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PubMed1990

Diagnostic results of psychiatric evaluations of state police officers.

Twenty-six state police officers referred by their department or self-referred were evaluated by a university department of psychiatry over a 28-month period. The most common primary diagnosis was adjustment disorder, followed by substance abuse and personality disorder. Sixteen of the officers were assessed to be psychiatrically capable of returning to duty; concurrent outpatient treatment was recommended for most of them. The most challenging cases for evaluation were those involving psychiatric symptoms after trauma on duty, behavioral manifestations of personality disorder, and substance abuse.

Adult↗
PubMed1991

Characteristics of patients attending an HIV-related psychiatric clinic.

Demographic and clinical data were recorded for 324 patients who visited an AIDS-related psychiatric outpatient clinic over a three-year period. Seventy-five percent of the patients had a diagnosis of AIDS, AIDS-related complex, or asymptomatic HIV seropositivity. Intravenous drug use and heterosexual relations were the most common HIV transmission risk factors. Seventy-three percent of the patients were black or Hispanic; 51 percent were female. In all stages of HIV infection, adjustment disorder was the most common diagnosis; one third to one half of the patients had substance abuse diagnoses. Only 5 percent were diagnosed with dementia, with the incidence highest (12 percent) in patients with AIDS. On the basis of their experience with the clinic, the authors discuss issues that have proved important in the treatment of patients with the triple diagnoses of medical illness, mental illness, and substance abuse.

Adolescent↗
PubMed1992

Differences in social resources and treatment history among diagnostic groups of older adults.

Differences in demographic and social characteristics and treatment history of 407 patients age 55 or older were examined in relation to diagnosis. Seven diagnostic groups in three mental health service programs were studied, all of which were characterized by surprisingly high rates of previous treatment (75 percent overall). Patients in the dysthymia, adjustment disorder, and V code groups appeared to be the most similar and to have the greatest psychosocial resources and fewest indicators of chronicity. Schizophrenic and bipolar patients had the least resources and most indicators of chronicity. Substance abuse patients tended to live alone, while those with major depression seemed to have more resources and later onset of their illness than schizophrenic and bipolar patients. About half of those with milder diagnoses had received prior outpatient treatment, suggesting that perhaps past treatment success leads older adults to revisit mental health services.

Activities of Daily Living↗
PubMed2001

Social problems in Pakistani psychiatric patients.

The paper presents a case register-based descriptive survey of social problems of general hospital psychiatric patients in Pakistan. 47.2% of psychiatric patients had a social problem. Problems with primary support group occurred in 33.4%, 14.2% had relational problems and 7.8% had problems relating to bereavement or death. Social problems were more common in females and patients who had adjustment disorder or depression. Psychiatric patients had more social problems than those who were diagnosed as having a physical problem only. Female depressed patients experienced problems with their in-laws more frequently than other types of social problem. The implications are that: i) some DSMIV categories require changing to make them more internationally applicable; ii) specific psycho-social inquiry during psychiatric diagnostic interviews is essential; iii) grief counselling and family therapy are important psychotherapeutic needs of Pakistani psychiatric patients; iv) these, in turn, indicate priorities in mental health professional training curricula.

Adolescent↗
PubMed1989

Consultation liaison psychiatry in a Kuwaiti general hospital.

The authors analysed the psychiatric profile of 208 general hospital patients referred for psychiatric consultation, about half of these patients presented with parasuicidal behaviour. The diagnoses of depression and adjustment disorders predominated. Characteristics of the referred patients, source of referral and main forms of psychiatric intervention are documented. Means to promote good relationships between psychiatrists and physicians are suggested. The need for a better liaison psychiatric service is emphasised.

Adolescent↗
PubMed1997

Crisis beds: the interface between the hospital and the community.

The main role of the crisis unit at a state psychiatric hospital was found to be the provision of brief hospitalisation for patients with adjustment disorders and personality disorders. The four bed crisis unit treated 14% of all patients admitted to the hospital, with an average length of stay less than three days. A study of 78 crisis unit patients found that 77% were able to be discharged directly to the community, and only 18% were readmitted during the following six months.

Acute Disease↗
PubMed1990

[Depression with panic attacks: clinical characteristics and prevalence in hospital].

