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PubMedDate not supplied

Assessing psychological distress in cancer patients: validation of a self-administered questionnaire.

BACKGROUND: Screening for psychological distress in cancer patients is important, considering the high prevalence of psychiatric disorders responsive to treatment. The aim of this study is to test the psychometric properties of the Psychological Distress Inventory (PDI), a 13-item self-administered questionnaire developed to measure psychological distress in cancer patients. PATIENTS AND METHODS: The PDI was tested in three samples of 434 cancer patients. In the first sample (n = 102) it was administered with the State Trait Anxiety Inventory (STAI) and with the Eysenck Personality Questionnaire (EPQ). Its validity as a screening method for psychiatric disorders was evaluated through a clinical interview in the second sample (n = 107). The third sample (n = 225) provided information on the ability of the PDI to discriminate among patients in different clinical phases of disease and allowed an estimate of the prevalence of psychiatric disorders in these groups of patients. RESULTS: A 0.88 alpha coefficient was obtained in the whole study sample. The correlations with the STAI scales were > 0.70. A positive correlation with neuroticism (r = 0.59) and a negative correlation with extroversion (r = -0.34) was observed. In the second sample, 67 patients (62.6%) received a psychiatric diagnosis according to the ICD-X criteria. The mean PDI scores were significantly lower for the 40 patients with no psychiatric diagnosis (mean 24.5) as compared with the 49 patients with adjustment disorders (mean 36.4) and with the 12 patients with depressive disorders (mean 40.8). The area under curve, estimated through a Receiver-Operating Characteristics analysis, was 0.88. A cut-off of 29 was associated with a 75% sensitivity and a 85% specificity. In the third sample, the lowest PDI scores were in patients with no evidence of disease (mean 24.7, 95% CL 23.0-26.4) as compared to patients undergoing antineoplastic treatment (mean 30.9, 95% CL 28.9-32.9) and to patients under palliative therapy (mean 36.0, 95% CL 34.0-37.9). The estimated prevalence of patients with psychiatric disorders in these three groups were respectively 5.0, 56.6 and 98.8%. CONCLUSIONS: Our results suggest that the PDI is a reliable and valid tool for measuring psychological distress in cancer patients and to detect psychiatric disorders through a screening procedure.

Adult↗
PubMed1990

[Mental health in software engineers. I. Frequency of mental complaints, physical complaints and psychiatric disorders].

This study examined the physical complaints, mental complaints and psychiatric disorders in software engineers. Subjects were 101 male software engineers. They were evaluated by a semistructured interview. Psychiatric diagnosis was based on DSM-III (Diagnostic and Statistical Manual of Mental Disorders, third edition). The results are summarized as follows: 1) Physical complaints were observed in 68% of the subjects with 25% of the subjects complaining of physical ill-health. This study showed that 12% of the subjects had hypertension, 12%, gastritis or gastro-duodenal ulcer, 14%, allergic disease, and 19% miscellaneous diseases. 2) Of the subjects 62% had mental complaints and 31% mental ill-health. Depressive symptom was the most frequent mental complaint with 32% of the subjects diagnosed as DSM-III. The common diagnoses were adjustment disorders (19%), major affective disorders (6%), psychological factors affecting physical condition (5%) and dysthymic disorder (3%). Only one subject sought professional help from a psychiatrist for relief of mental complaints. The data suggest the severity of mental ill health in software engineers, but methodological limitations preclude a firm conclusion at this time. Further studies should be made on the mental health state in software engineers.

Adult↗
PubMed2006

Psychological distress experienced by families of cancer patients: preliminary findings from psychiatric consultation of a Cancer Center Hospital.

