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PubMed2000

Psychological distress following first recurrence of disease in patients with breast cancer: prevalence and risk factors.

OBJECTIVES: To investigate the prevalence of and risk factors for psychological distress following first recurrences of breast cancer. PATIENTS AND METHODS: The sample was drawn consecutively from the inpatient and outpatient populations of the National Cancer Center Hospital in Japan during an 18-month period from July 1996 to December 1997. Of the 56 eligible patients, 55 women aged 30-73 year with recurrent breast cancer participated in the study. The prevalence of psychological distress, including major depressive disorder and adjustment disorders was evaluated according to the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Third edition-revised (DSM-III-R). Risk factors for psychological distress were analyzed with a logistic regression model. RESULTS: Of the 55 subjects, 42% met the DSM-III-R criteria for major depressive disorder or adjustment disorders. Major depressive disorder was seen in 4 (7%), and adjustment disorders in 19 (35%). Logistic regression analysis showed that a disease-free interval of less than 24 months significantly predicted a diagnosis of major depressive disorder or adjustment disorders (odds ratio 5.28, 95% confidence interval; 1.28-21.8, p = 0.02). CONCLUSIONS: These results suggest that it is important for all oncology staff to pay careful attention to the psychological health of patients who have been informed of their cancer recurrence, and that some psychosocial intervention is necessary for preventing distress in patients facing early recurrence.

Adjustment Disorders↗
PubMed2005

Suicidal ideation and correlates in Taiwanese adolescent methamphetamine users.

The aim of this study was to evaluate the prevalence of suicidal ideation and its correlates in adolescent methamphetamine (MAMP) users. Using the Epidemiological Version of the Kiddie Schedule for Affective Disorders and Schizophrenia, 200 adolescent MAMP users were assessed for suicidal ideation and psychiatric disorders during the preceding year. Demographic variables, family and peer interaction, characteristics of MAMP use, and personality were also evaluated. Factors correlating to suicidal ideation in adolescent MAMP users were analyzed by logistic regression. In the preceding year, 16% of adolescent MAMP users had suicidal ideation, and multiple factors, including illicit drug use among family members, depressive disorder, adjustment disorder, and emotional instability, correlated with suicidal ideation. Multiple factors, including family, psychopathology, and personality correlate with suicidal ideation in adolescent MAMP users. Subjects showing these characteristics should be monitored for suicidal ideation.

Adolescent↗
PubMed1999

Psychiatric features of children and adolescents with pseudoseizures.

BACKGROUND: Pseudoseizures may occur as a somatoform disorder in children and adolescents as well as adults. However, few data are available about psychiatric features or outcome in pediatric patients. PATIENTS AND METHODS: We studied 34 patients (25 girls [74%]) who were evaluated by a child psychiatrist at our institution immediately after diagnosis of pseudoseizures by ictal video electroencephalogram (EEG) at ages 9 to 18 years (mean age, 14 years). Each patient had at least 1 pseudoseizure recorded by video EEG that was judged by the patient and family as typical, characterized by unresponsiveness plus limb twitching or limpness and other features, with EEG showing persistence of normal cortical background rhythms. RESULTS: In addition to conversion disorder, 11 patients (32%) had mood disorders including major depression, bipolar disorder, or dysthymic disorder, usually with severe psychosocial stressors. Eight children (24%) had separation anxiety and school refusal with moderate psychosocial stressors. Two patients (6%) had brief reactive psychosis or schizophreniform disorder. A few (1-3) patients each had panic disorder, overanxious disorder, adjustment disorder, oppositional/defiant disorder, or impulse control disorder. Four patients (12%) also had personality disorders. Eleven patients (32%) had a history of sexual abuse. This was especially frequent in the subgroup with mood disorders (7 [64%] of 11 patients). Fifteen patients (44%) had severe family stressors including recent parental divorce, parental discord, or death of a close family member. Two patients (6%) had a history of physical abuse. Freedom from pseudoseizures for the preceding 9 to 55 months (mean, 30 months) was achieved for 15 (72%) of the 21 patients who could be reached for telephone follow-up. For 8 (53%) of these 15 patients, the last pseudoseizure was within 1 month of diagnosis by video EEG. CONCLUSIONS: Major mood disorders and severe environmental stress, especially sexual abuse, are common among children and adolescents with pseudoseizures and should be considered in every case. A subgroup of children with separation anxiety and school refusal had less severe psychiatric problems and moderate psychosocial stressors. Clear diagnosis by video EEG, together with prompt psychiatric evaluation and treatment, may result in freedom from pseudoseizures for most children and adolescents.

