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PubMed2001

Impediments to screening for hazardous alcohol use and dependence in general hospital psychiatric inpatients.

OBJECTIVE: The Alcohol Use Disorders Identification Test (AUDIT) has been developed to screen for hazardous and harmful alcohol consumption. It has been used among a variety of primary care, general population and general hospital populations. However, with the exception of one study undertaken by the author and colleagues, the use of the AUDIT in general hospital psychiatric patients has not been reported. This paper reports on a substudy of this larger study whose aim was to determine the frequency of hazardous alcohol use and dependence among patients admitted to the psychiatric units of general hospitals in Perth, Western Australia, and discusses major reasons for non-AUDIT screening among this group. METHOD: In a 12-month period 990 patients aged 18-64 years and residing in the Perth metropolitan area were admitted to the psychiatric unit of the two hospitals. Using the AUDIT alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders, was assessed. RESULTS: Of the 834 admissions targeted for AUDIT screening 263 were not screened. This non-screening represented 27-42% of patients in each of the major diagnostic categories. There was no significant difference in the proportion of patients screened versus not screened for mood, adjustment or schizophrenia/psychosis. There were however, significantly fewer patients with anxiety disorder screened compared with mood disorder. Those non-screened patients in major psychiatric groups had significantly shorter hospital stays than their diagnostic counterparts who were screened. The major reason for non-screening in all groups was due to patients leaving the psychiatric facility before they could be accessed. This included discharge before screening, transfer to another psychiatric facility and short admission. To a lesser extent cognitive dysfunction accounted for non-screening among major diagnostic groups. CONCLUSIONS: Failure to screen patients was largely due to short hospital stays. Screening was impeded by the brief window period, commonly 1 or 2 days, between the absence of acute psychiatric sequelae and discharge. This situation contrasts dramatically to the medical or surgical admission where major sequelae are largely resolved in 2-3 days and AUDIT screening can take place over the remaining 3-4 days prior to discharge. To be effective in the general hospital psychiatric setting, alcohol screening needs to be incorporated into the routine ward assessment procedures. The brevity of the AUDIT makes this possible. This would maximize the time available to implement an intervention programme to those found to be consuming alcohol at a hazardous or harmful level.

Adolescent↗
PubMed1996

Subthreshold psychiatric symptoms in a primary care group practice.

BACKGROUND: The authors define 6 groups of subthreshold psychiatric symptoms that do not meet the full criteria for a DSM-IV Axis I disorder and examine the clinical significance of these symptoms in an outpatient primary care sample. METHODS: The subjects were 1001 adult primary care patients in a large health maintenance organization. Data on sociodemographic characteristics and functional impairment, including scores on the Sheehan Disability Scale, were collected at the time of the medical visit, and a structured diagnostic interview for DSM-IV disorders was completed by telephone within 4 days of the visit. Subthreshold symptoms were defined for depressive, anxiety, panic, obsessive-compulsive, drug, and alcohol symptoms. RESULTS: Subthreshold symptoms were as or more common than their respective Axis I disorders: panic (10.5% vs 4.8%), depression (9.1% vs 7.3%), anxiety (6.6% vs 3.7%), obsessive-compulsive (5.8% vs 1.4%), and alcohol (5.3% vs 5.2%) and other drug (3.7% vs 2.4%) cases. Patients with each of the subthreshold symptoms had significantly higher Sheehan Disability Scale scores (greater impairment) than did patients with no psychiatric symptoms. Many patients (22.6%-53.4%) with subthreshold symptoms also met the full criteria for other Axis I disorders. After adjusting for the confounding effects of other Axis I disorders, other subthreshold symptoms, age, sex, race, marital status, and perceived physical health status, only depressive symptoms, major depressive disorder, and, to a lesser extent, panic symptoms were significantly correlated with the impairment measures. CONCLUSIONS: In these primary care patients, the morbidity of subthreshold symptoms was often explained by confounding mental, physical, or demographic factors. However, depressive symptoms and, to a lesser extent, panic symptoms were disabling even after controlling for these factors. Primary care clinicians who detect subthreshold psychiatric symptoms should consider a broad psychiatric assessment.

Adult↗
PubMedDate not supplied

Potential treatment for subthreshold and mild depression: a comparison of St. John's wort extracts and fluoxetine.

