Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Adjustment Disorders”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 577 records · Page 32Linked to original sources
PubMed1989

Psychiatric consultation on an otolaryngology liaison service.

Otolaryngology patients (especially those with tracheostomies) present a significant challenge to psychiatrists from both a diagnostic and therapeutic standpoint. To date, no study has been made of psychiatric disorders among this important group of patients. At the Mount Sinai Medical Center, a liaison psychiatrist has been involved with a specialized otolaryngology cluster unit since 1979. Using a 384-item computerized database protocol developed at Mount Sinai, data on 139 otolaryngology patients were recorded and compared with 1662 "Other" inpatient psychiatric consultations on the medical and surgical services during 1980-1987. The otolaryngology patients as a group were more likely to be male (p = 0.011), married (p = 0.001) and employed (p less than 0.001). Cancer was the most common medical disorder, and the average level of stress as reported on DSM-III's Axis IV (5.1, severe) was significantly greater (p less than 0.0001) than that for the "Other." The most common psychiatric response was adjustment disorder (36%). The length of stay of those ENT patients seen in psychiatric consultation was 26.4 days, in contrast to 11.1 days for all ENT patients. However, the length of stay of those patients on ENT receiving a psychiatric consultation was not different from the "Other" psychiatric consultation cohort (26.3 days). Despite the higher level of stress, the incidence of significant psychiatric morbidity was lower for the ENT cohort. The primary effect of the liaison psychiatrist was to lower the threshold for case identification that enhanced the referral rate on the ENT unit.

Adaptation, Psychological↗
PubMed1995

Case report: concordant traumatic brainstem contusion delayed diagnosis in a young man with Wilson's disease.

Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism. The corresponding gene locus has been localized on the long arm of chromosome 13. Three different clinical variants of the disease can be distinguished: hepato-cerebral, abdominal/hepatic, and central nervous type. The heterogeneity of symptoms can cause problems in differential diagnosis, especially when another concordant disorder can also explain the pathogenesis of symptoms. The case report of a young man who suffered from brainstem contusion demonstrates the possibilities of misinterpretation because presenting symptoms could be attributed either to traumatic brain injury followed by adjustment disorder or Wilson's disease. Clinical signs included leftsided hemiparesis, bilateral gaze direction nystagmus, marked dysarthria with consecutive pervasive mutism, choreo-athetoid movements, spasmodic torticollis and diplopia dependent on gaze direction. Slit lamp examination showed Kayser-Fleischer's corneal ring. EEG- and computer assisted tomography investigations revealed non-specific findings. The patient was treated with D-Penicillamine. Alternative treatment with oral zinc preparations is discussed.

Adolescent↗
PubMed1995

International study of expert judgement on therapeutic use of benzodiazepines and other psychotherapeutic medications: II. Pharmacotherapy of anxiety disorders.

OBJECTIVE: To assemble expert clinical experience and judgement in the treatment of anxiety and related disorders in a systematic, quantitative manner. METHODS: A panel of internationally recognized Experts in treating anxiety and depression was constituted by multistage peer nomination. 90% completed a questionnaire. This report focuses on case vignettes of 7 anxiety disorders followed by questions about relevant therapeutic options. RESULTS: Panelists usually recommended both psychological and pharmacological interventions. Most favored antidepressants, usually tricyclic, for agoraphobia, panic and OCD; beta-blockers for specific social phobia; and benzodiazepines for GAD and adjustment disorder. Some Experts favored polypharmacy, usually an antidepressant and a benzodiazepine. The majority usually advocated pharmacotherapy for 6 months or more. They recommended the same duration of treatment with benzodiazepines and other medications, except for GAD. CONCLUSIONS: The responses of the Expert Panel imply that; (1) most anxiety disorders are serious and merit vigorous, prolonged pharmacotherapy; and (2) antidepressants and benzodiazepines are effective and safe for long-term treatment of these conditions. This outcome contrasts with the widespread apprehension about long-term pharmacotherapy, especially with benzodiazepines, and some regulatory views.

Anti-Anxiety Agents↗
PubMed2003

Eating disorders and type 1 diabetes mellitus in adolescence.

