more likely to have a diagnosis of organic mental disorder, particularly dementia. There were no other differences in Axis I diagnoses, including depression, substance abuse, and adjustment disorder. Suicidal risk was no greater in the AIDS patients than in the non-AIDS patients. Axis II diagnoses were made more often in the non-AIDS patients, who also required more one-to-one nursing supervision. Consultation in AIDS patients took more staff time, and AIDS patients were more likely to have required one or more repeat consultations within the period of the study, thus creating a heavier burden on consultation staff. Although these predominantly heterosexual, Hispanic, and drug-using hospitalized AIDS patients do not show significantly higher rates of psychiatric morbidity than other, non-AIDS patients, except for more organic mental disorders, AIDS seems to create a much higher demand for psychiatric consultation services.

Acquired Immunodeficiency Syndrome↗

Prevalence and precipitants of aggression in psychiatric inpatient units.

OBJECTIVE: Aggression is a significant clinical problem in psychiatric facilities. The present study reviews data on aggression collected from psychiatric inpatient units in order to determine prevalence and causal factors. METHOD: Data on aggressive incidents were gathered from four adult psychiatric units in the Illawarra, Australia. Information obtained included diagnosis, causal factors and patient sociodemographic characteristics. RESULTS: During the 18-month period, a total of 1269 psychiatric patients were admitted and 174 patients (13.7%) were recorded as being aggressive. Patients with bipolar affective disorder and schizophrenia had a 2.81 and 1.96 significantly increased risk of aggression, respectively, while depression and adjustment disorder conferred a significantly lower risk. Aggression was most likely to occur within 2 days of admission and length of stay was greater for aggressive than non-aggressive patients. The greater number of incidents occurred on day shift. Most patients who displayed aggression did so on one occasion, but a small proportion of total patients (6.0%) accounted for a large number of incidents (71.0%). High-risk patients were identified as those who were under 32 years of age, were actively psychotic, detained and known to have a history of aggression and substance misuse. The most frequent form of aggression was physical and staff were most often the victims. CONCLUSIONS: These results have important implications for predicting and thereby reducing inpatient aggression. Organisations need to ensure aggression management strategies are in place and periodically identify and assess the level of risk for workers.

Adolescent↗

[Psychiatric disorders caused by global social change. Traumatization among the inhabitants of the former GDR].

More than a decennium after the reunion of East and West Germany, the psychological sequelae of traumatic experiences of East Germans are still evident. There were not only about 300 000 people imprisoned for political reasons in the German Democratic Republic between 1945 and 1989, partly exposed to physical and psychological torture, but also much more people subject of subthreshold traumatic experiences by harassment in public and private life. As a result, under a psychiatric perspective it should be taken into account not only specific post-traumatic stress disorders (PTSD), characterized by relieving of the traumata in intrusive flashbacks, avoidance of circumstances associated with the traumatic experiences, and increased psychological sensitivity and arousal, but also specific Adjustment disorders, or cultural shocks: many people of the former GDR had to deal with adjustment difficulties of different types to the new cultural environment after the reunion, which could be characterized as becoming intimate with post-modern Western culture within a process of identity development. This process encloses different phases or stages discussed under psychopathologic and psychodynamic perspective.

Germany, East↗

A psychiatric study of suicide among urban Swedish women.

A total of 104 suicides among women were investigated by means of a modified psychological autopsy, including interviews with survivors and a review of somatic and psychiatric records. Diagnosis according to Research Diagnostic Criteria (RDC) showed that 35% were suffering from a major depressive disorder during their final month and another 24% were also depressed; 12% were substance abusers and 14% had adjustment disorders. Two thirds had attempted suicide and another 23% had communicated suicidality in other ways. Slightly more than half of the women had been psychiatric inpatients and another 19% had at some time been outpatients. Fifty-seven percent had been psychiatric inpatients or outpatients during the final year of life. An increasing number of life events occurred during the final 6 months. In most cases the depressed women had been treated ineffectively with antidepressant drugs.