Adolescent↗
PubMed1984

Admission decisions and multiaxial diagnosis.

We comparatively examined the relevance of the various components of an expanded DSM-III diagnostic formulation to admission decisions by studying all 745 new patients who came to a 24-hour walk-in clinic during a six-month period and who were admitted to either inpatient or outpatient care at a comprehensive psychiatric institute. A diagnosis of psychotic disorders was found to be significantly associated with hospitalization, while anxiety disorders, adjustment disorders, personality disorders, and nonmental disorder conditions were associated with outpatient referral. The strongest correlations with hospitalization, however, were obtained for current adaptive functioning and, to a lesser extent, for highest level of adaptive functioning in the past year.

Adolescent↗
PubMed1998

Eating disorders and Axis I psychiatric comorbidity in amenorrheic women.

OBJECTIVE: The present study aimed to investigate the relationship between secondary amenorrhea due to different etiologic mechanisms, eating disorders, and psychiatric morbidity in a nonpsychiatric population observed in a gynecological department. METHOD: Amenorrheic women (n = 95) with hypogonadotropic, hyperandrogenic, and hyperprolactinemic features were interviewed individually using the SCID-R (Structured Clinical Interview for DSM-III-R) to diagnose Axis I disorders including mood disorders, anxiety disorders, somatoform disorders, adjustment disorders, and eating disorders. Binge eating disorder was diagnosed according to DSM-IV criteria. RESULTS: The incidence of eating disorders was significantly higher in hypogonadic women than in hyperandrogenic and hyperprolactinemic subjects (chi 2 = 23.03, p < .003). However, we also found a high percentage of hyperandrogenic women suffering from an eating disorder (40.9%) with a prevalence of binge eating disorder (27.2%), while the only eating disorder described in the hyperprolactinemic group was the not otherwise specified. In addition, a marked psychiatric comorbidity was found in amenorrheic women suffering from an eating disorder but a similar trend of pathologies was also found in amenorrheic women, without any positive SCID diagnosis for an abnormal eating disorder. DISCUSSION: Our study demonstrated that a high incidence of eating disorders, mainly anorexia and binge eating, characterizes hypogonadic and hyperandrogenic women, respectively. In addition, secondary amenorrhea displays a wide spectrum of Axis I diagnoses, without a significant comorbidity with eating disorders. Whether or not the endocrine findings related to the amenorrheic condition constitute a common background for the occurrence of psychopathology or, alternatively, the presence of psychiatric disturbances may contribute to the development of menstrual dysfunction remain to be clarified.

Adult↗
PubMed2006

Detection and treatment of depressive and anxiety disorders among cancer patients: feasibility and preliminary findings from a liaison service in an oncology division.

Our aim in this observational study was to evaluate the feasibility of a multiphasic screening project for the detection and treatment of mood and anxiety disorders among cancer patients in a natural setting. One hundred sixty-five patients with cancer, consecutively admitted to the Oncology Division of San Camillo-Forlanini Hospital, were recruited to the study. All patients had solid tumors; the majority of them were colon, breast, and lung cancers. All patients completed the Hospital Anxiety and Depression Scale (HADS). Patients screened as positive were administered the following instruments by a psychiatrist: the Structured Clinical Interview for DSM-IV (SCID-I), the Beck Depression Inventory (BDI), the Hamilton Anxiety Rating Scale (HARS), and a validated scale for the rapid dimensional assessment of psychopathology (SVARAD). The BDI, HARS, and SVARAD were administered again at 4 and 10 weeks to all treated patients. Out of 45 patients administered the SCID-I, 37 had a mood or anxiety disorder. Adjustment disorders were identified in 20 patients, depressive disorders in 14, and anxiety disorders in three patients. Most patients were prescribed psychotropic medications: mirtazapine was prescribed to 15 patients, citalopram to 13 patients, and escitalopram to four patients. A significant improvement in symptoms of depression and anxiety was observed on all measures (P<.001). Although the design of the study prevents any firm conclusions about effectiveness, this study suggests that including psychiatric expertise in an oncology division is feasible and may lead to improved detection and treatment of psychiatric disorders among cancer patients. Further randomized trials are needed to elaborate on our findings.