OBJECTIVE: The purpose of the present study was to obtain preliminary findings regarding psychiatric disorders and background characteristics among Japanese family members of cancer patients. METHODS: We investigated the psychiatric diagnosis and background factors of family members of cancer patients by analyzing the consultation data of patients referred to the Psychiatry Division, National Cancer Centre Hospital East, Japan. RESULTS: Of a total of 1469 psychiatric consultation, 47 (3.2%) family members were referred, and 85% of them were spouses. The most common patient cancer site was the lung. Approximately one-half of the referred family encountered patients' end-of-life issues. The most common psychiatric diagnoses were adjustment disorders, followed by major depression. CONCLUSIONS: These preliminary findings suggest that psychosocial support for family members is not fully delivered and development of a comprehensive support system for caregivers of cancer patients is an urgent issue in the clinical oncology setting in Japan.

Cancer Care Facilities↗
PubMed2003

Mental health evaluations of U.S. Air Force basic military training and technical training students.

A 2000 report by Staal, Cigrang, and Fiedler and a 1998 report by Cigrang, Carbone, Todd, and Fiedler described the attrition of U. S. Air Force basic military trainees due to mental health disorders for the year 1997. This article looks at the population of Air Force basic military trainees and technical training school students located at the same base during the year 2001. In addition, we look at the effect of allowing basic trainees and those in technical school to refer themselves for mental health evaluations as opposed to only evaluating those referred by secondary sources. Primary results of the data analysis suggest that mental health-related separation rates for calendar year 2001 basic military trainees are consistent with past years at 4.2%. For both basic trainees and technical school training students, adjustment disorders and depressive disorders are the top diagnostic categories related to recommendation for separation.

Female↗
PubMed2004

How does clients' method of payment influence psychologists' diagnostic decisions?

To what extent does payment method (managed care vs. out of pocket) influence the likelihood that an independent practitioner will assign a Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnosis to a client? When a practitioner does diagnose, how does payment method influence the specific choice of a diagnostic category? Independent practitioners responded to a vignette describing a fictitious client with symptoms of depression or anxiety. In half of the vignettes, the fictitious client intended to pay via managed care; in the other half, the fictitious client intended to pay out of pocket. Payment method had a very significant impact on diagnosis such that relative to out-of-pocket clients, managed care clients were much more likely to receive diagnoses and more likely to receive adjustment disorder diagnoses in particular. We discuss implications involving informed consent and other ethical issues.

Anxiety↗
PubMed2005

Findings from the National Comorbidity Survey on the frequency of violent behavior in individuals with psychiatric disorders.

Previous studies using probability samples have found a noticeable, but small association between violence and psychiatric disorder. In this article, we analyze data from the National Comorbidity Survey (NCS) to further examine this question. Psychiatric diagnosis of survey responses was based on a modified version of the Composite International Diagnostic Interview. The NCS study also included items that permitted self-report of violent behaviors in the past year. People with 12-month diagnoses of anxiety disorders, dysthymia and major depression were three to four times more likely to admit violent behaviors than those with no disorders. People with bipolar disorder or drug and alcohol abuse were eight times more likely to report violent behaviors. People with co-occurring non-substance and substance abuse disorders were more likely to report violence than those with only non-abuse disorders. Adjusting violence rates by population base rates shows demographics including ethnicity and gender to be a better predictor of violent behavior than psychiatric diagnosis. The NCS findings approximate those in other probability studies and echo the conclusions of the 1996 Consensus Statement by Advocates and Researchers on violence and mental illness; namely, mental illness is only a weak predictor of violent behavior.

Adolescent↗
PubMed2005

Pharmacologic response to depressive disorders among adolescents.

