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PubMed1997

The Nordic Comparative Study on Sectorized Psychiatry. Part V. Contact rates, contact patterns and care level at index contact.

As part of a Nordic comparative study on sectorized psychiatry in seven Nordic catchment areas, a prospective investigation of contact rates of new patients and pathways to the psychiatric services was performed. The results showed that there was more than a twofold difference between the services in the total contact rates. Regarding diagnostic groups, contact rates for neurosis were predominant in three of the services, while adjustment disorders, dependencies and personality disorders were predominant in other the services. The contact rate of functional psychosis, as well as the ratio of psychotic patients to the total contact rate were highest in two catchment areas serving inner parts of big cities. The most common way of getting into contact with the services was by self-referral, 39.4% of total referrals, followed by primary care referrals, although there were large differences between the services. Psychotic patients made contact with the services to a significantly less extent by self-referral. The majority of patients were treated in outpatient care at entry to the services, with a large variation between the services. It was also found that inpatient care at index contact was predicted by clinical characteristics-a diagnosis of psychosis and a history of former inpatient care-as well as by social characteristics-male, widowed or divorced, sick pension/old age pension.

Adolescent↗
PubMed1993

Variables affecting length of psychiatric inpatient treatment.

To discover whether variables such as gender, ethnicity, pay code, and diagnostic category affect length of psychiatric inpatient treatment, patient records for a recent 18-month period (January 1988 to June 1989) in a Midwestern teaching hospital setting were examined and statistically analyzed. Variables that emerged as related to length of stay are ethnicity, Axis I diagnosis of adjustment disorder, and presence of any Axis II diagnosis. Comparisons with length of stay statistics from an earlier period (1981) lead to conclusions about inpatient psychiatric services since the implementation of diagnosis related groups. Further, implications of this study's findings are discussed in relation to mental health service delivery.

Adult↗
PubMed2001

[Anxiety and depression in cardiology patients: how to diagnose, how to treat?].

IMPORTANCE: Anxiety and depression are frequent problems in patients with heart diseases. Prevalences vary between 15 and 50%, depending on diagnostic criteria as well as on sociodemographic and medical patient characteristics. During the last 10-15 years, a large number of studies have shown that anxiety and depression strongly affect overall well-being, cardiac and non-specific symptom reporting and overall quality of life. This leads to increased health care utilization, early retirement and imposes a financial burden on individuals and social security systems. In addition, anxious and especially depressed patients with heart disease tend to exhibit unhealthy illness behavior, low compliance and suboptimal risk factor control. Together with the known physiological effects of negative affect on cardiac autonomic balance, inflammation and platelet function, these behavioral mechanisms may lead to the frequently observed increase of cardiac event and mortality rates in depressed patients wit coronary artery disease. DIAGNOSIS: Despite their clinical relevance and unsatisfactory spontaneous remission rate, anxiety and depression still go unrecognized and undertreated in most cardiac patients. Case-identification can be improved by a graded approach. In the first step, symptoms of anxiety and depression should explicitly be asked for as part of a routine cardiological work-up. As an adjunct, validated self-rating questionnaires can be used for screening purposes. Patients screened positive should receive a thorough diagnostic interview and a criteria-based diagnosis. TREATMENT: Once a diagnosis has been obtained, several treatment options are available: In less severe cases (minor depression or adjustment disorders), supportive care by primary care physicians or cardiologists may be sufficient. Patients with major depression or panic disorder should receive structured psychotherapy and/or antidepressant medication. Exercise training can also improve symptoms of anxiety and depression. Although both psychotherapy and antidepressants, especially if integrated in a concept of comprehensive cardiac care, can be expected to result in marked subjective benefit for the majority of patients, the impact of these treatments on cardiac event and mortality rates still needs to be determined.

Antidepressive Agents↗
PubMed1999

Psychiatric hospital care among children and adolescents in Finland: a nationwide register study.