Adult↗
PubMed1990

Biopsychosocial approach to the human immunodeficiency virus epidemic. A clinician's primer.

The human immunodeficiency virus (HIV) epidemic has created a multidimensional crisis that is challenging the health care system. Individuals with or without risk behaviors have anxieties about acquired immunodeficiency syndrome (AIDS) and need support and counseling. Once symptoms of HIV infection develop, crisis intervention and support need to be integrated into ongoing medical care. A biopsychosocial approach enables persons with AIDS to develop strategies for coping, to improve adherence, and to prevent transmission and suicide. Persons with AIDS are confronted with severe illnesses, neuropsychiatric disorders, discrimination, and death. Each person deserves the best medical and psychologic care available and the services of other disciplines where indicated. Caregivers, anxious about contagion, are devastated by the complexity, severity, and multiplicity of the illnesses that comprise AIDS and the lack of adequate resources to combat the epidemic. AIDS is a paradigm of a medical illness that requires a biopsychosocial approach. Psychiatric sequelae complicate the HIV epidemic, affecting both the uninfected and infected. The psychiatric manifestations of the uninfected include anxiety, phobia, factitious disorder, delusions, and Munchausen's AIDS. Psychiatric disorders associated with HIV infection include organic mental disorders, substance abuse disorder, affective disorders, adjustment disorders, anxiety disorders, and personality disorders. The consultation-liaison (C-L) psychiatrist is in a unique position to clarify and treat the psychiatric complications and to provide leadership for multidisciplinary programs. The biopsychosocial approach enables persons with HIV infection, their loved ones, and caregivers to meet the challenges of the HIV epidemic with compassion, optimism, and dignity.

AIDS Dementia Complex↗
PubMed1995

Impact of the interaction of depression and physical illness on a psychiatric unit's length of stay.

Prior literature suggests that length of stay (LOS) on medical inpatient units is increased by the coexistence of depression and physical illness. The present study examined 532 psychiatric inpatient admissions to determine if physical illness increased LOS for patients grouped by diagnostic categories of psychosis, depression, personality disorder, anxiety disorder, adjustment disorder, bipolar disorder (not depressed), and other psychiatric disorders. LOS for depressed patients was significantly longer for those with any physical final diagnosis (mean = 20.08 days) than for depressed patients with no physical diagnosis (mean = 11.48 days). LOS was also longer for all patients with physical diagnoses (mean = 19.31 days) than all patients with no physical diagnosis (mean = 13.13 days). No other specific diagnostic group (psychosis, personality disorder, and so forth) showed significant differences in LOS for any associated physical illness vs no physical illness. The study results tend to indicate that physical illness is associated with increased LOS for depressed psychiatric patients but not for other specific diagnostic groups. Depressed patients may 1) mask physical illness by depression-generated physical complaints; 2) prioritize mood symptoms over physical symptoms; and/or 3) may suffer from feelings of hopelessness or be pessimistic that their physical symptoms will be effectively treated and, therefore, not report their physical symptoms.

Adult↗
PubMed1996

Acute intoxication and substance abuse among patients presenting to a psychiatric emergency service.

