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PubMedDate not supplied

Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards.

OBJECTIVE: To establish the frequency of criteria-based depression and anxiety in newly admitted medical inpatients and to determine the natural history of depressive and anxiety symptoms during hospitalization. DESIGN: Prospective structured assessment of criteria-based depression and anxiety diagnoses within 24 hours of hospitalization with routine follow-up depression and anxiety questionnaires until discharge. SETTING: A tertiary care university hospital and an affiliated Veterans Administration hospital. PATIENTS: One hundred twenty-eight adult patients admitted to internal medicine inpatient units between May 1990 and August 1990. MAIN RESULTS: On admission, 43 of the 128 patients inducted met the DSM-III criteria for major depression, while an additional six met the criteria for adjustment disorder with depressed mood. Only six patients met the criteria for panic disorder, generalized anxiety disorder, or adjustment disorder with anxious mood at the time of admission to the study. Patients with high symptom scores on the anxiety and depression scales showed significant decreases in these scores without specific psychiatric intervention. Those who remained in the hospital 20 days or longer showed initial improvement and subsequently returned to baseline symptom levels of depression and anxiety. In approximately 9% of patients, symptoms of depression persisted or worsened. CONCLUSIONS: Major depression occurs more commonly than anxiety disorder in newly admitted medical inpatients but both resolve spontaneously in the majority during the course of hospitalization without specific psychiatric intervention unless the hospitalization is prolonged. One in ten will continue to show symptoms of depression.

Anxiety↗
PubMedDate not supplied

Increased incidence of anxiety and depression during bone marrow transplantation.

BACKGROUND: Since the first organ transplantation in the 1950s, there have been reports that patients who underwent organ transplantation had a poor prognosis if they were depressed and/or anxious prior to transplantation. Our objective in this study was to determine the prevalence of anxiety and depression in the different stages of bone marrow transplantation (BMT). METHODS: Mood disorders (MD), anxiety disorders (AD), and adjustment disorders (ADD) were measured five times with DSM IV. The Beck Inventory of Depression (BID) and Hamilton Rating Scale of Anxiety (HRSA) were used to measure levels of depression and anxiety, respectively, at registration and at days -1, +21 +/- 7, +30 +/- 10, and 90 +/- 10 days from BMT. Analysis between diverse periods was made for allogeneic BMT (allo-BMT) with chi square test, while Fisher exact test was used for the autologous BMT (auto-BMT). RESULTS: We report on 26 patients, including 18 with allo-BMT, and eight with auto-BMT. The allo-BMT was associated with depression during post BMT period (chi(2) = 11.924; p = 0.01). Slight anxiety without statistical significance was found in all stages. There was a high prevalence of anxiety and adjustment disorder in the immediate posttransplantation stage. Anxiety and adjustment disorders were more frequently found in all posttransplantation stages, particularly in the immediate stage (chi(2) =11.104, p = 0.02). After 3 months, no survivor received a psychiatric diagnosis. We did not find any differences in MD. There were five deaths. CONCLUSIONS: The auto-BMT group did not show significant associations between different stages and psychiatric variables studied. One death occurred at 1 month. This patient had severe depression. We recommend that the depressive syndrome be intentionally researched during the different stages of BMT, specifically in the immediate transplantation stage.

Adolescent↗
PubMed1993

[Patients cared for at the mental health unit of a primary care office: morbidity study].

Establishing the frequency of mental disorders among patients cared for at the mental health unit of a primary care outpatient clinic of Santiago, Chile, is intended. In this connection, 618 medical records have been screened retrospectively (i.e. a whole universe excepting patients under age 15). A great majority of patients--with an absolute ratio of female patients (88.8%) were referrals from physicians' offices. The most frequent disorders were anxiety disorders and adjustment disorders. Comments are made on (a): the scarcity of referrals from larger general hospitals, and (b) the need for mechanisms apt at an early detection of the most frequent disorders to be set up.

Adjustment Disorders↗
PubMed1998

Expatriate mental health.

This paper reviews the historical aspects of expatriate mental health, and comments on the paucity of literature in the medical and psychiatric journals. Data obtained from 397 expatriate probands examined during overseas service are described. It was noted that there was a high incidence of affective and adjustment disorders. The results showed six areas significantly related to those with affective disorders at interview, namely a history of consultation for psychological problems in out-patient departments or with the patient's own doctor, a history of depressed mood, and a family history of suicide, psychosis or personality disorder. Subjects with adjustment disorders at interview showed a significant positive correlation with four stressors (occupational anxiety, home country anxieties, acculturation and physical ill-health), but showed a negative association with a past personal history of consultation for psychological problems at out-patient departments or with their own doctors. These findings are discussed and practical applications suggested for improving expatriate mental health.

