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PubMedDate not supplied

Measuring psychological outcomes following rehabilitation.

Recent literature leaves little doubt that people with disabilities experience depressive and adjustment disorders at a greater rate that those in the general population. Differences between rates detected in different studies, however, prompt researchers to explore the definition of depression as applied to people with a disability, and to challenge the long-held notions that everyone with a disability undergoes depression at one time or another as part of the process of adjustment to disability. The present study measures the two related, but theoretically distinct, constructs of depression and adjustment to disability in a sample of spinal cord injured adults interviewed at one, four and twelve months post-rehabilitation. On the basis of these data, a two-dimensional measurement model is empirically developed for psychological outcomes, with the two dimensions representing adjustment and depression. The measurement model is supported by data at all three time intervals and by a number of different analyses. These findings underline the importance of distinguishing between depression and adjustment both in clinical applications and in research.

Adaptation, Psychological↗
PubMed2000

Trends in special (high-security) hospitals. 1: Referrals and admissions.

BACKGROUND: Special hospitals in England provide psychiatric care and treatment in high security. Their future is often questioned. AIMS: To test for variation in demand for high-security psychiatric services over one 10-year period. METHOD: This study was from the special hospitals' case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by health region; admission episodes; legal category of detention; admission source and type of offence. RESULTS: Referrals to special hospitals showed no decrease during the 10 years; an apparent increase may reflect underrecording before 1992. Admissions fell by about 16% over the 10 years, but with regional variation. Women, civil cases, admissions under the MHA classifications of psychopathic disorder or mental impairment and directly from a court on a hospital order were most affected. There was an increase in admissions of pre-trial and sentenced male prisoners, and of transferred hospital order patients from other hospitals. CONCLUSIONS: There is continuing demand from all parts of the country for high-security hospital beds. The smaller numbers admitted appear to include more demanding cases.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Nonpsychiatrist house staff frequently misdiagnose psychiatric disorders in general hospital inpatients.

Nonpsychiatric house staff referring inpatients for psychiatric consultation were asked to make a psychiatric diagnosis before their patients were evaluated by the consultants. The psychiatrists confirmed this diagnosis in only 22% of patients age 50 years and older, but in 68% of patients under age 50. Referring physicians identified 27 cases of major depression; the psychiatric consultants agreed with this diagnosis in only 6 (22%) of these patients. In the remaining 21 patients, the psychiatrists identified 10 cases of delirium, 7 cases of adjustment disorder, and 4 cases of various other conditions. These results suggest that nonpsychiatric house staff frequently misidentify other psychiatric conditions as major depression and that the psychiatric diagnosis of older patients by nonpsychiatrist house staff is far more problematic than the diagnosis of younger patients.

Adult↗
PubMed1999

Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale.

The psychometric properties of the Italian version of the Hospital Anxiety and Depression Scale and its utility as a screening instrument for anxiety and depression in a non-psychiatric setting were evaluated. The questionnaire was administered twice to 197 breast cancer patients randomised in a phase III adjuvant clinical trial: before the start of chemotherapy and at the first follow-up visit. The presence of psychiatric disorders was evaluated at the follow-up visit using the Structured Clinical Interview for DSM-III-R in 132 patients. Factor analyses identified two strictly correlated factors. Crohnbach's alpha for the anxiety and depression scales ranged between 0.80 and 0.85. At follow-up, 50 patients (38%) were assigned a current DSM-III-R diagnosis, in most cases adjustment disorders (24%) or major depressive disorder (10%). Receiver operating characteristics (ROC) analysis was used to test the discriminant validity for both anxiety and depressive disorders. The comparison of the areas under the curve (AUC) between the two scales did not show any difference in identifying either anxiety (P = 0.855) or depressive disorders (P = 0.357). The 14-item total scale showed a high internal consistency (alpha = 0.89 and 0.88) and a high discriminating power for all the psychiatric disorders (AUC = 0.89; 95% CI = 0.83-0.94). The cut-off point that maximised sensitivity (84%) and specificity (79%) was 10. These results suggest that the total score is a valid measure of emotional distress, so that the Italian version of HADS can be used as a screening questionnaire for psychiatric disorders. The use of the two subscales as a 'case identifier' or as an outcome measure should be considered with caution.

Adult↗
PubMed1991

Geropsychiatry in long-term care: a nurse-centered approach.

