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 649 records · Page 36Linked to original sources
PubMed2006

Gabapentin's acute effect on mood profile -- a controlled study on patients with alcohol withdrawal.

RATIONALE: Delayed beneficial effects of gabapentin on mood were frequently reported in various patient populations. This is the first controlled study which addressed acute effects of gabapentin on mood. METHODS: Analysis of the German version of Profile of Mood States (POMS) throughout a randomised placebo-controlled, double-blinded study of gabapentin on acute alcohol withdrawal [Bonnet, U., Banger, M., Leweke, F.M., Specka, M., Müller, B.W., Hashemi, T., Nyhuis, P.W., Kutscher, S., Burtscheidt, W., Gastpar, M. 2003. Treatment of acute alcohol withdrawal with gabapentin -- results from a controlled two-center trial. J Clin Psychopharmacol 23, 514-519]. In addition, subjective severity of alcohol withdrawal was determined by the Essen Self-Assessment of Alcohol Withdrawal Scale (ESA) to control effects of concurrent withdrawal on POMS. Ratings were performed at intake (baseline), day 1 (study medication 400 mg q.i.d.), day 2 (study medication 400 mg q.i.d.) and day 7 (no study medication). RESULTS: Analyses could be performed on 46 out of 59 randomised subjects. Within the first two days of the study, a significant stronger increase in the POMS-vigour subscore occurred in the gabapentin group. A subgroup analysis suggests that gabapentin's effect on vigour largely results from a stronger improvement of vigour in a small group of 11 patients with co-morbid mild depression (according to ICD-10: dysthymia or depressive adjustment disorder). There were no significant differences between the treatment groups regarding the other POMS-subscores (dejection, fatigue, anger) ruling out an overall fast effect on mood. Moreover, ESA-measures were not significantly altered indicating a missing effect of 400 mg gabapentin q.i.d. on acute alcohol withdrawal itself. After tapering off study medication, no more significant differences between gabapentin and placebo group were observed on vigour, strongly suggesting that the initial effect results from a pharmacological gabapentin action. CONCLUSION: Gabapentin selectively accelerated the improvement of the vigour-subscore of patients with acute alcohol withdrawal within 48 h. This effect was independent from the subjective severity of withdrawal and especially marked in patients with co-morbid mild depression.

Adult↗
PubMedDate not supplied

Psychosocial aspects of xenotransplantation: survey in adolescent recipients of porcine islet cells.

INTRODUCTION: Transplantation is a process with several psychosocial challenges. Regarding the case of xenotransplantation, the perceived similarity between humans and pigs may be stressful. Adjustment disorders have been reported among transplantation recipients. We sought to assess the psychosocial aspects of xenotransplantation among porcine islet-cell recipients and their efforts to adapt themselves to this condition. MATERIAL AND METHODS: Ten insulin-dependent diabetes mellitus patients aged 14.58 +/- 7.93 who received porcine islet-cells were included. The bioartificial steel/fibrous tissue chamber method was used. All patients and their relatives were interviewed about their expectations, overall functioning, and experiences. The quality of life, enjoyment, and satisfaction scale and the hospital anxiety and depression scales were used. A 1-year follow-up was done. RESULTS: Their motivation was centered on autonomy; there were no troubles regarding the graft origin. Xenotransplantation was perceived with pragmatism, seeing pigs as an unlimited resource. The patients with best outcomes also had the greatest improvements in several quality of life areas (QOL) while the medium responders had fewer QOL improvements. The nonresponders experienced mainly frustration. Parents' concerns were not related to their children's health but to their recently gained autonomy. CONCLUSIONS: In addition to enthusiasm, the perception of animals as an unlimited source of organs may affect patient compliance; in this group, xenotransplantation was seen as using as a long-lasting drug, with chamber walls considered as a physical, immunologic, and, in certain manner, a psychological barrier.

Adolescent↗
PubMed1996

The ECLW Collaborative Study: III. Training and reliability of ICD-10 psychiatric diagnoses in the general hospital setting--an investigation of 220 consultants from 14 European countries. European Consultation Liaison Workgroup.