Seventy-three patients successively hospitalized in psychiatry and meeting the criteria of the DSM-III for diagnoses of major depressive episode with or without melancholia (n = 64), dysthymia (n = 5) or adjustment disorder with depressed mood (n = 2) were studied. Of these 73 patients, 50.7% also exhibited, at the time of their hospitalization, panic disorder as defined by the DSM-III criteria (53.4% having exhibited this disorder at some time in their life). Moreover, eight of the 73 patients (11%) exhibited, or had exhibited at some time in their life, a "sub-panic" state characterized by recurring rudimentary attacks, while five of the 73 patients (6.8%) exhibited "permanent panic anxiety" tending to fluctuation rather than paroxysm. These two forms of anxiety raise the question of the limits of panic disorder. The comparison of depressions with and without panic disorder shows an even distribution of endogenous and nonendogenous forms in both groups. Depressions with panic disorder, moreover, registered greater intensity (according to the HDRS score), a higher lever of anxiety (according to the AMDP-AT score), and a higher degree of nervousness (according to the EPI score) than depressions without panic disorder. The study of the chronology of the associations between depressions and panic disorder shows that in more than one-half of the cases these disorders began within one month of each other. In one-third of the cases, panic disorder preceded the depressive episode by more than one month. And finally, in just over 10% of the cases, panic disorder appeared more than one month after the beginning of the depressive episode.

Adolescent↗
PubMed1991

Repeated use of psychiatric emergency services by children.

In this study, the repeat utilization of child psychiatric emergency services was examined. There are patients who use psychiatric emergency services repeatedly, and these patients represent a significant proportion of child psychiatric emergencies seen in emergency rooms. Repeat patients were more likely to threaten to harm others, have a diagnosis of adjustment disorder, conduct or oppositional disorder and be under the care of a child welfare agency. They were significantly more likely than the one-time patients to be less compliant with outpatient follow-up, admitted to hospital more often, needed more social support and had greater difficulty remaining in a residential treatment setting. Intervention in the emergency room did not appear to change the way they used emergency services.

Adolescent↗
PubMed1994

Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: randomized double-blind study with 135 outpatients.

In a double-blind comparative study, 135 depressed patients were treated in 20 centers. Inclusion diagnoses were typical depressions with single episode (296.2), several episodes (296.3), depressive neurosis (300.4), and adjustment disorder with depressed mood (309.0) in accordance with DSM-III-R. The dosage was 3 x 300 mg hypericum extract LI 160 or 3 x 25 mg imipramine daily. The treatment lasted for 6 weeks. Main assessment criteria were the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S) and the Clinical Global Impressions (CGI). In both treatment groups, a parallel reduction of the Hamilton score from 20.2 to 8.8 (LI 160, n = 67) or from 19.4 to 10.7 (imipramine, n = 68), and the transformed D-S point values from 39.6 to 27.2 (LI 160) and 39.0 to 29.2 (imipramine) were found. The analysis of CGI revealed comparable results in both treatment groups. Clinically relevant changes of the safety parameters were not found. In the LI 160 group fewer and milder side effects were found as compared to imipramine.

Adult↗
PubMedDate not supplied

Attempted suicide in Kuala Lumpur.

A total of 306 patients were admitted to the University Hospital in Kuala Lumpur in 1989 after attempting suicide. Fourteen of them succumbed to injuries. Psychosocial data of 296 patients out of the 306 survivors are reported. Suicidal behaviour is more common in the young and especially amongst the females. Nearly 45.0% of them are from social class IV and V. Persons of Indian ethnic origin are overrepresented, while in Malays suicidal behavior seemed to be less common. Self-poisoning was reported to be the commonest method in attempting suicide. Diagnosis of adjustment disorder was made in 58.5% of the patients. Two-thirds of the patients had an intention score of less than 10 on the Pierce's Scale.

Adult↗
PubMed1995

Depression before and after diagnosis of multiple sclerosis.

Depression was examined in 45 patients evaluated within 2 months of diagnosis of MS. At the time of testing, 40% of the MS sample met the diagnostic criteria for major depression, 22% had adjustment disorder with depressed mood and 37% showed no evidence of mood disorder. Personal and family history of depression in patients with MS was also examined and compared with a sample of patients with chronic low back pain (CLBP) who were matched for age, gender, marital and employment status and current level of depression. Fifty-two per cent of patients with MS reported experiencing a depressive episode before the onset of MS compared with 17% of patients with CLBP (P < 0.001). Sixteen patients with MS (35%) reported family history (parent or sibling) of treatment for depression compared with seven (15%) of patients with CLBP (P < 0.05). MS patients with a history of depression reported more initial symptoms than MS patients without a history of depression. Clinical and theoretical implications of the findings are discussed.

Adult↗
PubMed2002

Stem cell transplantation: supportive care and long-term complications.

With increasing hematopoietic stem cell transplant (HSCT) activity and improvement in outcomes, there are many thousands of HSCT survivors currently being followed by non-transplant clinicians for their healthcare. Several types of late sequelae from HSCT have been noted, and awareness of these complications is important in minimizing late morbidity and mortality. Late effects can include toxicities from the treatment regimen, infections from immunodeficiency, endocrine disturbances, growth impairment, psychosocial adjustment disorders, second malignancies, and chronic graft-versus-host disease (GVHD). A variety of risk factors for these complications have been noted. The clinician should be alert to the potential for these health issues. Preventive and treatment strategies can minimize morbidity from these problems and optimize outcomes.

