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PubMed1994

Diagnostic and statistical manual of mental disorders, 3rd ed. (DSM-III), adaptive functioning in young Swedish suicides.

Fifty-eight consecutive suicides between 15 and 29 years of age occurring in Göteborg, Sweden, were assessed in accordance with DSM-III Axis V (highest level of adaptive functioning in the past year). The levels of adaptive functioning were compared to principal Axes I and II disorders. Subjects with a borderline personality or schizophrenic disorder as the principal disorder tended to have poor to very poor adaptive functioning and were frequently associated with substance abuse (19 of 24 subjects). Subjects with adjustment disorder or major depressive disorder as the principal disorder generally had very good to fair adaptive functioning. Clinicians are reminded that apparently higher functioning as defined by DSM-III Axis V is no insurance against suicide.

Adaptation, Psychological↗
PubMed2002

Use of opioid medications for chronic noncancer pain syndromes in primary care.

OBJECTIVES: To define the spectrum of chronic noncancer pain treated with opioid medications in 2 primary care settings, and the prevalence of psychiatric comorbidity in this patient population. We also sought to determine the proportion of patients who manifested prescription opioid abuse behaviors and the factors associated with these behaviors. DESIGN: A retrospective cohort study. SETTING: A VA primary care clinic and an urban hospital-based primary care center (PCC) located in the northeastern United States. PATIENTS: A random sample of VA patients ( n=50) and all PCC patients ( n=48) with chronic noncancer pain who received 6 or more months of opioid prescriptions during a 1-year period (April 1, 1997 through March 31, 1998) and were not on methadone maintenance. MEASUREMENTS: Information regarding patients' type of chronic pain disorder, demographic, medical, and psychiatric status, and the presence of prescription opioid abuse behaviors was obtained by medical record review. MAIN RESULTS: Low back pain was the most common disorder accounting for 44% and 25% of all chronic pain diagnoses in the VA and PCC samples, respectively, followed by injury-related (10% and 13%), diabetic neuropathy (8% and 10%), degenerative joint disease (16% and 13%), spinal stenosis (10% and 4%), headache (4% and 13%) and other chronic pain disorders (8% and 22%). The median duration of pain was 10 years (range 3 to 50 years) in the VA and 13 years in the PCC sample (range 1 to 49 years). Among VA and PCC patients, the lifetime prevalence rates of psychiatric comorbidities were: depressive disorder (44% and 54%), anxiety disorder (20% and 21%), alcohol abuse/dependence (46% and 31%), and narcotic abuse/dependence (18% and 38%). Prescription opioid abusive behaviors were recorded for 24% of VA and 31% of PCC patients. A lifetime history of a substance use disorder (adjusted odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4 to 10.8) and age (adjusted OR, 0.94; 95% CI, 0.89 to 0.99) were independent predictors of prescription opioid abuse behavior. CONCLUSIONS: A broad spectrum of chronic noncancer pain disorders are treated with opioid medications in primary care settings. The lifetime prevalence of psychiatric comorbidity was substantial in our study population. A significant minority of patients manifested prescription opioid abusive behaviors, and a lifetime history of a substance use disorder and decreasing age were associated with prescription opioid abuse behavior. Prospective studies are needed to determine the potential benefits as well as risks associated with opioid use for chronic noncancer pain in primary care.

Adult↗
PubMed2002

Recurrent attacks of fear and visual hallucinations in a child.

The case of a 7-year-old boy suffering from recurrent nocturnal and occasional daytime attacks with intense fear and complex visual hallucinations is presented. His state was otherwise normal, as were routine electroencephalographic (EEG) and magnetic resonance imaging (MRI) investigations in the past. Several differential diagnoses such as panic disorder, pavor nocturnus, and nightmares were considered but could not be definitely established or excluded. Since the attacks appeared after the divorce of his parents, an adjustment disorder was suspected, and the patient received psychotherapy for more than 2 years without an effect on the attacks. Only when long-term video-EEG recorded two typical attacks with left temporal ictal seizure patterns was focal epilepsy diagnosed and successfully treated with antiepileptic medication. A suspected origin of seizures in the amygdala was supported by a high-resolution MRI showing a cortical dysplasia extending from the left anteromedial temporal lobe to the amygdala. The case exemplifies difficulties in the differential diagnosis of panic-like attacks and underlines the value of long-term video-EEG, which may be necessary to establish the correct diagnosis and to prevent ineffective therapeutical approaches.