A comprehensive training program for reliable use of the ICD/10 in Consultation-Liaison (C-L) psychiatry was conducted with 220 psychiatrists and psychologists from 14 European countries. The training included rating of written test cases and development of a coding manual to avoid diagnostic pitfalls not addressed in the ICD-10 manual. Following this training, all consultants rated 13 written case histories. One hundred sixty-seven consultants (76%) had a kappa (kappa) of at least 0.70. Only 13 (6%) had a kappa 0.40. The percentage of high reliability raters was evenly distributed among the different countries. Consultants had some problems in the differentiation between adjustment disorders and depressive disorders, and in the classification of disorders where ICD-10 differs from the DSM-III-R system. National biases in diagnostic practice were found with regard to the "case" concept and the role of alcohol in confusional states. Finnish consultants coded "no psychiatric disorder" significantly more often, whereas German and Italian consultants attributed delirious state more often to alcohol than consultants from other European countries. The study demonstrates that it is possible to achieve acceptable interrater reliability in applying the ICD-10 guidelines, through training programs designed for C-L psychiatrists and psychologists. Nevertheless, this first cross-national study shows the importance of addressing differences in national diagnostic practice.

Diagnosis, Differential↗
PubMed1999

Psychological distress among cancer patients and informed consent.

This study examines the relationships between satisfaction with information provided, understanding of consent procedures, and levels of anxiety/depression in a sample of patients undergoing radiotherapy for cancer. One hundred patients completed a 13-item self-report questionnaire and the Hospital Anxiety and Depression Scale (HADS). Twenty-two percent of patients could not recall signing a consent form and, for those who did recall, the level of understanding for what they had consented to was patchy. One fourth of patients could not recall being told of the side-effects from radiotherapy and were unable to list even common side-effects, such as tiredness, skin irritation, and sickness. No patient had been told about the low risk of second malignancy. Twenty-eight percent of patients were unhappy with the amount of information offered to them. Thirty percent of patients reached caseness for adjustment disorder +/- anxiety/depression. Thirteen percent of patients reached caseness for major depression. There was a significant correlation between patients who scored highly on the HADS and dissatisfaction with the information provided. Clinical implications and possible mechanisms of these findings are discussed.

Adaptation, Psychological↗
PubMed1991

A psychiatry outpatient consultation-liaison clinic. Experience at the Cleveland Clinic Foundation.

This report describes the patients seen during the first 3 months of operation of a psychiatry outpatient consultation-liaison (C-L) clinic. A total of 113 patients were seen. For 8% of the appointments made, patients did not show up; the cancellation rate was 3.8%. Depression, anxiety, stress, and somatic symptoms were the most common reasons for referral, while the most common diagnoses made were major depression, adjustment disorder, and panic disorder. Practitioners in the fields of internal medicine, primary care, and psychology made the majority of the referrals. Patient satisfaction as expressed in a written survey was high. The results showed that an outpatient C-L clinic can be an effective way to access and treat medicine, surgery, and psychology outpatients in a big hospital setting.

Adult↗
PubMedDate not supplied

Liver transplantation using living donors. Preliminary donor psychiatric outcomes.

Twenty liver transplantations to sick infants from living-donor relatives were performed over a 16-month period. Before the operation, donors were screened psychiatrically by interview and psychological testing. Donor outcomes were assessed postoperatively to evaluate adverse psychiatric outcomes and to attempt a correlation with preoperative findings. There were three significant donor problems in the immediate postoperative period, two marital dissolutions and one adjustment disorder, as well as several other minor problems. These results are examined in light of past observations about living-donor renal transplantations and pediatric transplantation in general.

Adaptation, Psychological↗
PubMedDate not supplied

Consultation-liaison psychiatry: stability and change over a 10-year-period.

Few long term studies have reported observations of changes over time with Consultation-liaison (C-L) populations. This is a longitudinal observational study of a tertiary care psychiatric C-L-service over a ten-year-period (1988-1997) using a standardized computerized clinical database to examine 4,429 consecutive referrals. Sociodemographic variables, relative consultation rates, reasons for referral and psychiatric diagnoses, apart from a shift from adjustment disorders with depressed mood to major depressive disorders within the depressive syndrome group, did not demonstrate significant changes during the study period. Levels of psychosocial and somatic functioning of referred patients decreased. Changes occurred in the pattern of C-L-psychiatric recommendations, e.g., in the prescription of antidepressants where tricyclic antidepressants were replaced by newer agents such as the selective serotonin reuptake inhibitors. Consulting psychiatrists were more likely to refer to private psychiatrists to follow patients, and more patients were transferred to inpatient psychiatric units. Due to a decrease in length of stay over the ten year observation period, the correlation of lagtime (the time from admission to the hospital until referral to C-L psychiatry) and length of stay decreased from very strong to moderate.

Aged↗
PubMed1996

Left ventricular assist devices. Psychosocial burden and implications for heart transplant programs.