One of the main difficulties in managing type 1 diabetes mellitus (T1DM) in the young is nutritional treatment. Studies have shown that adolescents (particularly adolescent girls and young women) have an increased risk for clinical and sub-clinical eating disorders. Adjustment to the nutritional regimen and, consequently, to the management of the disease in adolescence seems to involve a complex interplay of various psychosocial and biological aspects. The aim of this review is to consider the relationship between T1DM and eating disorders in adolescence in the light of some important biological psychological and familial factors. Further research is required in order to detect the degree of the interactions between these factors in adolescents with T1DM.

Adaptation, Psychological↗
PubMed1999

Use of psychiatrists, psychologists, and master's-level therapists in managed behavioral health care carve-out plans.

OBJECTIVE: Outpatient claims data from a managed behavioral health company for 1996 were examined to determine the extent to which patients received services from different types of mental health care providers. METHODS: Claims data for 1996 were obtained from 75 plans with more than 600,000 members that were managed by one behavioral health care organization. Data were examined by type of provider and diagnosis. RESULTS: A total of 349,686 claims were examined. Doctoral-level psychologists accounted for most claims (33.4 percent), followed by psychiatrists (30.5 percent), social workers (19.8 percent), and other master's-level therapists (13.8 percent). Ninety-five percent of patients with a psychotic disorder and 86.2 percent of individuals with bipolar disorder were seen either by a psychiatrist alone or by a psychiatrist in combination with another provider. Among depressed patients, 62.9 percent were seen by a psychiatrist, alone or in combination with another provider. Only 23 percent of patients with an adjustment disorder and 14.1 percent of those with a V-code diagnosis were treated by a psychiatrist, alone or in combination with another provider. Because psychiatrists treated sicker patients, their proportion of patients treated (24.7 percent) was smaller than their proportion of all claims filed. Most patients (78.9 percent) saw only one type of provider. CONCLUSIONS: The results allay concerns that managed care shifts patients away from psychiatrists to doctoral-level psychologists and less expensive providers. The majority of patients with depressive disorders and almost all patients with psychotic disorders had contact with a psychiatrist.

Behavioral Medicine↗
PubMed1989

DSM-III disorders in a large sample of psychiatric patients: frequency and specificity of diagnoses.

This study examined certain nosological features of DSM-III axis I diagnostic categories and subcategories as applied to 11,292 general psychiatric patients presenting for care, using a semistructured assessment procedure. The most frequently used major categories were affective, substance use, childhood-onset, and adjustment disorders. Secondary diagnoses were given to 26% of the patients. Male patients predominated in the categories of impulse-control, psychosexual, and substance use disorders, and female patients predominated in the categories of anxiety, affective, and somatoform disorders. Of the 329 five-digit subcategories available in DSM-III, 296 (90%) were actually used. Sixteen percent of the patients were given unspecific primary diagnoses.

Adolescent↗
PubMed2000

Pathways and outcomes of psychiatric care: does it depend on who you are, or what you've got?

OBJECTIVES: To investigate predictors of outcome and cost for patients treated by Mental Health Services in the south metropolitan area of Perth using logistic regression to control for potential confounding factors. METHOD: Data were collected over a 3-month period on 2691 subjects (47% male, 53% female) as part of the Mental Health Classification and Services Cost Project. RESULTS: The average age of subjects was 44.3 years. Nearly 80% of care occurred in community settings and virtually all inpatient care was for acute emergencies. The most common diagnosis was schizophrenia (33%) followed by mood disorders (30%). Within the study period, 88% of patients had only one episode of care (n = 2361) and a further 8% two (n = 223). Patients with schizophrenia were one-third as likely to be discharged from care (95% CI = 0.2-0.4) and 30% as likely to have longer episodes of care (95% CI = 1.1-1.6). Patients with personality, substance or adjustment disorders spent less time in treatment, and those with personality or substance disorders were more likely to be discharged from psychiatric care. A past history of inpatient care was associated with a worse outcome in terms of length of care, or not being successfully discharged. Severity of illness as determined by involuntary treatment or elevated Health of the Nation Outcome Scales and Life Skills Profile (LSP) scores was associated with increased costs. Greater disability on the LSP was also associated with increased length of care. Sociodemographic factors were as least as important as diagnosis in predicting the cost and outcome of treatment. CONCLUSIONS: Demographic factors may better predict increased health service use than diagnostic casemix. Since sociodemographic variables contribute as much to outcome as diagnosis, comparing results between units is likely to be misleading unless adjusted for these factors.