OBJECTIVES: The purpose of this study was to identify determinants of use of psychoactive medication and receipt of selective serotonin reuptake inhibitors (SSRIs) among adolescents with a diagnosis of new-onset depression. METHODS: A population-based retrospective cohort study was conducted among 447 adolescents enrolled in the Quebec drug plan who had new episodes of depression diagnosed between October 2000 and March 2001 by pediatricians, general practitioners, or psychiatrists. The main outcomes were use of psychoactive medication in the year after diagnosis and receipt of SSRIs at the first visit during which pharmacotherapy was prescribed. Receipt of SSRIs was assessed by the initial psychoactive dispensing claim following the diagnosis of depression. RESULTS: In the year after diagnosis, 258 adolescents (58 percent) received psychoactive medications, of whom 135 (52 percent) initially received SSRIs. Diagnosing pediatricians were the least likely to prescribe psychoactive medication. Patients of psychiatrists were less likely than those of primary care physicians to receive antidepressants for dysthymia or adjustment disorder accompanied by depressed mood (26 percent compared with 42 percent). Being female, having a diagnosing general practitioner or pediatrician, and having the same diagnosing and treating physician were associated with higher odds of receiving SSRIs. Being a welfare recipient and living in a rural area rather than an urban area were associated with lower odds. CONCLUSIONS: Adolescent males, those receiving welfare, and those living in rural areas were less likely to receive treatment that was recommended at the time of the study and thus may need special attention from mental health care providers.

Adolescent↗
PubMed1999

Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders.

BACKGROUND: Arousal parasomnias (night terrors, sleepwalking, and confusional arousals) have seldom been investigated in the adult general population. Clinical studies of parasomnias, however, show that these disorders may be indicators of underlying mental disorders and may have serious consequences. METHOD: A representative sample of the United Kingdom population (N = 4972) was interviewed by telephone with the Sleep-EVAL system. RESULTS: Night terrors were reported by 2.2% (95% CI = 1.8% to 2.6%) of the sample, sleepwalking by 2.0% (1.6% to 2.4%), and confusional arousals by 4.2% (3.6% to 4.8%). The rate of these 3 parasomnias decreased significantly with age, but no gender difference was observed. Multivariate models identified the following independent factors as associated with confusional arousals (odds ratio [OR]): age of 15-24 years (OR = 4.1), shift work (OR = 2.1), hypnagogic hallucinations (OR = 3.3), deep sleep (OR = 1.6), daytime sleepiness (OR = 1.9), sleep talking (OR = 1.7), daily smoking (OR = 1.7), adjustment disorder (OR = 3.1), and bipolar disorder (OR = 13.0). Factors associated with night terrors were subjective sense of choking or blocked breathing at night (OR = 5.1), obstructive sleep apnea syndrome (OR = 4.1), alcohol consumption at bedtime (OR = 3.9), violent or injury-causing behaviors during sleep (OR = 3.2), hypnagogic hallucinations (OR = 2.2), and nightmares at least 1 night per month (OR = 4.0). Factors associated with sleepwalking were age of 15-24 years (OR = 5.2), subjective sense of choking or blocked breathing at night (OR = 5.1), sleep talking (OR = 5.0), and a road accident in the past year (OR = 3.9) after controlling for possible effects of sleep deprivation, life stress, and mental and sleep disorders. CONCLUSION: Arousal parasomnias, especially night terrors and confusional arousals, are often the expression of a mental disorder. Other life or medical conditions, such as shift work or excessive need of sleep for confusional arousals and stressful events for sleepwalking, may also trigger parasomnias. Prevalence rates are based on self-reported data and, consequently, are likely underestimated.