Subthreshold depressive disturbances and depressive episodes of mild severity are frequently associated with disability and socioeconomic burden, and often show an increase in symptomatology over time if untreated. Thus, there is an urgent need for antidepressant active compounds that are more readily available than those that must be obtained by prescription. To get an impression of the efficacy of the widely used phytopharmaceutical St. John's wort, the antidepressant efficacy in mild depressive disorders was compared with that of the standard antidepressant fluoxetine. The present overview includes controlled trials of fluoxetine in depression with a mean initial score on the Hamilton Rating Scale for Depression (HAM-D) < or =24, which were compared to the respective studies on St. John's wort. The mean HAM-D reduction of all St. John's wort studies was 10.2 (52.9%), and the respective figures for fluoxetine were 12.5 points and 55.5%. Thus, no relevant efficacy difference between the groups of investigations was found based on the studies included. The most important restrictions of this overview are no meta-analysis was performed, the studies were performed with heterogeneous methodological standards, and the St. John's wort extracts used were very different. However, St. John's wort might be a treatment option to reduce symptoms in patients not suffering from full-blown depressive disorder.

Adjustment Disorders↗
PubMed2002

A population-based study of measles, mumps, and rubella vaccination and autism.

BACKGROUND: It has been suggested that vaccination against measles, mumps, and rubella (MMR) is a cause of autism. METHODS: We conducted a retrospective cohort study of all children born in Denmark from January 1991 through December 1998. The cohort was selected on the basis of data from the Danish Civil Registration System, which assigns a unique identification number to every live-born infant and new resident in Denmark. MMR-vaccination status was obtained from the Danish National Board of Health. Information on the children's autism status was obtained from the Danish Psychiatric Central Register, which contains information on all diagnoses received by patients in psychiatric hospitals and outpatient clinics in Denmark. We obtained information on potential confounders from the Danish Medical Birth Registry, the National Hospital Registry, and Statistics Denmark. RESULTS: Of the 537,303 children in the cohort (representing 2,129,864 person-years), 440,655 (82.0 percent) had received the MMR vaccine. We identified 316 children with a diagnosis of autistic disorder and 422 with a diagnosis of other autistic-spectrum disorders. After adjustment for potential confounders, the relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92 (95 percent confidence interval, 0.68 to 1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95 percent confidence interval, 0.65 to 1.07). There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder. CONCLUSIONS: This study provides strong evidence against the hypothesis that MMR vaccination causes autism.

Autistic Disorder↗
PubMed2006

Population and service characteristics of youth with schizophrenia-spectrum diagnoses in the Hawaii system of care.

BACKGROUND: Population and service characteristics were compared for youth (age 0-18 years) with and without schizophrenia-spectrum disorders, who received public mental health services in Hawaii's comprehensive system of care between July 1, 2000 and June 30, 2001. METHODS: Electronic records of youth with a diagnosis in the schizophrenia-spectrum (n=71) were compared to all other youth (n=13,904) who received services with respect to age, gender, ethnicity, comorbidity, type of service, and service cost. RESULTS: The schizophrenia-spectrum group had higher Asian representation, greater comorbidity, and was more likely to receive restrictive services for a higher average annual expense. When restrictive services were provided, they were of similar duration and intensity across groups. Almost all youth received less intensive services, but the schizophrenia-spectrum group received a higher frequency or longer duration of such services. CONCLUSIONS: Although youth with schizophrenia-spectrum disorders were uncommon, collectively they represented a distinct population with above average service consumption. Future monitoring of interventions and outcomes may help develop systematic and effective treatment strategies for youth with schizophrenia-spectrum disorders.

Adjustment Disorders↗
PubMed2006

Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmö, Sweden, in 2001.

STUDY OBJECTIVE: Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform disorders); and (2) investigating the independent impact of contextual deprivation and neighbourhood social disorganisation on mental health, while assessing both the magnitude and the spatial scale of these effects. DESIGN: Using different spatial techniques, the study investigated mental disorders due to psychoactive substance use, and neurotic disorders. PARTICIPANTS: All 89,285 persons aged 40-69 years residing in Malmö, Sweden, in 2001, geolocated to their place of residence. MAIN RESULTS: The spatial scan statistic identified a large cluster of increased prevalence in a similar location for the two mental disorders in the northern part of Malmö. However, hierarchical geostatistical models showed that the two groups of disorders exhibited a different spatial distribution, in terms of both magnitude and spatial scale. Mental disorders due to substance consumption showed larger neighbourhood variations, and varied in space on a larger scale, than neurotic disorders. After adjustment for individual factors, the risk of substance related disorders increased with neighbourhood deprivation and neighbourhood social disorganisation. The risk of neurotic disorders only increased with contextual deprivation. Measuring contextual factors across continuous space, it was found that these associations operated on a local scale. CONCLUSIONS: Taking space into account in the analyses permitted deeper insight into the contextual determinants of mental disorders.