Acculturation↗
PubMed2001

Psychiatric disorders and associated and predictive factors in patients with unresectable nonsmall cell lung carcinoma: a longitudinal study.

BACKGROUND: Few longitudinal studies have investigated psychiatric disorders in patients with unresectable nonsmall cell lung carcinoma (NSCLC). This study addressed three questions: 1) Which psychiatric disorders are prevalent among patients with unresectable NSCLC? 2) What is the clinical course of psychological distress? 3) Which factors are associated with this distress, and do any antecedent variables predict subsequent psychological distress? METHODS: A series of 129 consecutive patients with newly diagnosed, unresectable NSCLC participated. Psychiatric assessments were conducted by using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised between the time of diagnosis and initial treatment for NSCLC (baseline) and 6 months after diagnosis (follow-up). Potential associated and predictive variables, including sociodemographic, biomedical, and psychosocial factors, were explored. RESULTS: The most common psychiatric disorder at baseline was nicotine dependence (67%), followed by adjustment disorders (14%), alcohol dependence (13%), and major depression (5%). At follow-up, adjustment disorders were diagnosed in 16% of patients, and major depression was diagnosed in 3% of patients. Thirty-five percent of patients who experienced depressive disorders (adjustment disorders and/or major depression) at baseline continued to experience the same disorders at follow-up. Multivariate analysis revealed that relatively younger age and pain were associated significantly with psychological distress at baseline. Only self-reported anxiety and depression at baseline could predict subsequent psychological distress. CONCLUSIONS: Substance dependence and depressive disorders are common psychiatric disorders in patients with unresectable NSCLC. Although this form of malignant disease often is progressive, depressive disorders do not seem to increase during its clinical course. Pain management is essential for alleviating patients' depressive disorders, and self-rating depression and anxiety seems to be an indicator of subsequent depressive disorders.

Adjustment Disorders↗
PubMed1990

Physical contact experience and depression.

Out of a consideration of the relevance of interpersonal physical contact to mental health is developed the hypothesis that unsatisfactory physical contact experience predisposes to depression. This hypothesis is then systematically explored using self-ratings of depression and physical contact (and love) experience obtained on admission and at discharge from 254 unselected psychiatric in-patients. Following the demonstration of a strong association between unsatisfactory physical contact experience and depression a significant relationship is also found between depression and the experience of being not loved. These two relationships are shown to exist independently of one another and when direction of causation is investigated both unsatisfactory physical contact experience and the experience of being not loved are seen to be causal of depression rather than vice versa. Unsatisfactory physical contact experience, however, clearly has the greater utility as an indicator of depression-proneness. Different categories and different kinds of physical contact experience are explored, first in relation to depression generally and then to each of the three major forms of depressive illness. Considered too is the patterning of physical contact experience and love experience for each of these latter. The results suggest that depression generally tends to be more closely linked with stable than unstable unsatisfactory physical contact experience and with present rather than childhood such experience. In addition endogenous depression is seen to be characterised by an absence of any physical contact experience in the present, while manic-depressive psychosis combines unsatisfactory physical contact experience with the experience of being loved and shows a relative lack of exclusively bad physical contact experience in childhood. Reactive depression, however, emerges with no distinguishing features of this kind. There follows an examination of the relationships between unsatisfactory physical contact experience and those psychiatric conditions other than depression represented in the subject sample. This raises the possibility that unsatisfactory physical contact experience could also be closely linked with schizophreniform disorder and adjustment disorder. Finally it is suggested that, above all, physical contact experience may be a major determinant of the capacity to cope with stress. Unsatisfactory such experience might then be predisposing to a wide range of psychiatric disorders, with depression seen as a commonly occurring symptom of inadequate coping.

Adaptation, Psychological↗
PubMedDate not supplied

Comorbid psychiatric disorders, sex, and methamphetamine use in adolescents: a case-control study.

The purpose of this case-control study was to elucidate the relative proportions of amphetamine use disorder (AUD) and amphetamine-induced disorder (AID) in a group of adolescents with the use of methamphetamine (MAMP) and to examine the risks for psychiatric comorbidity and sex for MAMP use. Psychiatric comorbidity in the preceding year was determined for 200 adolescent MAMP users and 400 drug-free control subjects by diagnostic interview using the Kiddie epidemiologic version of the Schedule for Affective Disorders and Schizophrenia. The proportions of AUD and AID were calculated, and the association between psychiatric comorbidity, sex, and MAMP use was assessed. The results revealed that among the MAMP users, 65 subjects (32.5%) had AUD, whereas 19 (9.5%) had AID. Early use of MAMP use was seen in AUD, whereas high-frequency MAMP use was associated with the occurrence of AID. Alcohol, nicotine, and betel nut use disorders were more prevalent in MAMP users for both sexes. By applying conditional logistic regression analysis, it was demonstrated that MAMP use was associated with conduct disorder in males, whereas in females, it was associated with conduct disorder and adjustment disorder. The results indicated that age of first use and subsequent frequency of MAMP use appeared to be associated with the development of amphetamine-related disorders. Sex differences in the association between psychiatric comorbidity and MAMP use were demonstrated. These factors have to be taken into consideration when intervening for adolescent MAMP use.