Adolescent↗
PubMed1998

The phenotypic spectrum of CADASIL: clinical findings in 102 cases.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an increasingly recognized autosomal dominant disorder that leads to cerebrovascular manifestations in early adulthood. This study delineates the phenotypic spectrum and the natural history of the disease in 102 affected individuals from 29 families with biopsy-proven CADASIL. Recurrent ischemic episodes (transient ischemic attack [TIA] or stroke) were the most frequent presentation found in 71% of the cases (mean age at onset, 46.1 years; range, 30-66 years; SD, 9.0 years). Forty-eight percent of the cases had developed cognitive deficits. Dementia (28%) was frequently accompanied by gait disturbance (90%), urinary incontinence (86%), and pseudobulbar palsy (52%). Thirty-nine patients (38%) had a history of migraine (mean age at onset, 26.0 years; SD, 8.2 years), which was classified as migraine with aura in 87% of the cases. Psychiatric disturbances were present in 30% of the cases, with adjustment disorder (24%) being the most frequent diagnosis. Ten patients (10%) had a history of epileptic seizures. To delineate the functional consequences of ischemic deficits, we studied the extent of disability in different age groups. The full spectrum of disability was seen in all groups older than age 45. Fifty-five percent of the patients older than age 60 were unable to walk without assistance. However, 14% in this age group exhibited no disability at all. Kaplan-Meier analysis disclosed median survival times of 64 years (males) and 69 years (females). An investigation of the 18 multiplex families revealed marked intrafamilial variations.

Adult↗
PubMed1988

Mental health training of primary care physicians: an outcome study.

It is well documented that primary care physicians encounter many patients in their practices who suffer psychiatric morbidity, especially affective, anxiety and substance abuse disorders. These physicians have been unable to effectively address the needs of these patients, over half of whom receive care exclusively in the primary care sector. Five years after implementing a curriculum to train family practice physicians to assume a comprehensive psychiatric role with patients in their practices, the authors undertook an outcome evaluation. The focus was on psychiatric disorder recognition, diagnosis, documentation, and management, including referral. It was hoped that biopsychosocial and community mental health orientations emphasized during training would be incorporated into the subsequent primary care practices of physicians in the study. In the research design, physician-generated diagnoses were compared with DIS/DSM-III diagnoses; physician interviews and chart audits enabled processes of care delivery to be evaluated. Unexpectedly, physicians were not found to assume an appropriately active or comprehensive mental health role in their practices following the training intervention. Of ninety-four DIS-generated diagnoses in the study population of fifty-one patients, 79 percent were unrecognized. Patients were assumed to function well emotionally, and psychiatric dimensions of patient complaints were not examined in the majority of cases. The physicians did diagnose and treat a number of patients with mental symptoms who were not identified by the DIS. These patients had high, but sub-diagnostic, DIS symptom counts. Most received a diagnosis of adjustment disorder in response to medical illness. Though this finding underscores shortcomings of present psychiatric nosology when applied in the general medical setting, the foremost consideration was the large number of DIS-identified patients with serious psychopathology, needing active assessment and intervention, who were unrecognized, undiagnosed or untreated. Implications of these findings for the psychiatric training of primary care physicians are examined.

Curriculum↗
PubMed1984

Diagnosis and drug use in mentally retarded, emotionally disturbed adults.

Inpatient and outpatient, emotionally disturbed, borderline to severely mentally retarded adults (N = 110) were assessed to evaluate the relationship of medication to psychiatric diagnosis and symptomatology. Patients were assessed on the Psychiatric Instrument for Mentally Retarded Adults, the Beck Depression Inventory, the Zung Self-Rating Depression Scale, the Hamilton Rating Scale for Depression, and the Social Performance Survey Schedule--a measure of social adaptation. All these instruments had been modified for use with mentally retarded persons. Comparisons were made evaluating patients receiving major tranquilizers, anticonvulsant and antianxiety drugs, by diagnostic category. Furthermore, an assessment was made of inpatients versus outpatients, based on amount of medication prescribed. It was found that considerable variation in the numbers of drugs and the amount of drug used occurred, based on the type of psychiatric condition, particularly those on informant data on schizophrenia, affective disorder, and adjustment reaction disorder. Implications of these and related results for psychotropic drug use with mentally retarded emotionally disturbed persons are discussed.

Adult↗
PubMed2000

Use of practitioner-based complementary therapies by persons reporting mental conditions in the United States.