It is common for patients to arrive at the Psychiatric Emergency Service (PES) under the influence of a variety of drugs. The purpose of this study was to 1) determine what impact there was on the PES of patients who arrive after engaging in substance abuse within the 24 hours prior to arrival; and 2) describe some of the parameters associated with substance abuse and mental illness in the PES setting. Consecutive evaluations done at the PES during the study month were reviewed retrospectively utilizing the extensive material collected in the screening chart. Of the 294 evaluations, 32.0% (n = 94) were on patients with acute intoxication and 17.0% (n = 50) had a primary diagnosis of substance abuse or dependence; 49 of 50 presented with active substance abuse. Schizophrenic and personality disorder patients presented with significant levels of acute intoxication (25.2%, 26/103), whereas substance use rate was quite low for patients with affective disorder, adjustment disorder, and other diagnoses. Alcohol was the overwhelming drug of choice by all diagnostic groups, making it difficult to determine group differences in choice of drug. Both the univariate and multivariate studies presented demonstrate that regardless of diagnosis, the impact of substance abusing patients is substantial. They present with high acuity (usually acutely suicidal), require high levels of behavior management, and spend more time in the PES. However, they have much less need for psychiatric hospitalization. In contrast, the patients presenting with psychosis also have a high rate of behavior management needs, but these patients are very likely to be hospitalized. These findings suggest that an important role for the PES is a "filter" to triage patients to the appropriate treatment setting and that this role is fulfilled when the PES is able to provide sufficient time and resources for evaluation and/or stabilization.

Adolescent↗
PubMedDate not supplied

Decreased corticotropin-releasing hormone (CRH) concentrations in the cerebrospinal fluid of eucortisolemic suicide attempters.

Several lines of evidence suggest a dysregulation of the adrenocortical (HPA) system with hypersecretion of CRH is associated with suicidal behavior. However, controversial results have emerged from the determination of corticotropin-releasing hormone (CRH) concentrations in the lumbar cerebrospinal fluid (CSF) of suicide attempters probably due to methodological differences. We simultaneously measured CRH concentrations in the CSF and in the plasma of 41 psychiatric in-patients with different diagnoses (affective disorder, schizophrenia, personality disorders, adjustment disorder, substance abuse) and eight neurological control subjects. We also measured plasma cortisol concentrations because data from animal experiments suggest that cortisol may influence CSF CRH concentrations. The major finding was that patients who attempted suicide prior to admission had significantly lower CSF CRH concentrations than psychiatric patients without suicidal behavior. CRH concentrations were significantly higher in the CSF than in plasma in both, psychiatric patients and neurological control subjects. There was no significant difference between suicide attempters and patients with acute suicidal ideations. The latter group showed a trend towards lower CSF CRH concentrations compared with the neurological control subjects. Patients with affective disorder alone as well as patients with multiple diagnoses, but not schizophrenic patients, showed significantly lower CSF CRH concentrations than neurological control subjects. Plasma CRH and plasma cortisol concentrations did not differ among diagnostic groups or between suicide attempters vs. non-attempters. Further studies with more homogeneous samples, drug-free patients and with simultaneous assessment of various parameters of the HPA system are warranted.

Adult↗
PubMedDate not supplied

Psychiatric consultation for competency to refuse medical treatment. A retrospective study of patient characteristics and outcome.

Forty-one psychiatric consultations on medical-surgical inpatients for competency to refuse medical treatment were studied retrospectively. The competent (n = 16) and incompetent (n = 25) patients were compared in terms of demographic data, diagnoses, clinical variables, details about treatment refusal, and outcome following competency assessment. The incompetent patients tended to be men, the focus of more urgent requests, and to have refused operations. The incompetent patients tended to have organic brain syndromes; the competent patients had personality disorders, adjustment disorders, or no psychiatric diagnosis. Ultimate acceptance of treatment initially refused was common in both groups; differential psychiatric interventions were recommended. The process of psychiatric consultation appeared to facilitate acceptance of treatment initially refused.

Adult↗
PubMed1984

Psychometric properties of the psychopathology instrument for mentally retarded adults.