Amygdala↗
PubMedDate not supplied

[Emerging aspects of occupational stress].

Work stress is caused by excessive demands which foster individuals to give prompt cognitive and behavioral answers. When these solicitations exceed the possibilities of the subject to comply, non-physiological reactions may follow, including emotional, neurovegetative and behavioral changes. If adverse stimuli persist, transient alterations form syndromes such as depression, phobic syndromes, anxiety syndromes, hypertension, heart disease, eating disorders, drug addiction, and so on. The authors examine specific stressful working areas causing illnesses in workers such as the burnout syndrome and the mobbing-related adjustment disorder or the post-traumatic stress disorder.

Burnout, Professional↗
PubMed1997

Clinical characteristics and biological parameters in temperamental clusters of suicide attempters.

A sample of 215 suicide attempters was categorized in a cluster analysis into four groups according to temperamental trails. Monoamine metabolites in the cerebrospinal fluid were analysed (n = 106). Dexamethasone suppression tests (DST) were performed (n = 154) and the activity of the enzyme monoamine oxidase in platelets (pl-MAO) was assessed (n = 103). Patients belonging to the two clusters with the most deviant temperament profiles (nos 2 and 3) were young and scored high on the Beck Hopelessness Scale and the Suicide Assessment Scale. "Cluster 3" ("neurotic, impulsive, aggressive") patients often had dysthymia and axis II, cluster B diagnoses (e.g. borderline or histrionic personality). "Cluster 2" ("neurotic and introverted") patients often had major depression. The "Cluster 1", with on the whole a normal temperament profile, had significantly higher levels of post-DST cortisol than the other clusters. The "Cluster 4" had a normal temperament profile. Adjustment disorders were most common in "Cluster 1" and "Cluster 4". The monoamine metabolite levels did not differ between the clusters, and the differences in pl-MAO activity disappeared after adjusting for age and gender. The results suggest that temperament profiles in suicide attempters are related to psychiatric diagnoses, suicidality, hopelessness, and post-DST cortisol, but are not predictive of completed suicide.

Adolescent↗
PubMed2002

A retrospective chart review of risperidone use in treatment-resistant children and adolescents with psychiatric disorders.

Antipsychotic drugs are used to treat a wide variety of child psychiatric disorders characterized by psychotic symptoms, aggression, excitement, tics, stereotypies and hyperactivity nonresponsive to other therapies. Unfortunately, typical antipsychotics have many adverse effects limiting their long-term use. Novel antipsychotics with combined dopaminergic and serotonergic action, such as risperidone, appear to offer better safety and efficacy profiles in controlled studies of adult patients, and therefore appeared as promising pharmacotherapeutic agents in child psychiatry. The purpose of this retrospective chart review was to obtain data on the potential effectiveness and tolerability of risperidone in children and adolescents presenting with a variety of chronic and severe psychiatric disorders who had been unresponsive to previous pharmacological treatments. Charts for 106 children and adolescents (males n = 81 or 76.4%; females n = 25 or 23.6%), presenting with attention deficit and/or hyperactivity disorder (n = 49 or 46.2%), conduct disorder (n = 13 or 12.3%), oppositional-defiant disorder (n = 5 or 4.7%), behavioural problems not otherwise specified (n = 2 or 1.9%), autism (n = 8 or 7.5%), Asperger's syndrome (n = 8 or 7.5%), pervasive developmental disorder (PDD) not otherwise specified (n = 4 or 3.8%), anxiety (n = 6 or 5.7%), depression (n = 2 or 1.9%), dysthymia (n = 2 or 1.9%), schizophrenia (n = 4 or 3.8%), adjustment disorder (n = 1 or 0.9%) and obsessive-compulsive disorder (n = 2 or 1.9%) were reviewed retrospectively to determine the tolerability and potential efficacy of risperidone treatment for a variety of psychiatric disorders. Six subjects also presented with mental retardation. The average length of illness prior to risperidone treatment was 5 years and the average age of risperidone treatment onset was 11 years. The mean daily dose of risperidone was 1.2 mg (range = 0.25 to 8.0 mg). Very few adverse effects were reported. The average length of risperidone treatment was 11 months with the majority (n = 75 or 76%) of patients maintained on risperidone following study termination. Seven cases (6.6%) were missing follow-up data. The majority (n = 78 or 74%) of patients were taking concurrent psychiatric medications, most commonly stimulants for the treatment of ADHD. Clinical global improvements for children and adolescents at the final study visit were marked (n = .37 or 34.9%), moderate (n = .40 or 37.7%), mild (n = 13 or 12.4%), none (n = 12 or 11.3%), or worse (n = 1 or 1%). Three cases (2.9%) were missing clinical improvement data. Results suggest that risperidone may be useful for managing behavioural disturbances and psychotic symptoms associated with a wide variety of childhood psychiatric disorders. For most patients in the study, a combination of risperidone and adjunctive pharmacotherapy was beneficial. Controlled and discontinuation studies of risperidone treatment in children and adolescents with behavioural and psychotic disorders are recommended.