Follow-Up Studies↗
PubMed1985

Day and full time psychiatric treatment: a controlled comparison.

Ninety-one patients admitted as emergencies, suffering from neurosis, personality disorder, or adjustment reaction, were randomly allocated to day hospital or to continued in-patient care. Follow-up was for up to one year. Clinical outcome was similar in the day care and in-patient groups, but patient satisfaction was significantly greater in day patients. Day hospital care was only about two-thirds of the cost of the cheaper of the two in-patient regimes, even though contact with it was on average twice as long as for in-patients.

Adjustment Disorders↗
PubMed1985

Day treatment: suitability and referral procedure.

In a prospective screening of emergency admissions of patients suffering from neurosis, personality disorder or adjustment reaction, 100 were assessed as suitable for early transfer to day hospital treatment, 101 as unsuitable, and 39 as not requiring further intervention. Of the unsuitable patients, 39 were grossly disturbed; the remainder did not differ in severity from those thought suitable, but there was a specific reason against day treatment in all but 13 of the 62--most commonly alcohol abuse, physical problems, social problems or aggression. Patients' attitudes were also important. Recruitment of patients had to be active, with regular visits to the wards by day hospital staff.

Adjustment Disorders↗
PubMed2000

Trends in special (high-security) hospitals. 2: Residency and discharge episodes, 1986-1995.

BACKGROUND: It has been argued that many patients in special hospital beds do not need to be there. In the 1990s there were initiatives to discharge women and people with learning difficulties. AIMS: To test for trends in special hospital discharges and to examine annual resident cohorts. METHOD: This study was from 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 region; admission episodes; legal category of detention; admission source and type of offence. RESULTS: The median annual number of residents was 1859 (range 1697-1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded. CONCLUSIONS: Service planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings, have gone against this trend.

Female↗
PubMed1997

Medical management of noncognitive sequelae of minor traumatic brain injury.

Mild traumatic brain injury (TBI) encompasses the postconcussion syndrome characterized by symptoms that include a variety of physical symptoms as well as cognitive and behavioral impairments. The focus of this discussion is on the medical management of posttraumatic headaches, posttraumatic seizures, dizziness, auditory impairments, anosmia, tremor, paraspinal pain, and visual symptoms. Adjustment disorders with disturbances of affect and emotion lability also may accompany mild TBI. All of these conditions may be approached with medications or a variety of therapy techniques or both. The approach to concussion in sports-related injuries is also reviewed.

Journal Article↗
PubMed1993

The Bender-Gestalt psychopathology scale: failure to infer validity in a school-aged sample.

The concurrent validity of Hutt's (1977) empirical psychopathology scale of the Bender Visual-Motor Gestalt Test was evaluated among three groups of younger school-aged children within the 7-to-10- year age range (M = 109.1): adjustment disordered, conduct disordered, and nonclinical controls (n = 40/group). Excellent interscorer reliability was achieved with approximately 2 hr of self-study of the scoring manual. Although the conduct-disordered group was significantly more immature on Koppitz' Developmental Scoring System, there were no significant differences among groups on the psychopathology scale when visual-motor development was covaried (M = 50.5). This was an unexpected result, given Hutt's initial validation study among school-aged children. The psychopathology scale was not inferred to be valid among adolescents in the only known concurrent validation study. Pending supportive validation research, the psychopathology scale should not be employed in the clinical assessment of younger school-aged children.

Journal Article↗
PubMed1988

Intentional isoniazid overdosage in young Southeast Asian refugee women.

During a two-year period, from January 1984 through December 1985, six cases of intentional overdosage with isoniazid were reported in young Southeast Asian refugee women. The patients were aged 14 to 23 years, had all immigrated within one year and were receiving isoniazid preventive therapy for tuberculosis infection without disease. Clinically, all patients experienced generalized seizures, and three sustained moderate metabolic acidosis. All recovered uneventfully. Psychiatric evaluations revealed that two patients had major depression; two, adjustment disorders with depressed mood; and two, no psychiatric illness. The latter two patients and two others ingested an excessive amount of isoniazid immediately following an argument with a family member. Because tuberculosis infection is prevalent in refugees immigrating from Southeast Asia, isoniazid, given for six months to one year as preventive therapy, is one of the most frequently prescribed drugs during the early resettlement period. There may be an increased risk of intentional isoniazid overdosage during preventive therapy of young refugee women.

Adolescent↗