One hundred and ten adults, from borderline to severe levels of mental retardation, were assessed through the outpatient clinic of a university-affiliated mental health center and a large state psychiatric hospital. These patients were included only after they had demonstrated the ability to respond to questions of similar difficulty to those presented in the Psychopathology Instrument for Mentally Retarded Adults. This measure was designed by the authors based on DSM III criteria, and covered seven types of psychopathology including schizophrenia, depression, psychosexual disorders, adjustment disorder, anxiety, somatoform disorders, and personality problems. In the present study the psychometric properties of the scale were reviewed and/or evaluated including internal consistency of items and test-retest reliability, and factor analysis.

Adolescent↗
PubMed1991

Psychometric assessment of psychiatric disorders in people with learning difficulties (mental handicap): a review of measures.

Instruments designed to assess psychiatric disorders in people with learning difficulties (mental handicap) were critically reviewed from a psychometric perspective. Major trends were found in the assessment of psychopathology related to DSM-III and depressive disorders although research in other areas was patchy. Although some psychometrically sophisticated measures were identified the area was characterized by an absence of important psychometric data for many measures. Future research should attend to developing assessments of schizophrenia, psycho-sexual disorders, adjustment disorders and the validation of screening procedures and instrument formats. Future studies should include more people with severe and profound learning difficulties.

Humans↗
PubMed1996

Mental health problems in the Gomel region (Belarus): an analysis of risk factors in an area affected by the Chernobyl disaster.

The epidemiology of mental problems in the Gomel region in the republic of Belarus was studied in a two-stage survey of a broad based population sample (N = 1617), using the General Health Questionnaire (12-item version) and the Munich Diagnostic Checklist for DSM-III-R. The Gomel region is one of the areas that was most severely affected by the Chernobyl nuclear disaster in 1986. In the studied population sample 64.8% had a GHQ-score above the threshold of 2. A DSM-III-R psychiatric disorder was present in 35.8%, with especially high rates for affective (16.5%) and anxiety disorders (12.6%). Dysthymia, general anxiety disorder, adjustment disorders and 'not otherwise specified syndromes' made up almost two-thirds of the observed morbidity (22.9%). A higher prevalence of mental health problems, both in terms of the GHQ and the DSM-III-R was observed among people who have been evacuated and in mothers with children under 18 years of age. These data indicate that the Chernobyl nuclear disaster may be partly responsible for the high prevalence of (milder) psychiatric disorders and psychological distress in the Gomel region, even 6 years after the event. Future studies comparing the data from Gomel region with an unexposed area will have to provide a more definite answer concerning the impact of this nuclear disaster on mental health.

Adolescent↗
PubMed1997

Prevalence and predictors of depressive, anxiety and substance use disorders in HIV-infected and uninfected men: a longitudinal evaluation.

BACKGROUND: There is little agreement on whether the prevalence of psychiatric disorder is elevated in HIV-seropositive (HIV+) populations compared with uninfected persons. However, evaluation of this issue has been limited difficulties of sampling, study design and failure to control for other risk factors for disorder. METHODS: Prevalence and clinical characteristics of DSM-III-R major depressive disorder (MDD), generalized anxiety disorder, adjustment disorder, and alcohol and substance abuse/dependence were evaluated in a representative sample of HIV+ men attending primary care physicians' offices in a defined geographical area. Lifetime prevalence at baseline and 1-year rates during longitudinal follow-up were determined for the 113 HIV+ men, as well as 57 HIV-men, via standardized interview. Multivariate analyses considered unique and combined effects of HIV serostatus and other risk factors on likelihood of disorder. RESULTS: Although there were no differences in lifetime rates prior to baseline, HIV+ men were at greater risk for disorders during the prospective study period. For MDD, this effect was maintained even after controlling for other risk factors. Several of these other factors bore their own effects: regardless of HIV serostatus, men were susceptible to psychopathology if at baseline they were younger, had a lifetime psychiatric history, or had poor social supports or a low sense of personal mastery. CONCLUSIONS: The risk of certain psychiatric disorders appears uniquely elevated in HIV+ men. Since other factors also influence risk, interventions designed to minimize psychopathology during HIV infection should attend to both HIV-related and non-HIV-related risk factors.