Adult↗
PubMed1993

Endocrine correlates of stress vulnerability.

Psychological stress is implicated as one element in a constellation of risk factors for the development and maintenance of psychosomatic disease. Endocrine responses to stressful experience vary widely among individuals, and may account for some of the individual variability in vulnerability to development of psychosomatic symptoms under stress. Endocrine stress responsiveness probably has a large genetic component, but is also known to be modifiable by prolonged and/or profound stressful experience. Social and cognitive factors influence the pituitary-adrenal response to stress, and sex differences may also be significant. It may be possible to develop specific tests of endocrine responsiveness, perhaps incorporating psychological and pharmacological challenges, that may serve as markers of chronic stress experience or of vulnerability to psychosomatic disorders.

Adjustment Disorders↗
PubMed1996

Insulin resistance and sleep-disordered breathing in healthy humans.

Fifty healthy, normotensive individuals (34 women) with a mean age of 44.3 +/- 13.2 yr and a mean body mass index of 27.1 +/- 5.4 kg/m2 were tested for the presence or absence of insulin resistance and sleep-disordered breathing. The hypothesis of this investigation was that insulin resistance is associated with sleep-disordered breathing. In vivo insulin action with determination of steady-state plasma glucose (SSPG) and insulin was measured using simultaneous intravenous infusion of somatostatin, glucose, and insulin via a Harvard pump. Determination of sleep-disordered breathing was performed through clinical assessment and portable nocturnal monitoring using a validated sleep apnea recorder. Individuals with > or = 10 hypoxic respiratory events per hour of sleep were significantly more insulin-resistant than subjects without sleep-breathing disorders. After adjusting the relationship between insulin resistance and sleep-disordered breathing for potential confounding variables, it was found that this relationship was entirely dependent on body mass.

Adult↗
PubMed1999

[The police in psychiatric daily routine].

PURPOSE: The following is a description of those patients brought by the police to the emergency room of a general hospital of Berlin for a psychiatric exploration. METHOD: The medical records of those patients brought in to the emergency room during one year were analyzed retrospectively. RESULTS: Within one year, 317 (10.8%) out of 2903 patients were brought by the police to have an emergency psychiatric exploration. The ratio of men to women was 2:1, and the median age was 41. Most illnesses diagnosed were schizophrenia, disorders caused by psychotropic substances, alcoholism, alcohol intoxication, and adjustment disorders/stress disorders. One third of the 317 patients were under influence of alcohol. 21.8% of the 317 patients were suicidal. Over two thirds of the patients were admitted to the psychiatric ward. Only 31 patients were not admitted to the ward for lack of indication. The most frequent reason for intervention of police was suicidal behaviour (35%), "strange behaviour" (28.7%) or aggressive behaviour (23%). CONCLUSION: The results show that those patients brought in by the police are in acute crisis situations often involving suicidal tendencies and suffer from more severe psychiatric illnesses. The psychiatric emergency exploration initiated by the police was generally justifiable.

Adult↗
PubMed1986

Delirium in surgical patients seen at psychiatric consultation.

All 150 psychiatric consultations performed upon patients hospitalized on the Surgery service at The Johns Hopkins Hospital during a period of two years were studied with particular attention to delirium which was found in 20.7 per cent of the patients. Delirium was the most common psychosis in elderly and postoperative patients. Mood disturbance was the most common reason given for request for psychiatric consultation (39.3 per cent). Delirium was diagnosed in 26.3 per cent of those patients. Delirium is a common syndrome and presents as altered consciousness with cognitive impairment. It is often not appreciated by the surgeon because of the impressive nature of associated symptoms which might be given undue emphasis. Assessment of consciousness and cognitive function should be performed promptly whenever psychiatric disorders are suspected.

Adjustment Disorders↗
PubMed2006

[Psychological stress in oncology: the role of glucocorticoids].