This register study includes all patients under 18 years in Finland discharged from psychiatric inpatient treatment in 1990 (n = 818) and 1993 (n = 958). The prevalence of children and adolescents in the population who had previously been treated was about 7-8 per 10,000. The incidence of new cases of children and adolescents who had previously been inpatients within the last year was about 5-6 per 10,000 in this age group. The prevalence was lowest in the preschool group (about 1:10,000) and highest in the adolescent group (about 12-14:10,000). About two-thirds of inpatients were boys. Adjustment disorders (DSM-III-R) were the most common diagnosis both in 1990 and 1993 (about 30%). Mood and anxiety disorders were the second most frequent (19-23%) and disruptive behaviour disorders the third most frequent (13-15%) diagnostic category. The diagnostic profiles differed largely according to sex and age.

Adolescent↗
PubMed2002

Biogenic amine turnover and serum cholesterol in suicide attempt.

The investigation of biological correlates of suicidal behavior is important in searching for possible changes in neuronal systems activity related to that behavior, so that pharmacological interventions may be proposed, especially in high-risk subjects. In a sample of 111 subjects admitted in a general hospital after suicide attempt, we studied the turnover of neurotransmitters by measuring the urinary output of the main metabolites of serotonin, dopamine and noradrenaline (5-HIAA, HVA, MHPG respectively), as well as serum cholesterol, and compared them to those of a group of 62 healthy controls. Venous blood samples and urine samples were collected within 24 hours of admission. Psychiatric diagnosis was made according to DSM-IIIR criteria and assessment of suicide intent with Beck's Suicidal Intent Scale (SIS). Fifty-four (54) subjects received the diagnosis of adjustment disorder, 25 of depression, 16 of schizophrenia and 16 of personality disorder. Fourteen subjects (14) had employed a violent mode of attempt. Urinary MHPG was found significantly higher in all diagnostic groups compared to controls. No difference was found concerning the excretion of HVA and 5-HIAA. Serum total cholesterol was found significantly lower both in violent and non-violent attempters compared to controls after correcting for age. No difference in serum cholesterol or MHPG was found between violent and non-violent attempts. Serum cholesterol and MHPG correlated negatively, while the correlations between cholesterol and 5-HIAA or HVA were not significant. Our results confirm previous reports of lower serum cholesterol in attempted suicide. They are also indicative of an increased noradrenaline turnover in subjects who attempt suicide, at least within 24 hours after the attempt. Whether this activation precedes or follows the attempt because of the specific stress, can not be answered at present.

Adult↗
PubMed2004

Psychiatric morbidity among cancer patients and awareness of illness.

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient's environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.

Academic Medical Centers↗
PubMed2006

Peripheral serotonergic markers in acutely suicidal patients. 1. Comparison of serotonergic platelet measures between suicidal individuals, nonsuicidal patients with major depression and healthy subjects.

BACKGROUND: A robust association between "suicidality" and deficits of the serotoninergic neurotransmission has been claimed in the past. However, many studies having investigated the relationship between suicidality and peripheral indicators of serotoninergic neurotransmission suffer from considering only one or a very small number of potentially useful serotoninergic parameters, whereas a synoptic multidimensional approach appears to be more appropriate. Furthermore, the psychiatric context within which suicidal behaviour occurs should be considered when interpreting biochemical findings of patients with suicidal ideation and suicide attempts. METHODS: In the present study 5 peripheral serotonergic markers, (platelet 5HT concentration, 5HT uptake activity, 5HT(2A) receptor binding characteristics, MAO-B activity and tryptophan concentration in plasma) were assessed simultaneously. Of the 60 acutely suicidal inpatients (ICD-10: F43.xx, n = 52; F31/32/33, n = 8), 45 were suicide attempters. Data of 28 nonsuicidal patients with major depression (F31, n = 4; F32, n = 14; F33, n = 10) and 123 healthy volunteers represented the control groups. RESULTS: Mean platelet 5HT concentration was significantly lower in suicidal inpatients when compared to nonsuicidal depressed patients, but did not differ from the figure in healthy subjects. Nonsuicidal depressed patients showed significantly higher mean platelet-5HT concentration than healthy controls. Mean V(max) of 5HT uptake in washed platelets, but not in platelet-rich plasma, was significantly higher in suicidal patients than in healthy controls, not, however, when compared to nonsuicidal depressed patients. Mean K(D) for the platelet 5HT(2A) receptor and MAO-B activity were significantly lower in suicidal patients as compared to nonsuicidal depressed patients and healthy controls. The observed differences in peripheral serotonergic markers between groups are partially due to a significant gender effect. A lower MAO-B activity was observed only in suicidal females, while the higher V(max) of 5HT uptake in washed platelets of suicidal patients was due to suicidal males. CONCLUSIONS: In view of conflicting observations made by other authors and the present findings on suicidal patients with adjustment disorder it remains doubtful whether and if so to which extent platelet studies can provide valid information on serotonergic mechanisms related to suicidal behaviour.