High prevalence rates of psychiatric disorders and disruptive behaviors in nursing home residents create the need for structured programs of psychiatric consultation and teaching in the long-term care setting. Over 40 months, 473 residents were evaluated by a psychiatric consultation-liaison clinical nurse specialist; 100 of these cases were reviewed in detail. Apparent depression was the most common reason for referral, and depressive and adjustment disorders were the most common diagnostic conclusions of the consultation team. Behavioral complications of dementia were also frequently diagnosed. Treatment recommendations usually included the development of a behavioral management plan, but the institution of psychotropic medications, usually antidepressants, was indicated in about one-fifth of the 100 cases. Treatment interventions were effective in the majority of cases. About one-half of the problems prompting referral were within the expertise of the nurse specialist and did not require the direct involvement of the geropsychiatrist. This nurse-centered consultation model proved effective, well accepted, and easy to implement.

Aged↗
PubMed1994

Axis V--Global Assessment of Functioning Scale. Evaluation of a self-report version.

The present study examines a self-report version of the Global Assessment of Functioning Scale according to Axis V (GAF self-report). The sample (n = 73) was a psychiatric outpatient population from a catchment area clinic. Patients with psychotic and organic mental disorders were not included. The diagnostic distribution on Axis I was similar to the findings from previous studies. Axis II disorders were identified among 47%, of whom a majority also had a concomitant Axis I disorder. The mean GAF expert score was 66.5 (range: 48-86). High complexity and severity of disorders and a high number of fulfilled Axis II criteria were significantly associated with low GAF scores. Independent expert ratings on GAF were correlated with the GAF self-report overall at r = 0.62, varying from 0.45 to 0.91 between different diagnostic groups. In general, the patients scored themselves lower (mean: -4.4 units) than expert ratings. Patients with depressive symptoms from an adjustment disorder or mood disorder were most prone to underestimation. Women also tended to score themselves lower than experts did. Conclusively, the GAF self-report turned out to be a valid and reliable unidimensional instrument measuring psychological, social and occupational functioning. The GAF is easy to handle, and with a self-report version as a complement, Axis V could be more frequently used in future clinical practice and research.

Activities of Daily Living↗
PubMed1997

A topography of psychiatric disorders among correction officers.

This study assessed the nature, scope, and work-related impact of psychiatric disorders among correction officers. It also examined the effect of psychiatric diagnoses on occupational functioning. Medical charts of 1029 correction officers with complaints of psychological distress were reviewed for DSM-III-R diagnoses and duration of disability. Subjects evinced a wide range of psychiatric conditions, accounting for a substantial loss of full-duty workdays. The most frequently observed diagnoses were V Codes, mood and adjustment disorders. The most disabling conditions in terms of duration of disability were mood, anxiety, and personality disorders. V Codes accounted for the highest cumulative duration of disability among all officers. Results suggest that psychiatric disability among correction officers is most often a function of V-Code conditions, as opposed to major Axis I or II psychopathology.

Adult↗
PubMed2002

Psychotropic medication use in a population of children who have attention-deficit/hyperactivity disorder.

OBJECTIVE: Recent reports suggest a trend of increasing prevalence of psychotropic drug prescriptions among children with attention-deficit/hyperactivity disorder (ADHD); however, reasons for the increased use of such medications is unclear. The objectives of this study were to examine differences in nonstimulant psychotropic medication fills between children with and without identified ADHD and to assess associations with non-ADHD neurobehavioral disorders. METHODS: A population-based retrospective matched cohort study was conducted of a large group model health maintenance organization located in western Washington State. Eligible patients were children who were ages 3 to 17 years and were continuously enrolled and used services from January 1 to December 31, 1997 (N = 57 216). Children with ADHD were identified by a diagnosis of ADHD or a pharmacy fill for a stimulant medication using automated patient files. Children without ADHD were randomly selected and matched 4:1 to children with ADHD on age and gender. Neurobehavioral disorders and pharmacy fills for psychotropic medications were measured. RESULTS: During 1997, 2992 children were identified as having ADHD (5.2%). These children were more likely to have a diagnosis of a non-ADHD neurobehavioral disorders (adjusted odds ratio: 6.3; 95% confidence interval: 5.4-7.3) than children without ADHD. Although most (78%) were treated with stimulant medications, children who were identified as having ADHD were also more likely to receive pharmacy fills for nonstimulant medications than were children without ADHD. Nonstimulant medications were more often used along with stimulant medications and were frequently prescribed in association with ADHD after controlling for other disorders. CONCLUSIONS: Children who were identified as having ADHD were more likely to have a diagnosis of other neurobehavioral disorders and to receive nonstimulant psychotropic medications than were children without ADHD. Because many of these drugs have little or no empirical basis in the treatment of ADHD, the rationale for their use is less clear. Future research to examine the use, effectiveness, and safety of these medications alone and in combination in children with ADHD is urgently needed.

