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Platelet monoamine oxidase activity and life stress as predictors of psychopathology and coping in a community sample.

The present study, using a diathesis-stress model, attempted to confirm prior findings with platelet monoamine oxidase (MAO) activity and stress in a middle-aged, non-clinic population. One hundred and seventy-eight adult males from a statewide community club were tested for platelet MAO activity and stressful life events and were also given a variety of psychological measures of both psychopathology and psychosocial coping. The data were examined both for correlations across the total sample and for a comparison of high-risk groups (top and bottom 15% of MAO activity) with a middle MAO group. Low platelet MAO activity was related to a higher incidence of contact with mental health professionals, and more frequent use of alcohol and cigarette smoking. High MAO activity was related to higher levels of anxiety and somatization. High levels of stress were related to increased psychosocial problems reported for female and family members, higher scores on two schizophrenia-related MMPI scales (schizophrenia and paranoia subscales), but fewer idiosyncratic associations, elevated hypomanic, depression, and anxiety scores, increased alcohol use, and increased use of prescribed antianxiety and sedative medication. Neither MAO nor stress were related to current levels of psychosocial coping. Moreover, no interaction effects were uncovered for MAO activity and stress combined.

Adaptation, Psychological↗

A retrospective study of adolescents' visits to a general hospital psychiatric emergency service.

Characteristics of 100 visits by adolescents (less than 18 years old) to a psychiatric emergency service were examined and compared with those of 100 visits by adults. Adolescents were less likely than adults to receive diagnoses of psychosis and personality disorder but more likely to receive diagnoses of adjustment and conduct disorders, were less likely to have had previous psychiatric treatment but equally likely (40%) to be in current treatment, and required more time to evaluate. Self-destructive ideation or behavior was present in 40% of the adolescents. Nearly all visits were judged to have represented genuine emergencies.

Adjustment Disorders↗

Earthquake-related psychological distress and associated factors 4 years after the Parnitha earthquake in Greece.

Exposure to earthquakes has been associated with psychological distress and in particular the development of post-traumatic stress disorder (PTSD). Earthquake-related psychological distress can be longstanding. The present study involved 157 Greek survivors of the 1999 Parnitha earthquake assessed approximately 4 years after the earthquake. Assessments were based on the Traumatic Stress Symptom Checklist (TSSC). Using stringent calibrations for the estimation of symptom presence 25% of the survivors endorsed at least 5 and 12% at least 10 TSSC symptoms. Approximately 22% of the survivors reported subjective distress and 15% impaired adjustment due to their symptoms. Intensity of fear during the earthquake and participation in rescue operations related to greater post-earthquake psychological distress. The results suggest that the psychological consequences of earthquakes can be serious and long-standing even when the magnitude of the earthquake is moderate. Psychological treatments that have been proven to reduce fear and PTSD symptoms need to be made available to the survivors. Such treatments may also increase the survivors' psychological preparedness and emotional resilience in view of future earthquakes.

Adjustment Disorders↗

The nosological status of neurotic depression: a prospective three- to four-year follow-up examination in light of the primary-secondary and unipolar-bipolar dichotomies.

One hundred patients with "mild" depressive states, variously referred to as "situational," "reactive," or "neurotic," were studied. During a three- to four-year prospective follow-up, 4% had developed bipolar I, 14% bipolar II, and 22% unipolar disorders with predominantly favorable social outcome. Most of the remainder were suffering from nonaffective disorders; in this group, intermittent depressive symptomatology followed a protacted course (paralleling the underlying disorder) with generally unfavorable outcome. Irrespective of diagnostic subtype, a "characterological" component occurring in 24% of the total sample appeared to predict unfavorable prognosis, including three suicides. The diagnostic usage of the concept of neurotic depression may no longer be clinically meaningful, since it lacks sufficient phenomenological characterization and refers to a heterogeneous group of disorders. The data suggest the merits of a biaxial approach to the nosology of depressive disorders whereby phenomenologically based affective diagnoses are qualified as to the presence or absence of character disorder.

Adjustment Disorders↗

Community-based study of the transition to adulthood for adolescents with psychiatric disorder.

This longitudinal study examines the transition to adulthood in a randomly sampled, community-based cohort of adolescents. The study compares young adult outcomes of 33 adolescents with and 148 adolescents without psychiatric disorder. After adjustment for differences in age, gender, and social class, adolescents with psychiatric disorder were 13.74 times less likely to complete secondary school (95% confidence interval (CI): 4.17, 45.17), 4.07 times less likely to be employed or in college or trade school (95% CI: 1.4, 12.3), 3.13 times more likely to be involved in criminal activity (95% CI: 1.11, 8.87), and 6.46 times more likely to have gotten pregnant themselves or to have gotten someone else pregnant (95% CI: 1.75, 23.87). While adolescents with psychiatric disorder in this community-based study had outcomes that were somewhat more favorable than those of adolescents with psychiatric disorder in prior treatment-based studies, they nonetheless are at high risk of failing to meet young adult role expectations.