During the last years, the correlations between biological processes, psychological adjustment and stress disorders have received increasing attention and a growing body of research results has been published in the general literature. In the realm of psycho-oncology, however, conceptual models on this topic and studies aimed at their validation have remained relatively scanty. On the basis of our observations and available literature in the field of post-traumatic and depressive stress disorders in oncology, we have proposed to apply the concept of allostatic load to the study and understanding of the psychological experience of cancer. This strategy has led us to the formulation of a novel classification of adjustment disorders in oncology and the creation of the clinical entity named "cancer-specific stress syndrome". Depending on clinical presentation of the syndrome, one distinguishes three subtypes, namely the depressive, post-traumatic and "dysallostatic" (mixed) forms. In the present paper, we examine the role of glucocorticoids and their relationships with one of the basic components of allostatic load--a failure to counter-regulate the immune system by the hypothalamic-pituitary-adrenal axis--in the physiopathology of stress disorders in oncology. Conflicting theories are presented--glucocorticoid cascade versus insufficient glucocorticoid signal transmission--and studies measuring potential correlations between stress and cortisol in oncology are critically reviewed. The results of this process provide substantial support for the application of the allostatic load model and post-traumatic phenomenology, but important advances have yet to be achieved before definitive conclusions can be established in this field. Such advances could lead to profound changes in the way we understand and treat psychological distress in patients with cancer, both pharmacologically and psychotherapeutically.

Adaptation, Psychological↗
PubMed2003

Psychosocial adjustment in young adulthood of women who experienced an eating disorder during adolescence.

OBJECTIVE: To examine the impact of an adolescent eating disorder on psychosocial adjustment in young adulthood. METHOD: A randomly selected sample of high school girls was assessed on a wide array of psychosocial and diagnostic variables twice during adolescence (n = 891, n = 810), and a stratified subset (n = 539) was assessed during their 24th year. Based on their history of psychopathology before age 19, participants were categorized into (1) partial- or full-syndrome eating disorder (ED; n = 36); (2) non-comorbid major depressive disorder (MDD; n = 95); (3) non-mood disorder without ED or MDD (NMD; n = 64); and (4) no disorder (ND; n = 138). RESULTS: Discriminant function analysis identified a single significant function (variance = 57%) in which the ED group was significantly elevated (mean = 0.87, SD = 1.20) compared with the other three groups; the MDD (mean = 0.14, SD = 1.00) and NMD (mean = 0.17, SD = 0.99) group means were intermediary and differed from the ND group (mean = -0.40, SD = 0.95). CONCLUSION: Despite apparent recovery of ED symptoms among most ED cases, women with a history of adolescent ED evidenced significant impairments in health, self-image, and important areas of social functioning. These findings underscore the clinical significance of adolescent ED.

Adolescent↗
PubMed2002

Social adjustment in in-patients with affective disorders: predictive factors.

We assessed social adjustment in 145 depressed in-patients using the self-reporting Social Adjustment Scale (42-item version) to evaluate the contribution of demographic and clinical variables and examine social functioning at different levels of depression. Our results indicate that the presence of a psychopathology in association with interpersonal sensitivity, hostility and perceived social support aspects -- and not the severity of current depressive symptoms -- were the most important factors affecting social adjustment. As expected, social disturbances are more pronounced in severe depressives who experience difficulties in all areas: by contrast, patients with low depressive symptom levels do not appear to be maladjusted, by comparison with a community sample.

Adolescent↗
PubMed1995

Occlusal adjustment in patients with craniomandibular disorders including headaches. A 3- and 6-month follow-up.

The aim of this study was to evaluate the therapeutic effect of occlusal adjustment on symptoms and signs of craniomandibular disorders (CMD), including headaches, after 3 and 6 months. Fifty patients were selected and randomly assigned to a treatment (T) or a control (C) group. All patients in the treatment group were subjected to occlusal adjustment, whereas the controls were comforted only. Pre- and post-treatment assessment of subjective symptoms and clinical signs was made by a dentist not performing the occlusal adjustment. There was significant improvement in overall subjective symptoms within the T group at the 3- and 6-month follow-up visits, but a statistically significant difference between groups was found at the 3-month follow-up only. With regard to changes in frequency of facial pain a significant deterioration was reported within the C group, which resulted in a significant difference between groups at the 6-month follow-up. No other significant differences were found within or between groups at the follow-ups with regard to the variables investigated. In conclusion, the results from this study that occlusal adjustment is a treatment modality with a statistically significant short-term effect on symptoms of CMD of muscular origin and superior to counseling.

Chi-Square Distribution↗