Adolescent↗
PubMed2000

Psychosocial problems secondary to cancer: an Italian multicentre survey of consultation-liaison psychiatry in oncology. Italian Consultation-Liaison Group.

Data relative to consultation-liaison psychiatry (C-L) in oncology are lacking. In order to examine this area, a multicentre investigation was conducted in 17 general hospitals in Italy. All psychiatric consultation requests for cancer patients referred to C-L during a 1-year period were evaluated. Only 5% (n=217 referred patients: 114 men and 103 women) of all C-L activity were for cancer patients. Most were 'routine' consultations (72%) for current psychiatric symptoms (69%) or coping/compliance problems (12%). Previous psychological or psychiatric disorders were shown in 32% of cases. Approximately 40% of patients were not informed of their referral to C-L. The most frequent ICD-10 psychiatric diagnoses were adjustment disorders (27%) and major affective disorders (23%). Transfer to psychiatric units was low (1%). These findings indicate the need for improvement of referral criteria to C-L and closer attention to continuity of psychosocial care of cancer patients during hospitalisation and post-discharge.

Adolescent↗
PubMed2001

Association between allergy and anxiety disorders in youth.

OBJECTIVE: Studies have documented associations between anxiety disorders and allergy in adults, but these associations have not been studied extensively in children. The objective of this study is to examine the associations between allergy and six anxiety disorders (AD) in youth. METHOD: This is a data analysis of two epidemiologic-services studies: (i) alternative service use patterns of youth with serious emotional disturbance (n = 936), and (ii) methods for the epidemiology of child and adolescent mental disorders (n = 1285). Child psychiatric diagnoses were measured by the diagnostic interview schedule for children. Allergy was assessed by the service utilization and risk factors interview. RESULTS: Among ADs, the strongest association found was between allergy and panic disorder (adjusted odds ratio 5.0; p < or = 0.001). Associations of allergy and the other ADs do not seem to be clinically significant. CONCLUSIONS: Findings suggest that in some patients panic disorder may be associated with hypersensitivity of immune system. Panic disorder should be considered in anxious children reporting allergy when no organic cause of allergy is found, and likewise allergy should considered in children with panic disorder.

Adolescent↗
PubMedDate not supplied

Evaluation of the Neurobehavioral Functioning Inventory as a depression screening tool after traumatic brain injury.