Adult↗
PubMed2005

Psychiatric interventions with returning soldiers at Walter Reed.

War is a malefic force and results in many psychiatric and medical casualties. Psychiatry's involvement with soldiers experiencing psychological stress resulting from combat experience has been reported for many years (Zajtchuk, 1995). It has been demonstrated that a myriad of diagnosis to include depression, anxiety, somatoform, adjustment disorders and psychotic behaviors also emerge (Wain et al., 1996, 2005a). Nearly all survivors exposed to traumatic events briefly exhibit one or more stress related symptoms (Morgan et al., 2003). In many instances these symptoms dissipate within a reasonable amount of time. However, symptoms persisting for a prolonged period following a traumatic event increase the probability of developing stress-related psychiatric disorders.

Combat Disorders↗
PubMedDate not supplied

Social breakdown in the elderly, II. Sociodemographic data and psychopathology.

Current understanding of the sociodemographic and psychopathological characteristics of the syndrome of social breakdown of the elderly (SBE) is reviewed. In DSM-III-R terms, pure SBE may be best classified as an adjustment disorder with profound social withdrawal. It is argued that pure SBE is a form of "personality development" in accord with Jaspers's concept of meaningful connections.

Aged↗
PubMed1989

Psychiatric referrals from a renal unit: a study of clinical practice in a British hospital.

Renal patients referred for a psychiatric opinion were compared with patients from the same unit who had never seen a psychiatrist. Overall the referrals had more psychiatric symptoms, but syndrome profiles of the two groups were very similar. In diagnostic terms, the referrals differed in having a range of adjustment disorders characterised by changes other than simple mood disturbance. There were relatively few major mental illnesses. Three other factors were associated with referral: youth, absence of a confiding relationship; and currently receiving haemodialysis. Most referrals were managed with short term non-intensive therapies, and there was little need for psychiatric in patient care. Psychiatric disorder did not influence survival. The significance of these findings for renal unit psychiatry is discussed.

Adult↗
PubMed1983

The use of DSM-III in a general hospital consultation-liaison service.

Eighteen months' use of DSM-III by a consultation-liaison service in a university hospital is reported. DSM-III's multiaxial system seems to be feasible and revealing, but presents some problems. Adjustment Disorder and Organic Mental Disorders were the most frequent Axis I diagnoses. Approximately one-fourth of the patients received an Axis II diagnosis and 85% received an Axis III diagnosis. In 70% of the patients there was both a psychiatric diagnosis (on Axis I or II) and a physical disorder (on Axis III). On Axis IV and V, this population appeared to be under moderate to severe psychosocial stress and had, as a group, a fair or better level of previous adaptive functioning. The possible significance of these findings and potential areas for further refinements and investigations are discussed.

Adaptation, Psychological↗
PubMed1993

Relationship of psychiatric illness to childbearing status: a hospital-based epidemiologic study.