Adult↗
PubMed1990

Prevalence of psychiatric disorders in a mandatory screening program for infection with human immunodeficiency virus: a pilot study.

Ninety-five randomly selected human immunodeficiency virus (HIV)-seropositive Air Force personnel were psychiatrically examined during a routine medical evaluation. Of the 95, 95% did not have acquired immunodeficiency syndrome and were largely asymptomatic; 61.1% had clinical axis I diagnoses, which included simple phobia, adjustment disorders, hypoactive sexual desire disorder, alcohol use disorder, major depression, and organic mental disorders; 30.5% had personality disorders. Significantly higher frequencies (p less than 0.05) of simple phobia and hypoactive sexual desire disorder were noted with knowledge of HIV seropositivity. Disorders that occurred more commonly than in age-matched Epidemiologic Catchment Area (ECA) participants included: simple phobia, antisocial personality disorder, alcohol abuse, and organic mental disorders. The high prevalence of major psychiatric illness in this sample supports the notion that screening for psychiatric illness, and counseling where indicated, should be integral to HIV screening programs.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The prediction of suicidal intent in depressed patients.

The aim of the present study was to examine the relationships between suicidal ideation or suicidal attempts and severity of depression, presence of personality disorders, and sociodemographic factors in a population of depressed in-patients. A total of 338 adult depressed psychiatric in-patients were examined and classified according to DSM-III criteria as having major depression with or without melancholic or psychotic features, adjustment disorder with depressed mood or dysthymic disorder. Scores on the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and Zung Self-Rating Depression and Anxiety Scales (SDS and SAS) were measured. We found that suicidal ideation was significantly related to severity of depression (according to the HDRS and all self-rating scales), a lower global assessment of functioning the year before hospitalization, and previous psychiatric hospitalizations. The items with the strongest predictive value for suicidal ideation were hopelessness, depressed mood, feelings of guilt, loss of interest and low self-esteem. These symptoms predicted 43% of the variance in suicidal ideation. None of the above predictors of suicidal ideation was related to suicidal attempts. Depressed patients with a personality disorder attempted significantly more suicidal attempts and showed more suicidal ideation than depressed patients without personality disorder. No significant correlations were found between suicidal ideation or suicide attempts and gender, marital status, employment status or psychosocial stressors during the previous 6 months.

Adolescent↗
PubMed2006

Catatonia in individuals with autism spectrum disorders in adolescence and early adulthood: a long-term prospective study.

The objective is to cast light on diagnosis and catastasis, course, and comorbidity as concerned with catatonia in patients with autism spectrum disorders (ASDs) with respect to long-term prospective follow-up. Eleven patients (all male) were enrolled. The mean age and the mean follow-up duration were 27.6 years (standard deviation (SD) 5.5) and 18.7 years (SD 8.7), respectively. The mean IQ was 27 (SD 16.4). Information was garnered from medical case records; current examination and observation of patients, interview of parents, and questionnaires completed by parents or other caretakers. Informed consent was obtained from the parents. Criteria for catatonia in this study were: (1) abrupt stop of movements and maintenance of immobility or bizarre posture beginning in adolescence and early adult life, (2) such a cataleptic state had continued for at least several minutes and appeared many times a day to the point of interfering with daily activities. We described two typical catatonic cases of ASDs. The average onset age was 19 years (SD 6). In all cases, our diagnostic criteria of catatonia evaluating at worse are fully compatible with those of Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-VI). In 8 out of 11, the onset of catatonia was clearly preceded by the appearance of slowness in movements accompanying the exacerbation of obsessive-compulsive symptoms. Catatonia was also found to have some connection with Tourette syndrome (3 cases), adjustment disorders (N=1), and depressive mood disorders (N=1). In one case, the manifestations of catatonia had to be distinguished from parkinsonism caused by antipsychotics. Catatonia in ASDs seems to be a chronic condition in most cases. However, there were also a few cases in which catatonia repeatedly aggravated over short spans of time. Catatonia in ASDs may be considered an epiphenomenon of ASDs or a manifestation of comorbidity in adolescence or early adulthood.

Adolescent↗
PubMed1988

The course of depression in elderly outpatients.