Adolescent↗

Common psychiatric disorders in cancer patients. II. Anxiety and acute confusional states.

Anxiety is a very prominent symptom of cancer patients and appears most frequently in connection with adjustment disorders. However, it can also be part of a normal adaptation to the disease, related to an anxiety disorder, or can be caused by variety of other reasons, including underlying somatic processes. The clinical presentation, etiology, diagnostic proceedings and the treatment of anxiety in patients with cancer is surveyed. Delirium (acute confusional states) is a neglected psychiatric syndrome in regard to diagnosis, treatment and research efforts. Especially in cancer patients, delirium is frequent and its incidence increases with advanced disease. A brief overview on the current literature of acute confusional states in cancer patients is presented.

Acute Disease↗

Causative factors for suicide attempts by overdose in epileptics.

We investigated possible causative factors for the high epileptic suicide rate by reviewing the cases of 22 patients with idiopathic epilepsy found among 711 patients hospitalized for a suicide attempt by overdose. Suicide attempts occurred with increased seizure activity in one epileptic; otherwise, no relationships were found with seizure-related variables. When matched by age, sex, and race with 44 nonepileptic controls from the same population, the epileptics had more borderline personality disorders with multiple impulsive suicide attempts (45.5% vs 13.6%), more psychotic disturbances, including command hallucinations (31.8% vs 9.1%), fewer adjustment disorders (18.2% vs 45.5%), and a comparable frequency of depression (13.6% vs 25%). We conclude that suicide attempts in epileptics are primarily associated with interictal psychopathologic factors, such as borderline personality disorder and psychosis, rather than with specific psychosocial stressors, seizure variables, or anticonvulsant medications.

Adult↗

Cancer and mental disorders in a national community sample: findings from the national comorbidity survey.

OBJECTIVE: To determine the association between cancer (past 12 months) and mental disorders (past 12 months) among community-dwelling adults. METHODS: Data were drawn from the National Comorbidity Survey (n = 5,877), a representative household sample of adults aged 15-54 years in the United States. Multiple logistic regression analyses were used to determine the association between cancer and mental disorders, adjusting for differences in sociodemographic characteristics. RESULTS: Cancer was significantly associated with increased rates of major depression [odds ratio (OR) = 3.6, 95% confidence interval (CI) = 1.4-8.8], drug dependence (OR = 3.6, 95% CI = 1.3-9.8), simple phobia (OR = 2.5, 95% CI = 1.0-6.2) and agoraphobia (OR = 3.3, 95% CI = 1.0-10.4). These associations persisted after adjusting for major sociodemographic factors, and sex plays a significant role in the association between cancer diagnosis and mental disorder, with cancer diagnosis having a stronger influence on major depression and drug dependence in men than in women. CONCLUSIONS: Clinicians and community health workers working with cancer survivors need to be not only alert for signs of clinical depression but also of co-occurring drug dependence and certain anxiety disorders so that appropriate referrals to mental health professionals can be made.

Adolescent↗

Psychiatric diagnoses aboard an aircraft carrier.

A descriptive study was conducted for 150 consecutive patients with a psychiatric diagnosis evaluated over 11 months by the medical staff onboard an aircraft carrier. Patients with sole diagnosis of alcohol abuse or dependence were excluded. Axis II diagnoses, or personality disorders, were more common (N = 120) than Axis I diagnoses (N = 46). The most common Axis I diagnoses were adjustment disorder and major depression. Axis II diagnoses were significantly more likely (OR = 7.33, 95% CI 4.45-12.16, p = 0.000) in sailors less than 23 years of age compared to ship's population. Suicide behavior was demonstrated in 68% (102/150) of the patient population. This study emphasized the requirement for extensive psychiatric training for the clinical aerospace medicine specialists providing operational support to aircraft carrier crews.

Adolescent↗

Risk factors associated with the development of postpartum mood disorders.