Women who presented to a University psychiatric hospital were categorized into those with childbearing-related onset illness (CBROI, n = 168) and compared to those with non-childbearing-related onset illness (NCBROI, n = 1004). Women with CBROI were an average of five years younger. The two groups did not differ in membership across five major psychiatric diagnostic categories. However, women with CBROI were given the specific diagnosis adjustment disorder with depressed mood more frequently. Anxiety disorders were also common in women with CBROI. Most women with CBROI had the onset of illness during the postpartum period compared to during pregnancy or after pregnancy loss.

Abortion, Induced↗
PubMed1996

Impairment of the blood-CSF barrier in suicide attempters.

In a patient group of 90 suicide attempters, 18% showed an impaired blood-CSF barrier; of these 16 patients, all but one were younger than 45 years. When compared with 105 healthy controls, a significant difference in impairment of the blood-CSF barrier, between patients and controls, was seen only in those younger than 45 years (z = -2.66; P < 0.01). Paracetamol intoxication was more common among those with an impaired blood-CSF barrier than among those without an impairment (Fisher's exact test, P = 0.00029). Paracetamol intoxication was the most common method of suicide attempt in patients with adjustment disorders. There was no significant association between alcohol and/or drug abuse and an impaired blood-CSF barrier (Fisher's exact test, P = 0.91977). There were no differences in IgG index between patients and controls. The hypothesis that a blood-CSF barrier leakage may be a confounding factor when assessing the levels of monoamine metabolites in the CSF did not receive any support.

Adult↗
PubMed2006

Adolescent violence screening in the ED.

Youth violence is widely recognized as a major public health problem. Adolescent suicidality (ideation, behavior, or both) is disturbingly common in the United States, and homicide remains one of the leading causes of death for young people aged 10 to 24 years. Assessing youth suicidality and homicidality in the emergency department (ED) is a complex and challenging task. Evidence about the value of available ED risk assessments is not encouraging. Attempts to develop models that predict violence have in part been unsuccessful from the fact that ideation is common and the value of depression is hard to determine. The current study presents an empirically based assessment (adolescent and child urgent threat evaluation) and algorithm (violence ideation and suicidality treatment algorithm) evaluating the impact of ideation and nonideation states on attempt among clinical samples, such as serotonin reuptake inhibitor akathisia and acute adjustment disorders. The authors suggest important time-related factors and easy-to-administer procedures when assessing near-future youth violence. A validated suicide-homicide final common pathway model is discussed.

Adolescent↗
PubMedDate not supplied

Father-son attachment and sexual partner orientation in Taiwan.

The topic of homosexual adjustment problems has never been explored in Taiwan. The aim of this study was to investigate the role of parental bonding in the adjustment problems of homosexuals. A total of 51 young homosexual males, 100 nonhomosexual personnel with adjustment disorder, and 124 controls were administered the Parental Bonding Instrument, the Eysenck Personality Questionnaire, and the Chinese Health Questionnaire. The final parsimonious logistic regression and structural equation modeling showed paternal attachment, especially paternal overprotection, to be a predisposing factor in the development of homosexuality. Paternal attachment, introversion, and neurotic characteristics were key factors in the development of homosexuals. In particular, paternal overprotection played the most important role in the developmental process of male homosexuals. This study can be used as a reference for clinical personnel in caring for male homosexuals.

Adult↗
PubMedDate not supplied

Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study.