Sixty-four elderly outpatients diagnosed according to the criteria of DSM-III as having affective disorders were submitted to follow-up study for 6-24 months (mean 15 months). Twenty patients (31%) were in good health throughout follow-up, fourty-four patients (69%) remained more or less chronically ill. The prognosis was better in patients diagnosed as having "adjustment disorder with depressed mood" and "dysthymic disorder"; when onset was late, and when there were no signs of organic brain C.N.S. damage.

Aged↗
PubMedDate not supplied

[Psychiatric disorders in hospitalized patients with hematologic neoplasms].

We report the results of a year of regular psychiatric support in the Hematology Department (UTI-DH) at Santa Maria Hospital. During a six-month period, the total group of hospital inpatients suffering from leukemia, Hodgkin's disease or non-Hodgkin's lymphoma, were assessed, using a semi-structured interview. A prevalence of 30% of adjustment disorders (depression and/or anxiety) and 2% of organic mental syndromes was found employing the DSM-III-R diagnostic system. In the second six-month period only patients referred by their doctor and/or nurse were observed. The two rates are discussed. A lower prevalence was found if compared with other studies in cancer patients in general. Possible causes will be focussed. General problems related to the nature of the cancer were identified. The consequences of the omission of cancer diagnosis to patients are analysed. The communication between physician and patient which is often neglected irrespectively of the culture or country, is stressed.

Adolescent↗
PubMed2006

What drives referral from primary care physicians to mental health specialists? A randomized trial using actors portraying depressive symptoms.

BACKGROUND: Referral from primary care to the mental health specialty sector is important but poorly understood. OBJECTIVE: Identify physician characteristics influencing mental health referral. DESIGN: Randomized controlled trial using Standardized Patients (SPs). SETTING: Offices of primary care physicians in 3 cities. PARTICIPANTS: One hundred fifty-two family physicians and general internists recruited from 4 broad practice settings; 18 middle aged Caucasian female actors. INTERVENTION: Two hundred and ninety-eight unannounced SP visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. MEASUREMENTS: Mental health referrals via SP written reports; physician and system characteristics through a self-administered physician questionnaire. RESULTS: Among 298 SP visits, 107 (36%) resulted in mental health referral. Referrals were less likely among physicians with greater self-confidence in their ability to manage antidepressant therapy (adjusted odds ratio [AOR] 0.39, 95% confidence interval [CI] 0.17 to 0.86) and were more likely if physicians typically spent > or =10% of professional time on nonclinical activities (AOR 3.42, 95% CI 1.45 to 8.07), had personal life experience with psychotherapy for depression (AOR 2.74, 95% CI 1.15 to 6.52), or usually had access to mental health consultation within 2 weeks (AOR 2.94, 95% CI 1.26 to 6.92). LIMITATION: The roles portrayed by SPs may not reflect the experience of a typical panel of primary care patients. CONCLUSIONS: Controlling for patient and health system factors, physicians' therapeutic confidence and personal experience were important influences on mental health referral. Research is needed to determine if addressing these factors can facilitate more appropriate care.

Adult↗
PubMed1999

Attention-deficit/hyperactivity disorder in preschoolers. Does it exist and should we treat it?

The diagnosis of ADHD in preschool-aged children is difficult. High activity level, impulsivity, and short attention span--to a degree--are age-appropriate characteristics of normal preschool-aged children. However, excessive levels of these characteristics impede successful socialization, optimal learning, and positive parent-child interaction. Environmental stressors, inadequate parenting skills, and other diagnoses such as oppositional defiant, posttraumatic stress, or adjustment disorders can mimic ADHD. Although labeling may be necessary to obtain services, the emphasis should be placed on symptom resolution, given the uncertainties of diagnostic accuracy in this age group. Deferring a specific diagnosis of ADHD until confounding issues are clarified should be considered. The evaluation of serious behavior problems in young children must include a comprehensive consideration of environmental, health, cognitive, educational, and behavioral interactions. Both assessment and intervention should focus on the interactions between the child and his or her environment to determine how they facilitate or hinder adaptive integration as both the child and surroundings change and evolve. Treatment invariably necessitates involvement of a child and family psychotherapist or counselor to address behavior management strategies as well as family dynamics, parental psychopathology, or life stress. Parents must understand that counseling is an essential component of treatment and that they must be active participants. Psychopharmacologic intervention may be appropriate in some instances, although conventional wisdom suggests caution in young children, given the limited information about safety and efficacy of many agents, especially in children younger than 3 years old. Stimulants appear to be safe in older preschool-aged children. Children started on medication should be monitored closely for both positive and negative effects. A double-blinded, placebo-controlled trial of medication is warranted in equivocal situations.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Risk of substance use disorders in adolescents with bipolar disorder.