OBJECTIVE: To examine the utility of the Neurobehavioral Functioning Inventory (NFI) for diagnosing depression in a rehabilitation setting. DESIGN: In a prospective study, a structured clinical interview (Structured Clinical Interview for DSM-IV-TR) was used to identify DSM-IV-defined major depressive disorder (MDD) symptoms among patients with traumatic brain injury (TBI). NFI Depression scale items were compared with DSM-IV diagnosis obtained by the Structured Clinical Interview for DSM-IV Axis I Disorders. SETTING: Outpatient neuropsychology clinic at a university hospital, private outpatient physical medicine and rehabilitation clinic, and a long-term specialized living assistance program. PARTICIPANTS: Participants consisted of 78 patients with TBI who were at least 3 months postinjury and 18 years of age or older. MAIN OUTCOME MEASURES: Structured Clinical Interview for DSM-IV Axis I Disorders and the NFI. RESULTS: Psychiatric diagnostic interview with the Structured Clinical Interview for DSM-IV Axis I Disorders indicated that 50% of patients with TBI in our sample had at least one of the following in their lifetime: MDD, MDD due to general medical condition, dysthymia, or adjustment disorder with depressed mood. Thirty percent met diagnostic criteria for current MDD with or without general medical condition. Analyses of the NFI items revealed that individuals with depression endorsed greater levels of problems than did those without depression on 14 of the 32 items related to the DSM-IV symptom domains for depression (P < .00156 with Bonferroni correction). In predicting the diagnosis of depression using individual NFI items, the classification rate based on the Random Forests estimate was 83%. CONCLUSION: Findings indicate that the NFI items differentiated between depressed and nondepressed patients with TBI. Imposing minimal burden on patients and staff, the NFI appears to have good predictive value in diagnosing major depression. In clinical practice and research, the NFI is a potentially valuable screening tool for identifying major depression in persons with TBI.

Adolescent↗
PubMed1999

Slapping and spanking in childhood and its association with lifetime prevalence of psychiatric disorders in a general population sample.

BACKGROUND: Little information is available in Canada about the prevalence of and outcomes associated with a history of slapping and spanking in childhood. The objectives of this study were to estimate the prevalence of a history of slapping or spanking in a general population sample and to assess the relation between such a history and the lifetime prevalence of psychiatric disorders. METHODS: In this general population survey, a probability sample of 9953 residents of Ontario aged 15 years and older who participated in the Ontario Health Supplement was used to examine the prevalence of a history of slapping and spanking. A subgroup of this sample (n = 4888), which comprised people aged 15 to 64 years who did not report a history of physical or sexual abuse during childhood, was used to assess the relation between a history of slapping or spanking and the lifetime prevalence of 4 categories of psychiatric disorder. The measures included a self-administered questionnaire with a question about frequency of slapping and spanking during childhood, as well as an interviewer-administered questionnaire to measure psychiatric disorder. RESULTS: The majority of respondents indicated that they had been slapped or spanked, or both, by an adult during childhood "sometimes" (33.4%) or "rarely" (40.9%); 5.5% reported that this occurred "often." The remainder (20.2%) reported "never" experiencing these behaviours. Among the respondents without a history of physical or sexual abuse during childhood, those who reported being slapped or spanked "often" or "sometimes" had significantly higher lifetime rates of anxiety disorders (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.04-1.96), alcohol abuse or dependence (adjusted OR 2.02, 95% CI 1.27-3.21) and one or more externalizing problems (adjusted OR 2.08, 95% CI 1.36-3.16), compared with those who reported "never" being slapped or spanked. There was also an association between a history of slapping or spanking and major depression, but it was not statistically significant (adjusted OR 1.64, 95% CI 0.96-2.80). INTERPRETATION: There appears to be a linear association between the frequency of slapping and spanking during childhood and a lifetime prevalence of anxiety disorder, alcohol abuse or dependence and externalizing problems.

Adolescent↗
PubMed1983

Reliability of DSM-III anxiety disorder categories using a new structured interview.