Adolescent↗
PubMed2005

[The psychopathy-concept and its psychometric evaluation in childhood and adolescence].

In accordance with Robert Hare's concept, over twenty years the word psychopathy is used to describe a specific combination of affective and interpersonal traits in adults as subtype of antisocial personality disorder. Recently in North America personality traits of psychopathy have also been studied in juveniles (and children). The Psychopathy Checklist: Youth Version (PCL-YV) was developed to take the special conditions of adolescents into account and focuses on assessing personality dimensions from age 12 upwards. In juveniles with a high score, research with the PCL-YV demonstrated for example a lack of empathy, impulsivity and social adjustment disorder. Furthermore, researchers found associations between the number and severity of violent offences, early drug abuse and heightened recidivism. This paper discusses the concept of psychopathy for adolescents on the basis of 3 case reports. Biological determinants, experimental results and diagnostic aspects are described.

Adolescent↗
PubMed2004

Profile of psychiatric disorders in the Sri Lanka Air Force and the outcome at 6 months.

The epidemiology of mental disorders in the Sri Lanka Air Force is not known, although they have been engaged in front line military service in a civil war for the past two decades. This study aims to identify the mental health needs of military personnel as a means to resource development. Referrals to a specialist psychiatry outpatient service were studied to assess the profile of diagnoses and outcome after 6 months. Fifty percent suffered from adjustment disorder or a stress reaction. In a majority, the onset of the mental health problem was not caused by direct exposure to the war situation. There was a high rate of return to work at 6 months. However, a disproportionately high loss of personnel was seen in the new recruits and trainee soldiers. These data are useful in developing services and resources for mental health care for the workforce.

Adolescent↗
PubMed2005

A communication intervention for training southern European oncologists to recognize psychosocial morbidity in cancer. I--development of the model and preliminary results on physicians' satisfaction.

BACKGROUND: The detection of psychosocial distress is a significant communication problem in Southern Europe and other countries. Work in this area is hampered by a lack of data. Because not much is known about training aimed at improving the recognition of psychosocial disorders in cancer patients, we developed a basic course model for medical oncology professionals. METHODS: A specific educational and experiential model (12 hours divided into 2 modules) involving formal teaching (ie, journal articles, large-group presentations), practice in small groups (ie, small-group exercises and role playing), and discussion in large groups was developed with the aim of improving the ability of oncologists to detect emotional disturbances in cancer patients (ie, depression, anxiety, and adjustment disorders). RESULTS: A total of 30 oncologists from 3 Southern European countries (Italy, Portugal, and Spain) participated in the workshop. The training course was well accepted by most participants who expressed general satisfaction and a positive subjective perception of the utility of the course for clinical practice. Of the total participants, 28 physicians (93.3%) thought that had they been exposed to this material sooner, they would have incorporated the techniques received in the workshop into their practices; 2 participants stated they would likely have done so. Half of the doctors (n = 15) believed that their clinical communication techniques were improved by participating in the workshop, and the remaining half thought that their abilities to communicate with cancer patients had improved. CONCLUSIONS: This model is a feasible approach for oncologists and is easily applicable to various oncology settings. Further studies will demonstrate the effectiveness of this method for improving oncologists skills in recognizing emotional disorders in their patients with cancer.

Affective Symptoms↗
PubMed2004

Mental health concerns of HIV-infected gay and bisexual men seeking mental health services: an observational study.

