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PubMed1994

[Primary/psychiatry interconsultation care: use of the single consultation].

OBJECTIVE: To study the use of single consultation in Primary Care/Psychiatry liaison. DESIGN: A retrospective study. SITE. Outpatients psychiatry department. Hospital Clínico Universitario. Zaragoza. PATIENTS OR OTHERS PARTICIPANTS: 200 consecutive referrals. PERIOD: June-December 1992. MEASUREMENTS AND MAIN RESULTS: GP does not report psychiatric symptoms in 24% of cases. If he reports it, describes significatively between GP and psychiatrist. There are important differences in relation to diagnosis: psychiatrist tend to diagnose less than GP Depression but uses more Dysthymia and Adjustment Disorder. 20% of patients referred to the psychiatrist are not considered psychiatric cases. GP ask for single consultation in 35% of patients, but psychiatrist discharges back to GP only 15% of cases. CONCLUSIONS: Primary Care/Psychiatry liaison should be improved. GP should clearly explain the amount of clinical responsibility they want to be involved in. Psychiatrists should asses more frequently the possibility of single consultation.

Family Practice↗
PubMed1995

Involuntarily detained HIV-infected patients in Sweden: reasons for referral and psychiatric diagnoses.

The Swedish Communicable Diseases Act permits the isolation of an HIV-infected person if there is risk of disease transmission. The purpose is for the patient to receive the support needed to alter his or her attitude and behaviour so that the isolation can be terminated. This study describes the reasons for referral and the psychiatric diagnoses of 34 isolated HIV-infected patients. All patients who were isolated in Stockholm from 1986 to 1993 were included. Psychiatric data were collected from their psychiatric records. The most frequent reason for referral was unprotected sex with a partner who was not informed about the infection. The most common psychiatric diagnosis was amphetamine or opiate abuse. Drug users without delusions and immigrants with adjustment disorders or post-traumatic stress disorder had the shortest treatment periods. All patients belonged to underprivileged groups, were drug users or refugees. More effort is needed to teach these groups about HIV.

Adult↗
PubMed1996

[Prevalence of depression in hospitalized patients over 65 years old in a medical service of the Military Hospital of Santiago].

AIM: To study the frequency of depression in elderly patients admitted to the Internal Medicine Service of an Institutional Hospital. PATIENTS AND METHODS: Patients over 65 years old admitted to the Internal Medicine Service of the Military Hospital at Santiago. Chile were assessed using the CDS-20 depression questionnaire and the FROMAGE score for dementia. RESULTS: One hundred twenty seven patients (71 female), were assessed. According to the FROMAGE score, 30% had moderate and 35% had severe dementia. Ten percent of males and 12% of females were depressive. Moderately demented patients, females, subjects with low educational levels and those living alone had a higher frequency of depression. According to DSM-III the most frequent diagnosis among depressive patients was "adjustment disorder with depressive mood". Attending physicians made the diagnosis in only 11% of patients with depression. CONCLUSIONS: Depression is frequent among hospitalized elders.

Aged↗
PubMed1997

Prevalence and risk factors for depression in children: an outpatient pediatric sample.

The purpose of this research was to study the prevalence, type, and psychosocial stressors associated with depression. The subjects were 81 children who came to the outpatient pediatric clinic, Chulalongkorn Hospital. There were 39 boys and 42 girls with the age range of 9.3-15.3 years. The results of the study were as follows. The prevalence of depression was 34.6 per cent. Types of depression were depressive symptoms only, 7.4 per cent; adjustment disorder with depressed mood, 17.3 per cent; dysthymia, 6.2 per cent; and major depression, 3.7 per cent. Females had more severe symptoms than males. Of the depressed group, 60.7 per cent had previous suicidal behavior compared with 20.6 per cent in the non-depressed group (p < 0.001). The rates of all psychosocial stressors were higher in the depressed group. Those with statistical significance were parental psychiatric illness, unstable living condition and history of abuse. Depressed children also experienced twice the number of psychosocial stressors compared with the non-depressed group (p < 0.01). This study shows that depression is prevalent in children with physical illnesses. It is imperative that physicians be aware of this problem especially in children who have many psychosocial stressors.

Adolescent↗
PubMed1997

[Turkish immigrants in ambulatory psychiatric treatment].

Socio-demographic and migration-specific particularities of first generation immigrants from Turkey (n = 133) treated at the Psychiatric Outpatient Department of the University Hospital, Basel were examined. 65.4% of the immigrants were men, 34.6% women. Women were significantly more often (p = 0.01) analphabetic than men and more often admitted as emergencies (p = 0.002). 66.7% of the married women and 57.8% of the married men were separated from their partners for more than one year because of migration. Adjustment disorder was the most frequent diagnosis in both genders. Opiate-dependency was not found in both genders, and none of the women were alcohol-dependent. The data are discussed on the background of socio-demographic characteristics of the Turkish immigrant population living in Basel and compared to studies made in Turkey.

Acculturation↗
PubMed1997

[Children and adolescents under 18 years of age admitted to a psychiatric department for adults].