Adolescent↗

DSM-III-R as a taxonomy. A cluster analysis of diagnoses and symptoms.

While there have been many applications of cluster analysis in psychiatric classification research, there are no studies in which cluster analysis is used to discover the taxonomic structure implicit in the DSM-III itself. In order to do so, the symptom index in the DSM-III-R manual was summarized in a two-way matrix of disorders by symptoms and then analyzed using a hierarchical classes model and companion algorithm (HICLAS) that permits overlap among classes. A novel feature of this model is that superordinate-subordinate relationships among diagnostic and symptom classes are explicitly represented. The HICLAS analysis revealed that there are several discrete symptom classes in DSM-III-R and that many psychiatric disorders can be modeled as combinations of one or more of these classes. The disorders associated with these symptom classes tend to fit the hierarchical classes model relatively well, particularly the mood disorders and the psychotic disorders. However, disorders such as adjustment, personality, and sexual disorder fit the model poorly or not at all. The results are in line with the conjecture that the taxonomic model implicit in DSM-III-R is a hybrid of discrete symptom classes and some other structure, perhaps a dimensional one.

Algorithms↗

Childhood asthma, chronic illness, and psychiatric disorders.

Asthma is a serious and vexing problem for many children and their families. Asthma, like most syndromes, has many symptoms and potential causes and effects. Studies have shown that pediatric asthma is associated with psychiatric disorders, but the specificity and temporality of these relations is not well known. This study examined the associations between any and specific psychiatric disorders and both childhood asthma and other childhood chronic illnesses. The study used the Methods for the Epidemiology of Child and Adolescent Mental Disorders data, a four-site, community-based study of 1,285 pairs of youths and caretakers. Psychiatric disorders were assessed using the Diagnostic Interview Schedule for Children (DISC 2.3). Methods for the Epidemiology of Child and Adolescent Mental Disorders was also used to assess individual characteristics, parental reports of asthma, and other chronic illnesses. Asthma and 'other' chronic illnesses were associated with different psychiatric disorders. In particular, having a history of asthma was associated with having an anxiety disorder, after adjustment for potential confounding, but was not associated with having an affective disorder. Having a chronic illness other than asthma or cancer was associated with having any affective disorder and dysthymia but not anxiety disorder. These results call for more mechanistic research that explores the specific relations between childhood anxiety disorder and asthma and between affective disorder and other pediatric chronic illnesses.

Adolescent↗

Time trends in the adjustment of Swedish teenage girls: a 26-year comparison of 15-year-olds.

The aim of this study was to investigate stability and change over 26 years in self-reported adjustment of Swedish teenage girls. Data were collected with the same questionnaire from two school-cohorts in a middle-sized Swedish community: 522 girls attending Grade 8 (approximately at age 15) in 1970, and 529 girls attending Grade 8 in 1996. The first cohort was part of the longitudinal research programme Individual Development and Adaptation (IDA). In most domains, adjustment problems were approximately as common in 1996 as in 1970, with two exceptions: more girls reported problems with self-esteem and antisocial problems in 1996. In the antisocial domain, a polarization process was indicated, with an increase also in the number of girls without adjustment problems. In the relational domains, especially peer relations, there was an increase in positive adjustment. The results are discussed in relation to earlier findings and to social changes during the period.

Adjustment Disorders↗

Psychotherapy for bipolar disorder.

BACKGROUND: Psychosocial factors may contribute 25-30% to the outcome variance in bipolar disorders. Sufferers have identified benefits from psychotherapy, but biological models and treatments dominate the research agenda. The author reviews research on psychosocial issues and interventions in this disorder. METHOD: Research on adjustment to the disorder, interpersonal stressors and obstacles to treatment compliance were located by computerised searches and the author's knowledge of the literature. All published outcome studies of psychosocial interventions in bipolar disorder are reviewed. RESULTS: There is an inadequate database on psychosocial factors associated with onset and maintenance of bipolar disorder. While the outcome studies available are methodologically inadequate, the accumulated evidence suggests that psychosocial interventions may have significant benefits for bipolar sufferers and their families. CONCLUSIONS: Given the significant associated morbidity and mortality, there is a clear need for more systematic clinical management that addresses psychosocial as well as biological aspects of bipolar disorder. The author identifies appropriate research strategies to improve knowledge of effective psychosocial interventions.

Adaptation, Psychological↗