BACKGROUND: Various factors have been reported to be associated with the development of postpartum mood disorders. The relationship between postpartum mood disorders and putatively hormone-related phenomena such as premenstrual dysphoric disorder (PMDD) is unclear. This study attempts to determine whether such mood phenomena are risk factors for postpartum mood disorders. METHODS: Postpartum women (n=1800) were assessed for risk factors for postpartum mood disorders during the first 2-4 days after parturition. Of these, 133 were defined as "high risk" and 109 as "low risk" according to fixed criteria. A structured phone diagnostic interview was performed at 6-8 weeks postpartum to assess for the presence of postpartum depression or the blues. RESULTS: Premenstrual dysphoric disorder (PMDD), mood symptoms during the first 2-4 days postpartum, a past history of depression and mood symptoms during past oral contraceptive use, were found to be significant risk factors for postpartum mood disorders. Women at high risk for postpartum mood disorders had a 9.3-, 1.5-, 1.6- and 2.6-fold increase in risk for major depression, minor depression, the blues and adjustment disorder respectively compared to women at low risk. LIMITATIONS: While the study design is prospective, it is limited by the retrospective assessment of risk factors. CONCLUSIONS: This study provides preliminary evidence that putatively hormone-related phenomena such as PMDD are related to the occurrence of postpartum mood disorders. The results go some way to support the hypothesis that the etiology for postpartum mood disorders may be related to differential hormonal sensitivity. Such risk factors should be included in any assessment of the risk for these disorders.

Adult↗

Anxiety in the Lundby Study: re-evaluation according to DSM-III-R, incidence and risk.

This study presents the incidence and risk of Anxiety Disorders according to DSM-III-R in the 1947 Lundby cohort. The figures are based on a re-evaluation of 124 first-ever episodes of 'Anxiety' according to the Lundby definition. Panic Disorders without/with Agoraphobia constituted the largest groups, while a proportionally low rate of Generalized Anxiety Disorder was obtained. The incidence rates per 100 person years in Panic Disorders without Agoraphobia were 0.07 for men and 0.20 for women, the female dominance being statistically significant. Corresponding figures in Panic Disorders with Agoraphobia were 0.04 and 0.07. About 20% fell into other diagnostic categories, the most dominating being Mood and Adjustment Disorders and Hypochondriasis. Comparisons with incidence rates from the ECA and Stirling County studies are made and outlines for further research presented.

Adolescent↗

Characteristics of persons utilizing a geriatric psychiatry outpatient clinic.

Mental-health service utilization among elderly people has been shown to be low relative to younger age groups. This study was done to determine the current proportion of elderly persons served in a university-affiliated psychiatry outpatient clinic, and to better characterize elderly patients who receive specialized mental-health care in this setting. The proportion of visits from elderly patients (aged 60 and over) was found to be 16%. Demographic and clinical characteristics of a sample of 140 consecutive geriatric patients evaluated at the clinic were obtained. The data revealed that the patients had a mean age of 74.7+/-7.5 (SD) years, and were mostly female (72.1%) and white (78.6%). Surprisingly, the age distribution was found to be bell shaped, with a small upper tail. The three most prevalent psychiatric diagnoses were depression (56.4%), dementia (35.7%), and substance use disorder (20%). Overall, 59.3% of geriatric patients had a history of prior psychiatric treatment. Females were significantly more likely than males to have a psychiatric history (69.3% vs. 33.3%, P = .0001). Among patients with a psychiatric history, females were more likely to have a current diagnosis of major depression (P = .0006), while males were more likely to have a current substance use disorder (P = .03). The prevalence of dementia increased with each successive decade above 60, while the occurrence of bipolar and adjustment disorders was confined to younger geriatric patients. Elderly patients receiving psychiatric treatment in the clinic thus formed a heterogeneous group. Gender, age, and presence of a psychiatric history were all associated with differences in prevalence and distribution of various mental disorders in this geriatric psychiatry outpatient clinic.

Age Distribution↗

Shyness, friendship quality, and adjustment during middle childhood.