BACKGROUND: To our knowledge, this study provides the first national estimates for use of practitioner-based complementary treatments by US residents reporting mental conditions. METHODS: A total of 16038 respondents to the 1996 Medical Expenditure Panel Survey were asked about visits for 12 complementary medical services (eg, chiropractic services and herbal remedies). Bivariate and multiple regression models examined use of these therapies in individuals reporting a mental condition (n= 1803), fair or poor mental health status (n=992), and 1 of 4 chronic medical conditions (n = 3262) and in the remainder of the sample (n= 10 793). RESULTS: A total of 9.8% of those reporting a mental condition made a complementary visit, and about half of these (4.5%) made a visit to treat the mental condition. Persons reporting transient stress or adjustment disorders were most likely (odds ratio, 9.1%; 95% confidence interval, 5.5%-12.7%), and those with psychotic (odds ratio, 1.5%; 95% confidence interval, 0.0%-4.2%) and affective (odds ratio, 2.6%; 95% confidence interval, 1.5%-3.8%) conditions least likely, to use complementary therapies to treat their mental condition. In multivariate models controlling for medical comorbidity, fair or poor mental health status, and demographic factors, report of a mental condition predicted a 1.27-fold increase in the odds of a complementary visit (95% confidence interval, 1.04-1.54). CONCLUSIONS: Self-reported mental conditions were associated with increased use of complementary treatments, although use of these treatments was concentrated in respondents with transient distress rather than chronic and serious conditions. More research using structured diagnostic interviews is needed to examine the prevalence, patterns, and clinical implications of use of these treatments by individuals with mental conditions in "real world" community settings.

Adult↗
PubMed2000

A comparison of approaches to modeling the relationship between ergonomic exposures and upper extremity disorders.

BACKGROUND: For a study of upper extremity musculoskeletal disorders among automobile manufacturing workers, an ergonomic exposure index was constructed by summing ten psychophysical (interview) items. Here we explore the sensitivity of the exposure-response relationship to the formulation of that index. METHODS: Five alternative exposure indices were constructed: three a priori weighting schemes and two sets of weights derived from multivariate regression coefficients. In addition, structural equation modeling was performed with LISREL. RESULTS: The original index and a priori weighting schemes had similar associations with upper extremity disorders, adjusted for nonoccupational covariates. A reasonable model fit was achieved in LISREL after two modifications; the standardized solution showed that nonneutral postures were significantly related to upper extremity signs and symptoms. CONCLUSIONS: In this large population, with adequate range of exposures, the exposure-response relationship appeared generally robust to the mathematical formulation of the exposure index. Among the available exposure variables, postural strain had the strongest association.

Adult↗
PubMed1990

Construct validity of the Diagnostic Inventory of Personality and Symptoms: external correlates.

This study extended knowledge of the construct validity of Vincent's Diagnostic Inventory of Personality and Symptoms (DIPS) by examining the relationships between the DIPS and the MMPI, the Millon Clinical Multiaxial Inventory, the Profile of Mood States, the Symptom Check List-90, and the California Psychological Inventory. Subjects were 300 predominantly male psychiatric inpatients. Correlational analyses revealed that the DIPS clinical scales were related most strongly to MMPI and MCMI clinical scales. Eleven of 14 DIPS clinical scales showed clinically significant correlations with similar scales of the external measures. The validities of the Stress-Adjustment Disorders and Psychological Factors Affecting Physical Condition scales were not ascertained directly.

Adult↗
PubMed2005

Assessment of sexual functioning in depressed patients treated with mirtazapine: a naturalistic 6-month study.