Adaptation, Psychological↗
PubMed2001

The syndrome of traumatic grief.

Traumatic grief is a common and debilitating syndrome whose clinical presentation is well recognized but whose diagnostic criteria have only recently been delineated. Though it shares features with major depressive disorder, adjustment disorder, and posttraumatic stress disorder, none of these subsume the criteria set for traumatic grief, and the diagnostic overlap is limited in community samples. Furthermore, diagnosis of traumatic grief appears to have prognostic value for clinical course and treatment response among bereaved individuals. In the absence of empirically supported treatments of pathological grief, a new, manualized treatment for traumatic grief symptoms has been developed and is currently undergoing testing in a randomized controlled trial. The conceptual basis for Traumatic Grief Treatment (TGT) is presented, the structure of the treatment is outlined, and the primary clinical strategies employed are described.

Journal Article↗
PubMed2002

[Distribution of alexithymia as a personality-trait in psychosomatically ill in-patients--measured with TAS 20 and LEAS].

Preliminary findings of an ongoing study of the distribution of alexithymia in different diagnostic-groups of psychosomatically ill in-patients (n = 240, will be increased to n = 400) are reported. Alexithymiea is measured simultaneousely by the Levels of Emotional Awareness Scale (LEAS, a performance-test) and the 20-item Toronto Alexithymia Scale (TAS 20, a self-report-scale). Measured by the LEAS and compared with other diagnostic groups (affective, anxiety and compulsive-obsessive disorders; adjustment disorders; eating disorders), patients with somatoform disorders showed a decreased ability to be aware of and to communicate their emotional states. This finding which meets theoretical considerations about the origin of alexithymia could not be found with the TAS 20. The TAS 20 did not differentiate between the diagnostic groups, but showed - in accordance with two other self-report-scales (STAI for self reported anxiety as a personality trait and SCL-90-R for self reported somatic und psychic complaints) - higher mean scores at the onset than at the end of treatment. Methodical implications of the different findings of the two alexithymia scales are discussed.

Adolescent↗
PubMed2006

[Chronic fatigue in complementary rehabilitative medicine--predictors of the outcomes].

Chronic exhaustion and fatigue are increasingly important in rehabilitation medicine. Objectives of this study were (a) to describe the effects of in-patient rehabilitation on patients with chronic fatigue syndromes, (b) to identify predictors for treatment outcome, and (c) to analyze the impact of comprehensive diagnosing on these issues. A total of 171 patients with chronic exhaustion or fatigue (90 % female, mean age 55 +/- 10 yrs) from a rehabilitation hospital with a complementary medicine-based treatment concept were included in a prospective observational study. Within the longitudinal study patients were examined three times (on admission to hospital, at discharge as well as six months later). Participation rate of the postal inquiry was 69 %. Besides items constructed ad hoc, Patient questionnaires included the Symptom Checklist and assessment instruments for depression, quality of life, sense of coherence as well as for changes in experience and behaviour. Treatment outcome was defined as sum score of binary-coded response criteria. The pattern of complaints differed clearly between diagnostic subgroups (neurasthenia, affective disorders, adjustment disorders) before treatment. At discharge from hospital patients showed clinically relevant improvements lasting for six months after rehabilitation. Multiple regression analyses revealed a statistically significant relationship (R (mult) = 0.59) between predictors and outcome at discharge from hospital. A better result was associated with higher trust in treatment success, active information seeking on complementary medicine, healthier feeding habits, better somatic health and a decreased mental status, with regard to the status before treatment. The prediction of outcome after six months was comparably poorer (R (mult) = 0.42). Treatment success was higher in the absence of a diagnosis of neurasthenia, in patients accepting the group-oriented treatment concept and in patients not believing that their disease was due to their own way of living. Trust in the success of the treatment was a highly ranked predictor for longer lasting outcome, too. The results underline the importance of motivation aspects for treatment outcome indicating that individual expectations and attitudes should be considered in a more distinct way when allocating patients to rehabilitative programmes.

Complementary Therapies↗