Whereas many young children show initial wariness on meeting a stranger, shyness that lasts into middle childhood may be indicative of concurrent problems and subsequent disorder. Adjustment problems of an internalising nature, such as low self-esteem, loneliness, and anxiety may occur. Special significance has, however, been ascribed to preadolescent friendships as a means of validating self-worth and buffering against loneliness and anxiety. The main aim of the present study is to examine associations between shyness, perceptions of friendship quality, and indices of adjustment related to internalising problems. The study involves a sample of 8.4-10.6-year-olds (N = 50), preselected at 4.5 years to include a high proportion of shy children. Ratings of shyness to an unfamiliar adult had been made by different observers at 4.5 and 7 years, and at the present ages by another observer, mothers, and teachers. Observer-rated shyness was highly consistent over time and was significantly correlated with mothers' and teachers' ratings, although both significantly underestimated children's shyness relative to observer ratings. Compared with the younger children (mean age of 9 years), observed shyness (a composite over all three age points) increased in salience for the older children (mean age of 10 years), becoming significantly correlated with trait anxiety as well as low global self-worth. Indeed, global self-worth took on a central role for the older children, showing significant correlations not only with observed shyness and internalising problems (loneliness and anxiety), but also with perceptions of social acceptance and classmate support as well as friendship quality, with a named "best friend". Thus by 10 years of age, aspects of peer relationships may influence and be influenced by global self-worth, with a possible buffering effect on any potential detrimental effects of shyness.

Adult↗

Effects of time in the United States and Indian ethnicity on DSM-III-R psychiatric disorders among Mexican Americans in California.

The study examines the effects of time in the United States and Indian ethnicity on prevalence of 12 DSM-III-R psychiatric disorders among Mexican Americans in California. In Fresno County, primarily an agricultural area, 3012 participants of Mexican origin (18 to 59 years) were selected under a cluster sampling design and interviewed using a version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI). Lifetime prevalence of any psychiatric disorder was 46.4% for Indians and 32.9% for non-Indians. Alcohol dependence was the most prevalent disorder (Indians = 17.4%, non-Indians = 10.7%). Indians had significantly higher risk of affective disorders (adjusted OR = 2.9) and drug abuse/dependence (adjusted OR = 2.6) compared with non-Indians. Time in the United States was associated with higher risk of lifetime affective disorders and drug abuse/dependence. This effect was more pronounced among Indians. Mexican immigrants are ethnically heterogenous and Indians appear to be more vulnerable to negative effects of exposure to U.S. society.

Acculturation↗

[Depression in General Hospital: a study of 136 cases].

OBJECTIVE: To investigate the depressive symptoms that differentiate patients with and without depression associated to medical disease. METHOD: During 1998, 293 consecutive referrals for consultations were studied, 168 (57.5%) of females and 124 (42.5%) males, with ages ranging from 18 to 93 years (47.2 +/- 18.0 years). Psychiatric diagnosis was made by clinical interviews, according to DSM-IV criteria. For statistical analysis the chi-square and logistic regression tests were adopted. RESULTS. Of the 293 patients under study, 230 (78.5%) fulfilled the criteria for psychiatric diagnosis, 136 (59.1%) of them presented disorders within the depressive spectrum: Major Depression (n= 60 - 26.1%), Minor Depression (n = 31 - 13.5%). Secondary Depression (n= 19-8.3%) and Adjustment Disorder with Depressive Mood (n= 26-11.3%). Except for greater appetite, weight gain, agitation and delusions, the occurrence or not of the diagnostic of depression was significantly different (p<0.05) when comparing the presence with the absence of the remaining potential depressive symptoms. The anedonia and morning worsening were detected in 4 and 3 patients without depression respectively, which did not allow the inclusion of these symptoms in the regression analysis model. In accordance with the logistic regression analysis (IC= 95%) the selected variables to explain diagnosis of depression were thoughts of death (OR= 20.6; 2.5-170.5), irritability (OR= 4.5; 1.7-11.9), early awakening (OR=15.0; 1.7-129.3) and weight loss (OR=8.1; 2.6-24.4). CONCLUSION: Thoughts of death, irritability, early awakening, loss of weight, anhedonia (loss of pleasure); and morning worsening were the symptoms that strongly supported depression diagnosis. Even symptoms that could be a manifestation of medical condition and/or of depressions (such as sleeplessness, diminished concentration, fatigue and slowing down) were significantly more associated to the diagnosis of depression. These data outline the need for an active clinical investigation of depression by the physician in the case of physical symptoms that could be related to a medical condition or a depression. Owing to its high prevalence, the diagnosis of depression should not be made on an exclusion basis.