The reliability of DSM-III anxiety disorder diagnoses was determined using a new structured interview, the Anxiety Disorders Interview Schedule (ADIS). Two interviewers examined 60 consecutive outpatients at an anxiety disorders clinic and assigned primary and secondary diagnoses based on the ADIS. The kappa statistic, calculated on the basis of perfect matches on primary diagnoses, indicated good agreement for anxiety, affective, and adjustment disorders, as well as for the specific anxiety disorder categories of agoraphobia, panic, social phobia, and obsessive-compulsive disorder, but not for generalized anxiety disorder. We evaluated the causes for diagnostic disagreement, particularly in relation to the difficult differentiation between generalized anxiety disorder and other anxiety disorders.

Anxiety Disorders↗
PubMed2006

[Predictors of the discharge status in acute day-hospital and inpatient care - a comparison between the two settings within a randomised controlled trial].

OBJECTIVE: To search for predictors of the discharge status in day-hospital patients and inpatients, within a randomized controlled trial on the effectiveness of acute psychiatric day hospital treatment as compared to inpatient treatment. METHOD: The study was conducted at the Department of Psychiatry and Psychotherapy, Dresden University of Technology. Regression analyses assessing the relationship between theoretically chosen predictor variables and the discharge status as measured using the Brief Psychiatric Rating Scale (BPRS 4.0) were conducted on a sample of 69 day-hospital patients and a sample of 76 inpatients. RESULTS: In both settings, admission status was the strongest predictor of discharge status. As concerns day-hospital patients, those suffering from a personality disorder as well as those showing a higher degree of social disability were discharged with a higher level of psychopathological symptoms. Among inpatients, those suffering from an anxiety, obsessive-compulsive, or adjustment disorder as well as those being retired or unemployed benefited less from treatment. CONCLUSIONS: Given the explorative character of the present study, further prospective studies are needed in order to cross-validate findings on the potential criteria for allocating acute mentally ill either to day-hospital or inpatient treatment.

Adult↗
PubMed1992

Psychiatric diagnoses of maltreated children: preliminary findings.

The study sample consists of 96 children (61 maltreated, 35 controls) between 5 and 10 years of age. The two groups of subjects were compared on diagnoses as determined by the administration of the Diagnostic Interview for Children and Adolescents, Revised 6th Version (DICA-6-R) as well as clinical DSM-III-R diagnoses. Children who had suffered maltreatment exhibited significantly greater incidences of attention deficit hyperactivity disorder, oppositional disorder and post-traumatic stress disorder diagnoses than did controls, on both child and parent DICA interviews. The children's interviews revealed that maltreated children present with a significant incidence of psychotic symptomatology as well as personality and adjustment disorders. Conversely, conduct and mood disorders emerged as significant factors in the parent interviews, with the maltreated group showing significantly greater incidence of these diagnoses.

Child↗
PubMed1998

Depression and social functioning in general hospital in-patients.

Impairment of social functioning is often associated with depression and contributes to an unfavorable course of the disease. Although it must be suspected that both social maladaptation and depression could obstruct recovery from somatic diseases, little attention has been paid to their interaction in general hospital patients. To assess social integration in depressive and psychiatrically healthy general hospital in-patients, 250 patients were studied with the Composite International Diagnostic Interview (CIDI), a structured clinical interview, and the Social Interview Schedule (SIS). From clinical interviews, it was established that 16.4% of the patients suffered from depressive disorders (ICD-10). When these patients were compared with patients without psychiatric disorder, only a tendency to social dysfunctioning with regard to social management and satisfaction with social situations was observed. But when the depressive sample was divided into three diagnostic groups (depressive episode, dysthymia, depressive adjustment disorder), significant social impairments were found in the dysthymia subsample. Family and other interpersonal problems were most prominent. When depression preceded somatic illness, a higher level of impairment was observed. The majority of dysthymia patients suffered from long-term somatic diseases, often cancer, which were preceded by depression. The results of this study single out a small group of patients who seem to be at an extensive risk of chronic psychiatric and somatic illnesses and should therefore be a focus of consultation/liaison (C/L) interventions.

Aged↗
PubMedDate not supplied

[Findings in HIV infected patients in a psychiatry unit].