Little is known concerning the natural history of psychiatric morbidity, postoperative delirium, cognitive decline and health-related quality of life (HRQOL) in cardiac surgery patients and the impact of neurocognitive dysfunction on HRQOL after cardiac surgery with cardiopulmonary bypass (CPB). In a prospective study, we followed up for 1 year 30 of the original 34 patients who had undergone cardiac surgery with CPB. Patients were assessed preoperatively, before discharge, and at 1 year after surgery with the Structural Clinical Interview for DSM-IV and a series of neuropsychological tests. Psychometric scales were administered to evaluate cognitive functioning (Syndrom Kurztest), depressive symptomatology (Montgomery-Asberg Depression Rating Scale), posttraumatic stress symptoms (Posttraumatic Stress Syndrome 10-Questions Inventory) and HRQOL (SF-36 Health Status Questionnaire). Delirium Rating Scale (DRS) was used daily over the course of intensive care unit treatment. Postoperative delirium developed in 11 of the 34 patients (mean DRS rating scale score+/-S.D.: 20.36+/-6.22, range: 14-31). Short-term consequences of cardiac surgery included adjustment disorder with depressed features (n=11), posttraumatic stress disorder (n=6), major depression (n=6) and clinically relevant cognitive deficits (n=13). At 12 months, the severity of depression and anxiety disorders improved and returned to the preoperative level, and 6 out of the 30 followed-up patients displayed cognitive deficits. Our patients' HRQOL SF-36 self-reports significantly improved compared with baseline quality of life data. However, 1-year overall lower cognitive function scores were associated with lower HRQOL. Cardiac surgery with CPB is associated with improvements in HRQOL relative to the preoperative period, but the presence of cardiac surgery-related cognitive decline impairing HRQOL is a complication for a subgroup of cardiac surgical patients in the long-term outcome.

Aged↗
PubMedDate not supplied

Predicting community tenure in patients with recurrent utilization of a psychiatric emergency service.

OBJECTIVE: Factors determining community tenure (CT) between subsequent referrals to a psychiatric emergency room (PER) are only partly understood. We investigated the differential effect of patient and health system characteristics on the CT of patients with a previous referral to a PER. METHOD: Data were collected for patients with a history of PER referrals (N=531) in a university hospital in Leuven, Belgium, between March 2000 and March 2002. Using logistic regression analysis, we compared patients with a short (<2 months), intermediate (2--12 months) and long (>or=12 months) CT between previous and current referrals. RESULTS: A short CT (53% of the patients) was predicted by not receiving aftercare at the previous PER visit (OR=6.43) or by not complying with recommended aftercare (OR=3.89). An intermediate CT (38% of the patients) was predicted by an adjustment disorder (OR=6.72) or a substance use disorder (OR=3.47) or by the absence of a mental disorder (OR=4.13). Nine percent had a long CT. Protective factors of a long CT were noncompliance with aftercare at the last PER visit (OR=0.09) and currently being in outpatient treatment (OR=0.05). CONCLUSION: For patients with a previous use of a PER, short CT was highly influenced by aftercare arrangements and not by clinical characteristics.

Adolescent↗
PubMedDate not supplied

Factors related to suicide in New York state prisons.

OBJECTIVE: Examine factors related to prison suicides to aid prevention. METHOD: Review the mental health records of all 76 suicides that occurred between 1993 and 2001 in New York State Department of Correctional Services (NYSDOCS) prisons that had some contact with mental health services during their incarceration. (This represented 84% of all NYSDOCS suicides.) Extract data from the psychological autopsies for a sample of 40 of these suicides. RESULTS: Of the suicide victims with some mental health contact, 95% had a substance abuse history, 70% displayed agitation or anxiety prior to the suicide, and 48% had a behavioral change. Common stressors preceding the suicide were inmate-to-inmate conflict (50%), recent disciplinary action (42%), fear (40%), physical illness (42%), and adverse information (65%) such as loss of good time or disruption of family/friendship relationships in the community. Forty-one percent had received a mental health service within 3 days of the suicide. Compared to the about 7200 inmates actively receiving mental health services in state prison, African-Americans and patients with a Major Mood (Bi-polar or Major Depression) were under-represented. Adjustment Disorder, Schizophrenia, and Personality Disorder diagnoses were over-represented. Suicide victims were more likely to have been incarcerated for a violent crime. CONCLUSION: Mental illness, anxiety/agitation, behavior change, stressors, history of substance abuse, and non-African-American were important risk factors.

Adolescent↗