OBJECTIVE: Previous work in adults and youths has suggested that juvenile onset bipolar disorder (BPD) is associated with an elevated risk of substance use disorders (SUD). Considering the public health importance of this issue, the authors now report on a controlled study of adolescents with and without BPD to evaluate the risk of SUD. METHOD: Probands with DSM-IV BPD (n=57, mean age +/- SD=13.3 +/- 2.4 years) and without DSM-IV BPD (n=46, 13.6 +/- 2.2 years) were studied. Structured psychiatric interviews and multiple measures of SUD were collected. RESULTS: Bipolar disorder was associated with a highly significant risk factor for SUD (32% versus 7%, Z=2.9, p=.004) that was not accounted for by conduct disorder (adjusted odds ratio=5.4, p=.018). Adolescent-onset BPD (> or =13 years) was associated with a higher risk of SUD compared with those with child-onset BPD (chi1=9.3, p=.002). CONCLUSIONS: These findings strongly indicate that BPD, especially adolescent onset, is a significant risk factor for SUD independently of conduct disorder.

Adolescent↗
PubMed1991

Short-term effect of occlusal adjustment on craniomandibular disorders including headaches.

The aim of this study was to assess the short-term effect of occlusal adjustment on craniomandibular disorders. Fifty patients were randomly selected and divided into a treatment (T) and a control (C) group. The initial clinical examination and the follow-up were made by one observer and the occlusal adjustment by another. There were no significant differences between groups with regard to frequency of headaches, facial pain, pain on mandibular function, or duration of headaches and facial pain. Fifty-two percent of the patients in the treatment group and 20% of the patients in the control group reported reduced subjective symptoms overall at follow-up examination. The improvement was statistically significant within the T group and significantly greater than in the C group. There was no significant change within or between groups with regard to frequency of headaches, facial pain, or pain on mandibular movements. There was an almost significant difference between groups after treatment with regard to changes in the number of tender muscles. The results of this study indicate that occlusal adjustment provides a general subjective improvement of craniomandibular disorders.

Adolescent↗
PubMed2006

Disparities in diagnoses received prior to a diagnosis of autism spectrum disorder.

This study estimated differences by ethnicity in the diagnoses assigned prior to the diagnosis of autism. In this sample of 406 Medicaid-eligible children, African-Americans were 2.6 times less likely than white children to receive an autism diagnosis on their first specialty care visit. Among children who did not receive an autism diagnosis on their first visit, ADHD was the most common diagnosis. African-American children were 5.1 times more likely than white children to receive a diagnosis of adjustment disorder than of ADHD, and 2.4 times more likely to receive a diagnosis of conduct disorder than of ADHD. Differences in diagnostic patterns by ethnicity suggest possible variations in parents' descriptions of symptoms, clinician interpretations and expectations, or symptom presentation.

Black or African American↗
PubMed1995

Management of behavioral emergencies.

Accurate diagnosis and a clear management approach are the most important considerations in caring for behaviorally disordered emergency department patients. Treating behavioral emergencies often precedes an accurate diagnosis. A useful approach is differentiating emergencies that need nonpharmacological intervention, minimal pharmacological intervention, or maximal pharmacological intervention. Conditions that require nonpharmacological interventions include suicidal state, homicidal state, self-neglect state, abuse state, and conditions primarily requiring an organic workup. Behavioral emergencies usually requiring minimal pharmacological intervention include adjustment disorder, acute grief, rape and assault, and borderline personality disorder. Behavioral emergencies requiring maximal pharmacological intervention include assault, agitated psychosis, exacerbation of bipolar disorder, exacerbation of schizophrenia, brief reactive psychosis, delirium, dementia, substance withdrawal, and substance intoxication accompanied by violent behavior.

Diagnosis, Differential↗