A study has been made of 107 HIV infected patients by the C/C. Psychiatry unit in the department of infections diseases, during 1987-1988. In this group the psychiatrist studied the following factors: the AIDS risk group, HIV infection stages, the somatic disorders and the neuropsychiatric complications. Also are described the different aspects of the therapy. The results from the study show that 95% were drug abusers and the most common psychopathological diagnosis were delirium and adjustment disorders.

AIDS Dementia Complex↗
PubMed2006

A double-blind, multicenter, parallel-group study of paroxetine, desipramine, or placebo in breast cancer patients (stages I, II, III, and IV) with major depression.

OBJECTIVE: This study compared the efficacy and safety of paroxetine and desipramine with those of placebo in the treatment of depressive disorders in adult women with breast cancer, stages I-IV. METHOD: In a double-blind, placebo-controlled study, 35 female outpatients with breast cancer and DSM-III-R major depression or adjustment disorder with depressed mood were randomly assigned to treatment with paroxetine (N=13), desipramine (N=11), or placebo (N=11) for 6 weeks. Primary efficacy was assessed by change from baseline in score on the 21-item Hamilton Rating Scale for Depression (HAM-D), and the secondary outcome measure was change from baseline in the Clinical Global Impressions-Severity of Illness scale (CGI-S) score. RESULTS: Mean changes in the total HAM-D and CGI-S scores from baseline to 6-week endpoint for the paroxetine and desipramine groups were not significantly different than those for the placebo-treated group. An unusually high rate of response (defined as >or=50% improvement in the HAM-D score) in the placebo group was observed (55% [N=6]); adverse events precipitated patient discontinuation in the active treatment groups (9% [N=1] for desipramine, 15% [N=2] for paroxetine) similar to that in the placebo-treated patients (18% [N=2]). Improvement on symptom dimensions within the HAM-D and Hamilton Rating Scale for Anxiety (depressive, anxiety, cognitive, neurovegetative, or somatic) was also similar between groups. CONCLUSION: The small number of women in this study most likely contributed to the lack of observed differences in efficacy observed during the 6 weeks of treatment. Randomized, placebo-controlled trials of adequate power seeking to determine efficacy of antidepressants in the United States for the treatment of women with breast cancer and comorbid depression remain of paramount importance.

Adult↗
PubMed1991

[Hiv patients in a psychiatric outpatient clinic].

The most often reported psychiatric complications among HIV-infected outpatients include: mood and anxiety disorders, and alcohol or nonopiate drug abuse. Medical records of 32 HIV-infected psychiatric outpatients in the Netherlands were studied. The most common DSM-III(-R) diagnoses included: major depression (n = 10) and adjustment disorder with depressive or anxious mood (n = 10). The psychiatric treatment of the HIV-infected outpatients did not differ fundamentally from the treatment of other psychiatric outpatients with similar problems. The increasing number of HIV infected patients in the Netherlands living outside of Amsterdam, would appear to urge more education of psychiatric and other health care professionals concerning specific aspects of HIV infection, homosexuality, prostitution and intravenous drug abuse.

AIDS Dementia Complex↗
PubMed2006

Premorbid adjustment in bipolar disorder: comparison with schizophrenia.

Knowledge that poor premorbid adjustment (PMA) precedes illness onset in many schizophrenia cases can facilitate early detection. Increasing consideration is being given to a similar early detection strategy for bipolar disorder (BPD). Results of this preliminary investigation comparing PMA in BPD (N = 53) and schizophrenia (N = 39) outpatients revealed a significant difference at the late adolescent (F[1,58] = 4.499, p = 0.038) stage only, with specific differences in two areas of PMA: adaptation to school (t [58] = 1.83, p = 0.036) and social sexual functioning (t [58] = 2.441, p = 0.009). However, mood state may affect some PMA ratings in BPD. Depression ratings were not correlated with reported late adolescent PMA, but a significant, positive correlation was found for the childhood stage (r = 0.32, p = 0.02). Findings fail to support a trend similar to schizophrenia of deteriorating PMA in BPD; however, the approach to investigations of PMA in BPD may need to be reconsidered.

Adaptation, Psychological↗