Addressing mental health concerns of HIV-positive individuals is an important component of providing quality HIV care. Mental health intake information from patients with HIV can be an important source of data to complement existing research on HIV and mental health because the intake information contains concerns that are both from the perspective of the patients and are significant enough to bring them into treatment. The current study describes the mental health intake information of HIV-positive men who have sex with men (MSM) at an urban community health clinic over a 1-year period. This information included presenting problems, current symptoms from a symptom checklist, ratings of impairments in functioning, and client histories (e.g., substance abuse, emotional, physical, and sexual abuse, previous treatment). It also included clinicians' Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of the participants, and recommended treatments. Depression was the most prevalent presenting problem (58.1% of clients), followed by anxiety (38.2%). Consistently, depression (96.3%) and low energy (78.2%) were the most frequently endorsed symptoms on a symptom checklist, followed by anxiety (69.2%). HIV-specific problems also played a large role both directly, as a presenting problem, and indirectly as they related to such concerns as relationship issues. Axis I diagnoses included adjustment disorders (50.0%), major depressive disorder (21.4%), and dysthymia (a less severe but more chronic depression) (8.9%). This review highlights the mental health issues that HIV-positive MSM feel are significant enough to require treatment. Because mental health is a key component of overall quality of life, HIV providers who work with MSM can use these data to increase awareness of the types of mental concerns that are most distressing to this population.

Adult↗
PubMed1990

On the therapeutic action of alpidem in anxiety disorders: an overview of the European data.

This review analyzes the available data on the therapeutic activity of alpidem in various anxiety syndromes. Up to now, 17 studies have been completed in Europe, dealing with a total population of more than 1500 patients suffering from either chronic (n = 987) or situational anxiety (n = 400). In a series of five placebo-controlled double-blind studies in situations of stress-induced anxiety (gastroscopy, minor surgery, cardiac catheterization), the therapeutic efficacy of alpidem was evident in 53% of the patients and significantly (P less than 0.001) superior to that of placebo (30%). In more than 400 patients suffering from generalized anxiety or adjustment disorders with anxious mood, six double-blind studies run against placebo or reference drug over a period of two to three weeks indicated an anxiolytic effect superior (P less than 0.01) to that of placebo and comparable to that of reference drugs (DZ, LZP, CZP). A long-term (6-12 months) open-label study conducted on a population of more than 300 patients suffering from chronic anxiety indicated that no tachyphylaxis occurs during prolonged treatment and that following abrupt drug discontinuation no withdrawal or rebound phenomena are observed. Globally, alpidem appears to be well tolerated with a minimum of dose-related, sedative effects (6-7% of the cases) and no effects on memory or cognitive functions. Four studies conducted specifically in an elderly population (n = 191) indicate that the elderly patients do not show an increased sensitivity to alpidem. On the contrary, as in adults, the anxiolytic effect was not accompanied by a reduction in performance or in cognitive functions nor by withdrawal reactions when treatment was discontinued.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Anxiety Agents↗
PubMedDate not supplied

Neuropsychiatric assessment of liver transplantation candidates: delirium and other psychiatric disorders.

Forty consecutive liver transplantation candidates underwent a standard psychiatric evaluation as part of a multidisciplinary preoperative examination. Psychiatric diagnoses were determined using DSM-III criteria and correlations between the psychiatric diagnoses and the results of bedside cognitive examinations, biochemical measures of hepatic function, and EEG's were made. Half of the patients could not be given a specific psychiatric diagnosis despite the fact of their being in terminal stages of a severe medical illness and being stressed by the uncertainty of whether they would be accepted for possible liver transplantation. Of the twenty patients given a psychiatric diagnosis, 60 percent were found to be delirious and 35 percent had an adjustment disorder. Delirium was associated with a serum albumin less than 3.0 g/dl, grades 1 through 3 EEG dysrhythmias, a Mini Mental State score less than 24 or impairment on Trailmaking Tests. In addition, discriminant analyses were performed to determine which batteries of tests best differentiated the delirious patients. A unique pattern of psychosocial stressors was noted in these patients where the severity of overall stress and of occupational dysfunction was high in most, yet family and social relationships were reported as less affected.

Delirium↗
PubMed1998

[Psychological comorbidity in patients with alarming chest pain symptoms].