Adolescent↗

A psychiatric study of 247 liver transplantation candidates.

This study prospectively evaluated 247 consecutive liver transplantation candidates for the presence of psychiatric disorders. While one-half did not meet DSM-III criteria for a psychiatric diagnosis, 18.6% had delirium, 19.8% had an adjustment disorder, 9% had alcohol abuse or dependence, 4.5% had major depression, and 2% had other drug abuse or dependence. Delirious subjects were significantly more likely to have a lower serum albumin, lower Mini-Mental State exam scores, higher Trailmaking Test scores (both A and B), and more dysrhythmia on electroencephalogram (EEG). In addition, while both delirious and nondelirious subjects were judged to have high levels of overall stress, those with delirium had significantly poorer adaptive functioning and lower occupational, family, and social scale ratings. Thus, while all liver transplant candidates are under substantial psychosocial stress and require psychosocial support, those identified as being delirious require particular attention because of their numerous cognitive, medical, and psychosocial problems.

Adolescent↗

Mental disturbances during isolation in bone marrow transplant patients with leukemia.

The mental status of 39 leukemia patients, who received bone marrow transplants (BMT), was studied during the period of isolation. Mental disorders (diagnosed according to DSM-IV criteria) occurred in 16 patients (41%) during the observation period. The most frequent diagnoses were adjustment disorders, with anxiety and/or depression. Logistic regression analysis suggested higher Tension-Anxiety score in the Profile of Mood States (POMS) prior to isolation (P = 0.011), donation of the bone marrow from unrelated subjects (P = 0.026) and in female patients (P = 0.033). The results are preliminary, but indicate a high frequency of mental disturbances and highlight the importance of psychiatric intervention in BMT patients. Bone Marrow Transplantation (2000) 25, 315-318.

Adolescent↗

Private psychiatric hospitalization of children: predictors of length of stay.

OBJECTIVE: To quantitatively identify predictors and determinants of length of psychiatric hospital stay for children. METHOD: Forty-seven demographic, psychosocial stressor, psychopathology, and disposition variables were statistically reviewed as correlates of length of stay in 100 consecutive discharges from a child psychiatry inpatient service (age range 4-12) in a private hospital. Those with strong statistical significance were then analyzed by multiple regression. RESULTS: Greater severity of psychopathology (measured by the Children's Global Assessment Scale), greater severity of psychosocial stressors (by Axis IV scale), diagnosis of post-traumatic stress disorder, special educational and out-of-home dispositions, and severe tantrums in hospital all strongly predicted longer hospital stay. Diagnosis of adjustment disorder predicted shorter stay. Together these variables explained 57% of the total variance in length of stay. CONCLUSIONS: The most powerful of these predictor variables could potentially be measured at the time of admission, thus permitting accurate prediction of length of stay. A set of models was generated for this purpose.

Child↗

Chronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders.

The authors studied the prevalence of eight chronic medical conditions in an adult population sample (N = 2,554) with and without psychiatric disorders. Adjusted for age and sex, the prevalence of any lifetime chronic medical condition for persons with any lifetime affective, anxiety, or substance use disorder was 61.4%, 57.1%, and 57.7%, respectively. Each of these percentages was significantly higher than that for persons with no lifetime psychiatric disorder (53.4%). Both lifetime affective and anxiety disorders were uniquely associated with a greater prevalence of any lifetime chronic medical condition, but the only psychiatric disorders uniquely associated with current (i.e., active) chronic medical conditions were anxiety disorders, suggesting that the association between anxiety disorders and chronic medical conditions develops more quickly than associations between medical conditions and other psychiatric disorders.

Adult↗