Left ventricular assist devices (LVADs) driven by external sources and capable of sustaining life over weeks to months as a bridge to heart transplantation have been implanted in over 300 patients in the United States. Because of the limited availability of organs for transplantation, the remarkable degree to which LVADs reverse end-organ dysfunction, and patient acceptance, proposals for home LVAD treatment and for use of the LVAD as a permanent treatment for heart failure are being considered. LVAD therapy is associated with characteristic psychiatric and psychosocial problems, however, which must be addressed to optimize results. Among the first 30 LVAD patients treated at our center, psychiatric interventions were frequently required for family stress, major depression, organic mental syndromes, and serious adjustment disorders. Psychiatric problems most often occurred in patients with ongoing medical complications following LVAD implantation, and often significantly impaired rehabilitation. Both depression and organic mental syndromes were frequently associated with preexisting cerebrovascular disease, which was sometimes occult, and with strokes complicating LVAD therapy. Aggressive treatment of depression played a major role in improving functional status. LVADs may decompress heart transplant waiting lists and make it possible to optimize patients' physiological and functional status before transplantation. With increased LVAD use, however, neuropsychiatric factors can be expected to play a large role in determining quality of life and outcome both before and after heart transplantation.

Activities of Daily Living↗
PubMedDate not supplied

Suicidal behavior among young people in Singapore.

The purpose of this study was to investigate suicidal behavior among young people in an Asian community. Tracing records of all patients below 21 years of age who attempted suicide and were managed in a teaching hospital, the authors found the incidence increased sixfold between 1991 and 1995. Young females of Indian origin were found to be a risk group. Differences in suicidal behavior among the three main ethnic communities appear to be influenced by various sociocultural factors. The most common diagnosis was adjustment disorder stemming from interpersonal losses and conflicts. Schizophrenia, alcohol, and other substance abuse were rarely reported.

Adolescent↗
PubMed1984

Biochemical markers in suicidal patients. Investigations with cerebrospinal fluid amine metabolites and neuroendocrine tests.

141 female psychiatric patients, suffering from major depression, schizophrenia, alcohol dependence or adjustment disorder, were investigated for their 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and cortisol level in the cerebrospinal fluid (CSF). Dexamethasone suppression tests were also performed in 111 cases, and TRH/TSH tests in 40 subjects. Fifty-two patients were hospitalized following a recent suicide attempt, 18 of which were made using a violent method. The other 34 attempters took tranquilizer or sedative overdoses. CSF 5-HIAA was significantly lower in violent attempters in all 4 diagnostic categories. CSF HVA was higher in those taking drug overdoses, but only in depression (and less markedly in schizophrenia). CSF cortisol did not differ among either diagnostic or suicidal subgroups. Dexamethasone suppression was more frequently abnormal in suicidal patients than in nonattempters, and this difference was more important where the overall nonsuppression rate was lower. Maximal TSH response to TRH showed an inverse correlation with CSF 5-HIAA, and it was lowest in the nonattempter group. The difference between violent suicide attempters and nonattempters in their TSH response was significant. Since these biochemical changes were more or less independent of clinical diagnoses, it seems relevant to explore further the biological background of human aggression and suicide as a separate research direction.

Adult↗
PubMed1998

The scientific, quasi-scientific and popular literature on the use of St. John's Wort in the treatment of depression.

St. John's Wort, also known as Hypericum, is an herbal product that is available in health food stores as an allegedly 'safe' alternative to antidepressants developed by the pharmaceutical industry. Recently it has received extensive coverage through the media, especially in the United States. To the best of our knowledge, Germany is the only country where it has been formally approved for clinical use. We reviewed both the vulgar and the scientific literature on this product. Although the few controlled studies that have been conducted pertain to adjustment disorder with depressed mood, several books and the media advocate its use for clinical and/or chronic depression. The high placebo rate in these studies, often in the 50% range, does indeed suggest that the controlled trials have been conducted on mild transient depressions; extrapolation to more serious or chronic depressions would therefore be unwarranted. We could not find any published literature comparing the efficacy of Hypericum to a standard antidepressant versus placebo. Furthermore, the studies claiming safety and freedom from potentially serious side effects appear flawed methodologically. Actually, little is known about the putative mechanism of action of Hypericum in depression; if indeed it does involve serotonergic mechanisms or monoamine-oxidase inhibition, it invites caution with concurrent use with an SSRI and, of course, with a MAOI. A skeptic might conclude that St. John's Wort should not be used until more definitive data are available. A less conservative view would be that, while its current widespread use is not warranted, the product may still have some merit for mild nonchronic depressive states below the clinical threshold. If this were conclusively proven, it would indeed constitute an important development in the field of antidepressants.