About 1/3 of patients with chest pain undergoing coronary arteriography (CA) have no coronary artery disease (CAD). Individuals with non-CAD chest pain may be younger and more likely to be female; they may express higher degrees of neuroticism. Are those features stable enough to justifi; exclusion from CA if present? To investigate this issue, data on psychodiagnostic parameters (depression, anxiety, somatic complaints) were obtained in patients before this were referred to CA. Inclusion criteria were a chief complaint of chest pain with episodes of angina-like pain at rest, suspicious enough to warrant cardiac catherisation; and no prior history of CAD or other organic heart disease. The sample consisted of 77 patients, recruited from 89 eligible patients. 12 patients were excluded because CA findings were missing for multiple reasons. CA was conducted by Judkins technique. Patients were labeled as CAD (-) if no stenosis were detectable. In 50 (65%) of cases CA findings were positive and in 27 (35%) findings were negative. CAD+ were significantly older (p < 0.05); the superiority in both groups were male. Prevalence of emotional disorders was markedly more pronounced in both groups in comparison to the normal population and to a group of male myocardial infarction survivors. However, those features did not discriminate between the groups. Long acting chest pain was predictive for high degrees of emotional disability (relative risk 5.33; 95% Kl 1.6-61.6; p < 0.012). Chest pain at rest is a major source of anxiety, depression and subsequent somatic preoccupation despite its ischaemic or functional origin. It leads to clinically relevant adjustment disorders in a significant proportion of chest pain patients and triggers emotional disstress. These factors may thus have less impact on risk stratification than expected.

Adult↗
PubMed1994

[Techno-Stress; techno-centered and techno-phobia].

The "Techno-Stress" is a sociological new concept, hypothesized by Craig Brod and it includes clinically "Techno-Centered" and "Techno-Phobia". Based on 34 cases with mental disorders or psychosomatic diseases, we evaluated symptomatically these categories from standpoint of computer operating works. Fourteen cases represented severe problems in human relationship and they adapted excessively to computer operation. This group was thought as "Techno-Centered" and 50% of them were diagnosed as narcissistic, obsessive and schizophreniform personality. Twenty cases with maladaptation to computer operation were characterized as strict or avoidant personality and this group was evaluated as "Techno-Phobia". The "Techno-Phobia" was thought as simple adjustment disorder caused by new technology, on the other hand, the cases of "Techno-Centered" were seemed to be well-adapted to social skill only superficially, but psychological disturbance should be severer than "Techno-Phobia".

Adult↗
PubMed2004

The prevalence of psychiatric disorder and the wish to hasten death among terminally ill cancer patients.

OBJECTIVE: This study assessed the prevalence of psychiatric disorder among a group of terminally ill cancer patients with or without a wish to hasten death (WTHD). METHODS: Consecutive patient referrals to a hospice inpatient unit, home palliative care service, and hospital palliative care-consulting service were recruited. A group of these patients (n = 56) consented to participate in a structured clinical interview (SCID) to identify the presence of psychiatric diagnoses. Patients were categorised into those with or without a wish to hasten death. RESULTS: Current major depressive episode and adjustment disorder were the most prevalent disorders in this group of patients. Patients with a high WTHD were significantly more likely to have a current major depressive episode compared to patients with no WTHD. Patients with a high WTHD were also significantly more likely to have a past major depressive episode compared to patients with no WTHD. SIGNIFICANCE OF RESULTS: These results support the view that terminally ill patients with a high WTHD are significantly more likely to be suffering from a depressive disorder as assessed by a structured clinical interview. This has important clinical implications for those caring for dying patients who may make a request to hasten death.

Adult↗
PubMed1989

The General Health Questionnaire by interview. Performance in relation to recent use of health services.

The General Health Questionnaire (GHQ) is a widely used method of assessing psychiatric distress in clinical settings and in the community. The authors administered a 20-item interview version of the GHQ and a battery of survey items on use of ambulatory health care services to 3,389 respondents in eastern Baltimore as part of the Epidemiologic Catchment Area survey. In addition, a subsample of these respondents (n = 810) was examined by research psychiatrists who provided a reference mental disorder diagnosis for comparison with GHQ results. Psychiatrists determined that 102 respondents had American Psychiatric Association's Diagnostic and Statistical Manual, third edition, (DSM-III) disorders suitable for detection by the GHQ. These respondents were categorized by the health service use they reported over the previous 6 months. A comparison indicated that 82% of the diagnosed cases with recent specialty care also had elevated GHQ scores. Among cases with recent general medical care, 52% had elevated GHQ scores. Among diagnosed cases reporting no recent ambulatory health care, only 38% had elevated GHQ scores. Receiver operating characteristic analysis demonstrated a similar trend. Cases of depression were separated into less severe cases (adjustment disorder with depressed mood) and more severe cases (major depression). There were relatively more cases of severe depression than cases of mild depression in those respondents reporting recent health service use compared with those respondents reporting no recent service use. This may account for the higher sensitivity of the GHQ in detecting psychiatric disorders for those persons utilizing health services compared with individuals using no health services.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