UNLABELLED: Antidepressant-induced sexual dysfunction is a frequent side effect which may greatly contribute to treatment non compliance. Mirtazapine has a pharmacological profile expected to result in a lack of sexual dysfunction. The main purpose of this 6-month open-label study was to evaluate the effects of mirtazapine on sexual function of a sample of depressed patients. METHODS: Seventy-eight patients meeting DSM-IV criteria for major depression or adjustment disorder with depressed mood or with mixed anxiety and depressed mood, sexually active prior to the episode, were treated with mirtazapine (15-60 mg/day). Effectiveness was assessed using the 17-item Hamilton rating scale for depression (HAM-D-17), the Hamilton rating scale for anxiety (HAM-A) and the clinical global impression (severity and improvement) scales (CGI). Sexual function was evaluated with the psychotropic-related sexual dysfunction questionnaire (PRSexDQ) which detects clinical changes in sexual dysfunction. RESULTS: Forty-eight patients (61.5%) were experiencing sexual dysfunction at baseline. A return to normal sexual functioning was observed in 27 of 38 (71.1%) patients completing the study. Significant reductions in mean total PRSexDQ scores were detected at day 90 and endpoint and only four patients withdrew or required dose reduction due to mirtazapine-induced sexual dysfunction. A total of 37 patients (47.4%) achieved complete remission of depression (HAM-D-17 score <or= 7) at endpoint. Only seven patients (9.0%) withdrew the study because of adverse events. CONCLUSION: Mirtazapine showed in this study that it is an effective and well-tolerated antidepressant treatment with a possibly lower incidence of sexual side effects than other antidepressants.

Adult↗
PubMed2001

Thought Field Therapy clinical applications: utilization in an HMO in behavioral medicine and behavioral health services.

Thought Field Therapy (TFT) is a self-administered treatment developed by psychologist Roger Callahan. TFT uses energy meridian treatment points and bilateral optical-cortical stimulation while focusing on the targeted symptoms or problem being addressed. The clinical applications of TFT summarized included anxiety, adjustment disorder with anxiety and depression, anxiety due to medical condition, anger, acute stress, bereavement, chronic pain, cravings, depression, fatigue, nausea, neurodermatitis, obsessive traits, panic disorder without agoraphobia, parent-child stress, phobia, posttraumatic stress disorder, relationship stress, trichotillomania, tremor, and work stress. This uncontrolled study reports on changes in self-reported Subjective Units of Distress (SUD; Wolpe, 1969) in 1,594 applications of TFT, treating 714 patients. Paired t-tests of pre- and posttreatment SUD were statistically significant in 31 categories reviewed. These within-session decreases of SUD are preliminary data that call for controlled studies to examine validity, reliability, and maintenance of effects over time. Illustrative case and heart rate variability data are presented.

Adult↗
PubMed1996

Diagnosis in adolescent inpatients: diagnostic confidence and comparison of diagnoses using ICD-9 and DSM-III.

In a prospective Multi-Centre research study involving four British Adolescent Psychiatry Inpatient Units, all 276 adolescent admissions were diagnosed using both ICD-9 and DSM-III. Ratings of diagnostic confidence for each diagnostic group varied considerably. Clinicians recorded high levels of confidence in the diagnosis of both Schizophrenia and Anorexia nervosa, while considerably lower scores were noted for Adjustment Disorders (ICD-9 3-digit code 309.), and for Emotional Disorders (ICD-9 3-digit code 313.). Exact concordance in diagnoses made for each case using both ICD-9 and DSM-III occurred in 72% of the entire cohort. The dissimilar concordance rates comparing ICD-9 and DSM-III diagnoses for the same patient admissions suggest differences in validity measures, such as face validity and content validity, in the reliability of diagnostic criteria between similarly named disorders across the two systems, and in the clinician's training and attitude to diagnosis. With the recent introduction of DSM-IV following upon ICD-10, further comparative studies are needed to examine both reliability and validity issues into diagnosis and classification in child and adolescent psychiatry.

Adolescent↗
PubMed1991

Older adult users of outpatient mental health services.

Descriptive demographic, clinical and interview data from clients of an outpatient mental health clinic for older adults are presented. These clients are better educated and have a more frequent history of marital difficulties than older adults in general. Although a significant minority received V code and Adjustment Disorder diagnoses, the majority were depressed and had histories of prior mental health services. Economic factors are a major issue in seeking services.

Aged↗