Now and then children and adolescents are admitted as emergencies to adult psychiatric wards. The reasons for these admissions are frequently pronounced aggressiveness, behavioural problems, and threat of suicide or intended suicide. The aim of the study was to describe the cause of admission for those children and adolescents (younger than 18 years) that in the period concerned were admitted as emergencies to the adult psychiatric ward in Frederiksberg, Denmark. During the ten-year period concerned there were 42 emergency admissions. Compulsory measures according to the mental health act were used in one-third of the admissions. Forty percent of the admissions lasted more than one month. An arrangement for treatment after discharge was not achieved in one-third of the admissions. The most common diagnoses were adjustment disorder and conduct disorder. On the basis of this retrospective review the need for a locked adolescent ward is considered to be a relevant part of an emergency psychiatric service. There is an ethical problem in those cases where children and adolescents cannot be motivated for treatment after discharge.

Adolescent↗
PubMed1997

[Zopiclone dependence. Report of one case].

We report a 55 years old married woman without history of drug dependence. Due to a severe marital conflict she developed a chronic adjustment disorder with depressed mood. Zopiclone, 7.5 mg at night was prescribed for her insomnia and she rapidly became tolerant and dependent to the hypnotic. She was admitted to a psychiatric clinic, slowly detoxified and treated with pharmacotherapy and psychotherapy. Six months later, she has resumed her housekeeping and professional activities and is maintained with a benzodiazepine at night for insomnia.

Azabicyclo Compounds↗
PubMedDate not supplied

Pilot investigation of thyrotropin-releasing hormone-induced thyrotropin and prolactin release in anxious patients treated with diazepam.

Benzodiazepines have been reported to inhibit thyrotropin (TSH) and prolactin (PRL) secretion in response to stressful and pharmacologic stimuli in experimental animals. The current study investigates basal and thyrotropin-releasing hormone (TRH)-stimulated TSH and PRL release in anxious patients treated with diazepam. Six hospitalized patients having generalized anxiety or adjustment disorder with anxious mood (DSM III-R criteria) were treated during 1 week with diazepam (mean daily dose 33.3 mg). TRH testing was performed comparatively before and after 7 days of diazepam administration (with 250 micrograms protirelin and blood sampling at 15-min intervals over 60 min). Steady-state plasma levels of diazepam and its metabolite nordazepam (desmethyldiazepam) were determined by high-performance liquid chromatography. After 7 days of diazepam treatment, basal plasma levels of TSH and PRL were not affected compared with pretreatment values. Similarly, the time-course of TRH-induced TSH release was not modified by the treatment. By contrast, there was a trend to decrease in the TRH-induced PRL release, and the decrease in the PRL response to TRH on day 7 was significantly correlated with plasma nordazepam concentrations (rs = 0.943, p = 0.02). These preliminary results suggest that benzodiazepines, at therapeutic doses for the treatment of anxiety, may alter TRH-induced PRL release in humans.

Adolescent↗
PubMedDate not supplied

Psychosocial care of breast cancer patients.

Research in the field of Psychooncology has yielded useful data that may be helpful in clinical practice and in minimising psychosocial distress among breast cancer patients and their families. After the initial crisis following the diagnosis, the majority of patients adjust fairly well by mobilizing personal resources and social support. Adjustment may be enhanced by promoting open communication, offering support to the patient as to the whole family, and by aiding them in decision making. Comparisons of mastectomy to breast conservation have not consistently favored one surgery for all women, therefore, patients should be given the option to choose their preferred type of surgery. Since 20-30% of patients experience long-standing distress, early identification of patients at risk for severe adjustment disorders is important to provide them with professional support. Various kinds of psychosocial interventions have proven to be effective in reducing distress and improving patients' quality of life.

Breast Neoplasms↗
PubMed2000

Hospital adjustment in personality disorder patients admitted to a therapeutic community milieu.

This study investigated aspects of adjustment to the therapeutic community milieu in a group of personality disorder patients. Eighty-one patients consecutively admitted to the Cassel Hospital for medium/long-term residential treatment between April 1994 and October 1997 comprised the sample. The adjustment to the milieu was rated on the Hospital Adjustment Scale, while outcome was evaluated at 6-monthly intervals using a battery of self-rated and rater-based instruments. The aims of the study were: (a) to identify demographic and pre-admission clinical variables that would predict adjustment to the therapeutic regime; (b) to study the relationship between hospital adjustment and external social adjustment; and (c) to investigate the hypothesis that hospital adjustment and internally and externally directed aggression do not predict clinical outcome. The results showed that pre-admission level of global functioning and a previous history of substance misuse are the most significant predictors of hospital adjustment. No significant association between hospital adjustment and external social adjustment was found. Neither hospital adjustment not level of aggressiveness predicted outcome at 12 months. The implications of these results for therapeutic community treatment of personality disorder are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Reliability and validity of the work and social adjustment scale in phobic disorders.