Antidepressive Agents↗
PubMed1998

Validity of the shortened Mood and Feelings Questionnaire in a community sample of children and adolescents: a preliminary research note.

The Mood and Feelings Questionnaire (MFQ) was designed to detect clinical depression in children and adolescents. Our aim was to investigate the relationship between symptom scores obtained using the short-version MFQ and psychiatric disorders in a non-clinical sample. Seventy-eight parents and 71 twins, who had completed the MFQ, were interviewed separately using a semistructured diagnostic interview, the Child and Adolescent Psychiatric Assessment. Parent-rated MFQ scores (MFQ-P) were found to distinguish those with ICD-10 (point biserial correlation = 0.345) and DSM-III-R depression (point biserial correlation = 0.369) from non-depressed cases. MFQ-P scores also differentiated depressed cases from those with 'other psychiatric diagnoses' (any anxiety disorder, oppositional defiant disorder and conduct disorder, hyperkinetic disorder/attention deficit hyperactivity disorder and adjustment disorder/post-traumatic disorder). The MFQ-P at the chosen cut-off point showed a sensitivity of 0.75 and specificity of 0.73 for an ICD-10 diagnosis of depression and a sensitivity of 0.86 and specificity of 0.87 for DSM-III-R depression. The number of self-rated reports (MFQ-C) was small, but overall the results suggest that self-rated MFQ scores may show less specificity. The MFQ-C at the selected cut-off point showed a sensitivity of 0.6 and specificity of 0.61 for ICD-10 depression, and a sensitivity of 0.75 and specificity of 0.74 for DSM-III-R depression.

Adolescent↗
PubMed1995

Clinical outcomes and satisfaction of patients of clinical nurse specialists in psychiatric-mental health nursing.

Survey research was conducted to examine clinical outcomes and satisfaction of patients of psychiatric mental health clinical nurse specialists (CNSs). Patients who had terminated from outpatient psychotherapy with 6 CNSs in 1993 were mailed a questionnaire (N = 223). Follow-ups by mail yielded a response rate of 45% (n = 100). The questionnaires included the Profile of Mood States-Short Form ([POMS-SF]; McNair, Lorr, & Droppleman, 1992). Quality of Life Function ([QOL]; Lehman, 1991), and Patient Satisfaction Scale (Baradell, 1994). Paired difference t-tests were used to evaluate clinical outcomes. Percentages were used to report satisfaction, and Pearson correlations were used to examine the relationship between clinical outcomes and patient satisfaction. The mean age for respondents was 37 years; 82% were female. Diagnoses included depression (46%), adjustment disorders (34%), anxiety (10%), and other (10%). Patients reported significant improvement in all clinical symptoms: anxiety, depression, anger, confusion, fatigue and vigor. Patients reported significant improvement in all domains of QOL: family, social, and job. Patients reported a very high level of satisfaction with the care provided. The more clinical improvement the patients reported, the more satisfied they were with the care provided. If nurses are to be included in a reformed health care delivery system in the future, additional research is essential.

Adolescent↗
PubMed2001

An attempt to employ the Zung Self-Rating Depression Scale as a "lab test" to trigger follow-up in ambulatory oncology clinics: criterion validity and detection.

We examined issues of criterion validity and detection of depression employing the Zung Self-Rating Depression Scale (ZSDS) as a "lab test" to trigger follow-up interviews of ambulatory oncology patients by oncology staff and the possibility of subsequent algorithm-based antidepressant treatment. Sixty oncology patients were screened with the ZSDS and then interviewed using the Mini-International Neuropsychiatric Interview (MINI). We examined the sensitivity and specificity of various cutoffs on the ZSDS and a briefer version, the Brief Zung Self-Rating Depression Scale (BZSDS) as they predicted results of the MINI, which was used as the criterion. Mean age of patients was 58.3 years (SD = 11.9). Thirty-two were female (53.3%) and 28 were male (46.7%). The correlation of the ZSDS (r = -0.66, P <.0001) and BZSDS (r = -0.57, P <.0001) with the MINI overall suggested acceptable levels of criterion validity. Additionally, we examined various cutoff scores on the ZSDS and BZSDS to explore the false negative and false positive rates that are associated with each. For example, using the mild cutoff on the Zung (score > 48) to determine depression or adjustment disorder, 14 false negatives and 2 false positives were found. When the more stringent moderate cutoff (score > 56) was used, 25 false negatives and 0 false positives were found. Oncology staff can utilize such data to make decisions about where to set cut-offs that trigger follow-up based on the amount of error that is allowable in their attempts to identify depressive symptoms in their patients. We discuss that such decisions might be based on many factors including the resources available in a particular site for follow-up or the comfort of particular oncologists and nurses managing and prescribing psychotropic medications, or in providing supportive counseling.

Aged↗
PubMedDate not supplied

Psychiatric diagnoses among self-referred dental injection phobics.

In order to determine the psychiatric characteristics of people with dental injection phobia. 118 dental injection phobics were systematically assessed using a structured clinical interview and a written questionnaire. Fifty-four percent of subjects had a current Axis I diagnosis other than dental injection phobia, mainly anxiety, mood or adjustment disorder, and 68.6% of subjects had an additional lifetime Axis I diagnosis. Subjects with additional current Axis I diagnoses reported higher dental anxiety, greater severity of injection fear cognitions, and poorer relationships with dental professionals, than did subjects without any or with past Axis I diagnoses. Further investigation is needed to explore the treatment possibilities for patients with and without additional current diagnoses.

Adolescent↗
PubMed1995

Screening for major depression in the early stages of multiple sclerosis.

BACKGROUND: Multiple Sclerosis (MS) is associated with a high risk of developing major depression, but depression in MS patients frequently goes undetected and untreated. The current study examined the clinical utility of the Beck Depression Inventory (BDI) as a screening measure for major depression in newly diagnosed MS patients. METHODS: Forty-six new referrals to an MS clinic completed the BDI and participated in a structured interview for major depression, within 2 months of the diagnosis of MS. RESULTS: According to DSM-III-R criteria, 40% of patients were diagnosed with major depression, 22% had adjustment disorder with depressed mood, and 37% showed no evidence of mood disorder. Sensitivity and specificity values, and positive and negative predictive values are reported for every BDI cut-off score between 9 and 21. CONCLUSIONS: A BDI cut-off score of 13 (sensitivity = .71, specificity = .79) is recommended as optimal for use in screening for major depression in newly diagnosed MS patients. The use of the BDI as a screening measure for major depression must proceed with caution given that a cut-off score of 13 still yielded a false-negative rate of 30%.

Adult↗
PubMed1991

Delirium in cancer patients.

Delirium is the second most common psychiatric diagnosis among hospitalized elderly cancer patients. A variety of factors are known to cause delirium in cancer patients, and the most frequently observed are outlined. History, presence of an altered mental state with identification of the cognitive impairment, and a close watch of mental function will help to differentiate delirium from a normal stress reaction, an adjustment disorder to cancer diagnosis, or early dementia. As in other medically ill patients, antipsychotic drugs are the cornerstone of treatment for delirium not manageable with environmental manipulation or causal therapy. Haloperidol is the most commonly prescribed drug for delirium in the cancer setting because of its low cardiovascular and anticholinergic effects. Cancer patients who are debilitated require a much lower starting dose than do the physically healthy.

Aged↗
PubMed2004

Police referral to victim support: the predictive and diagnostic value of the RISK (10) screening instrument.

One of the basic rights of crime victims granted under victim-orientated legislation introduced during the last 20 years in more than 100 countries worldwide is the right to be referred to victim support by the police. The under-utilization of psychological services by crime victims who are objectively in need of external support is substantial. Current legal procedures tend to perpetuate this unwanted condition. Programs aimed at the early detection and prevention of persistent postvictimization distress are more in line with the ideals of therapeutic jurisprudence. The RISK (10) screening instrument, which was specifically developed to be administered by police officers, may provide a basis for early detection. RISK (10) consists of a selection of 10 Risk factors with prior empirical evidence and theoretical significance. The focus of the present study was to examine the predictive and diagnostic power of RISK (10) components to detect persistent future psychological distress, among other things, in terms of Adjustment Disorder. Analyses were based on a sample of 93 crime victims who participated in the police and (3 months) follow-up parts of the study. Findings provided initial validation for the predictive accuracy of most RISK (10) components, and confirm the diagnostic value (in terms of specificity, sensitivity, positive and negative predictive power) of risk factors, such as engaging in character attributions, upward comparison processes, fatalistic appraisals of the episode, and the initial reporting of expected deficiencies in social support. The clinical utility of RISK (10) for early detection in police stations is confirmed.

Adolescent↗