The Work and Social Adjustment Scale (WSAS) is a simple widely used 5-item measure of disability whose psychometric properties need more analysis in phobic disorders. The reliability, factor structure, validity, and sensitivity to change of the WSAS were studied in 205 phobic patients (73 agoraphobia, 62 social phobia, and 70 specific phobia) who participated in various open and randomized trials of self-exposure therapy. Internal consistency of the WSAS was excellent in all phobics pooled and in agoraphobics and social phobics separately. Principal components analysis extracted a single general factor of disability. Specific phobics gave less consistent ratings across WSAS items, suggesting that some items were less relevant to their problem. Internal consistency was marginally higher for self-ratings than clinician ratings of the WSAS. Self-ratings and clinician ratings correlated highly though patients tended to rate themselves as more disabled than clinicians did. WSAS total scores reflected differences in phobic severity and improvement with treatment. The WSAS is a valid, reliable, and change-sensitive measure of work/social and other adjustment in phobic disorders, especially in agoraphobia and social phobia.

Adult↗
PubMed1997

Dimensions and disorders of adolescent adjustment: a quantitative genetic analysis of unselected samples and selected extremes.

One of the fundamental questions for developmental psychopathology concerns the etiological links between the normal and abnormal. To what extent do disorders differ quantitatively or qualitatively from variation in the normal range? Genetic research on the normal and the abnormal differs in terms of concepts, methods, statistics, and target audiences. An approach, referred to as "DF" analysis, provides a framework for integrating these two worlds of genetic analysis. We applied traditional correlational analyses as well as DF (DeFries & Fulker, 1985) analyses to mother and father ratings of adjustment of adolescent siblings in a 3-year longitudinal twin and step-family study. At wave 1, the sample included 720 sibling pairs (average age of 12.9 years for the younger sibling and 14.5 years for the older siblings) and, in wave 2, 395 pairs still living at home. Both correlational analyses of the entire sample and DF analyses of selected extremes suggested moderate genetic influence and modest shared environmental influence for internalizing and externalizing behavior problems. Similar estimates were found for unselected individual differences and selected extreme groups. A framework is proposed that focuses on quantifying the etiologies of disorders (QED) as measured on continuous dimensions.

Adjustment Disorders↗
PubMed1987

Combat stress reactions, posttraumatic stress disorder, and social adjustment. A study of Israeli veterans.

This study assessed social functioning among three groups of Israeli soldiers: a) front-line soldiers who had been treated for combat stress reaction during the 1982 Lebanon war (N = 382); b) matched control front-line soldiers who did not sustain combat stress reaction (N = 334); and c) combat-ready soldiers who did not participate in the 1982 war (N = 88). Subjects were screened 1 year after the war for posttraumatic stress disorder and social functioning. Results indicated that participation in combat per se did not have adverse effects on postwar social functioning. However, combat stress reactions and posttraumatic stress disorder were found to be associated with a decline in postwar social functioning. The practical and theoretical implications of these findings were discussed.

Adolescent↗
PubMed1995

Screening prison inmates for mental disorder: an examination of the relationship between mental disorder and prison adjustment.

The rapidly expanding population of prison inmates has severely challenged the prison system's ability to effectively screen incoming inmates for mental disorders and mental health service needs. This study describes a comprehensive mental health screening of inmates at a maximum security prison, using a modified version of the Referral Decision Scale (RDS), a screening measure developed from the Diagnostic Interview Schedule. Modified items and adjusted cut-off scores were used in order to reduce the rate of false positives. Survey results indicate that this modified version of the RDS may be an effective screening measure for correctional settings. Subjects who were positive on the RDS were compared to negative subjects on a variety of offense and prison adjustment variables. Findings indicate that while subjects who were positive on the RDS experienced some initial adjustment problems within the prison, they were generally not found to be involved in an elevated rate of prison violence and were not more often remanded to disciplinary units than those subjects who were negative on the RDS.

Adaptation, Psychological↗
PubMed1992

Screening for psychiatric disorders in a lymphoma out-patient population.

The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item self-assessment questionnaire, was tested as a screening method for psychiatric disorders in a sample of 117 Hodgkin's lymphoma and non-Hodgkin lymphoma consecutive out-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1--specificity). This makes it possible to choose an optimal cut-off score that takes into account the costs and benefits of treatment of psychiatric disorders (mainly adjustment, depressive and anxiety disorders) in a lymphoma out-patient population. A cut-off point of 10 gave 84% sensitivity and 66% specificity. HADS appears in this study to be a well accepted, simple, sensitive and specific tool.

Adjustment Disorders↗
PubMed1992

Psychological adjustment to pediatric physical disorders: a meta-analytic review.

Reviewed 87 studies of children's adjustment to physical disorders in a meta-analysis. Results indicate (a) children with such disorders show increased risk for overall adjustment problems, internalizing and externalizing symptoms; (b) risk was greatest in studies making comparisons to norms rather than to study controls; (c) risk varied by informant (teacher, mental health professional, parent), and by degree of matching with controls; (d) the self-concept of children with physical disorders across all studies appears significant for studies with careful matching or comparisons with norms; (e) there are interdisease differences, but the number of studies within individual disorders, with a few exceptions, are quite small. The need for improved methodology is discussed.

Adaptation, Psychological↗