Adjustment Disorders↗
PubMed1987

The spectrum of anxiety disorders in family practice.

The spectrum ranges from fearful concerns about illness to clinical anxiety disorders, such as phobias, panic attacks, generalized anxiety, post-traumatic stress disorder and adjustment disorder. Anxiety and fear are often associated with hospitalization, heart disease, insomnia, and somatopsychic syndromes. Determining the cause of the anxiety may help the physician plan the treatment approach. In selected cases, benzodiazepines are useful adjuncts to therapy.

Adjustment Disorders↗
PubMedDate not supplied

Depressive disorders in childhood. III. A longitudinal study of comorbidity with and risk for conduct disorders.

As part of a longitudinal nosologic study of major depressive disorder (MDD), dysthymic disorder, and adjustment disorder with depressed mood in 104 school-aged probands, the prevalence and consequences of comorbid conduct disorders (CD) were examined. During the index depressive episodes, 16% of the patients had comorbid CD; during the full study observation 23% had CD; and the estimated time-dependent risk of conduct disorder developing was 36% by age 19. For most cases, comorbid CD developed as a complication of the depression and persisted after the depression remitted. Comorbid CD was not differentially associated with the type of depression at study entry, did not affect depressive symptom presentation, was similarly distributed among boys and girls, and was unrelated to demographic factors. Additionally, comorbid CD did not affect recovery from the index depressive episodes and did not influence the symptom-free interval before a recurrent depression among cases with MDD. The risk of CD developing was not altered by chronologically earlier family variables or demographic factors. But girls who had attention deficit disorder, compared to those who did not, seemed to be at higher risk for CD during study observation. Finally, in this depressed cohort, having CD any time was associated with an increased rate of long-term functional problems.

Adjustment Disorders↗
PubMed1989

Psychiatric aspects of patients with HIV infection in the general hospital.

The study describes the psychiatric disorders found in 100 HIV-positive patients, in different stages of the illness, at the psychiatric consultation service of a general hospital in Madrid. Eighty-five percent of the sample fell within the intravenous drug addicts risk group, which coincides with the epidemiological characteristics of Spain's HIV-positive population. The most frequently noted psychiatric diagnosis was substance dependence disorder (41%), followed by organic mental disorder (29%), adjustment disorder (15%), and affective disorder (5%). Fifteen percent of the subjects had depressive symptoms, and 11% expressed suicidal ideation. A follow-up conducted on part of the sample showed a development towards dementia, emphasizing diagnostic difficulties in the initial evaluation of these patients.

AIDS Dementia Complex↗
PubMed1997

Outcome evaluation of a short-term mental health day treatment program.

OBJECTIVES: To determine whether a structured, 6-week mental health day treatment program was meeting its objectives and to examine the program's effectiveness with specific patient groups. METHOD: Self-report questionnaires focusing on psychiatric symptoms, assertiveness, stress management, and social functioning were completed by patients directly prior to admission (pretest), at discharge (posttest), and at 4-month follow-up. Clinician ratings, including the DSM-III-R Global Assessment of Functioning (GAF) scale, were collected. Ninety-one participants completed pre- and posttests, and 51 completed the 4-month follow-up. RESULTS: The majority of the participants displayed affective disorders or adjustment disorders. There was significant reduction in psychiatric symptoms and improvement in assertiveness, social functioning, and stress management from pretest to posttest. These gains were maintained at follow-up. All diagnostic groups responded similarly, except the bipolar disorder group. CONCLUSION: These data indicate that the program was meeting its objectives and offer strong support for the usefulness of short-term day treatment for wide range of patients. The bipolar group performed differently compared with the other subsamples. The reliability of the GAF scale and when it may be most useful are discussed.

Adjustment Disorders↗
PubMedDate not supplied

The dexamethasone suppression test, the Hamilton Depression Rating Scale and the DSM-III depression categories.

The Hamilton Depression Rating Scale (HDRS) score and plasma cortisol values were measured in 100 depressed patients at 8 a.m., 4 p.m. and 11 p.m. after oral administration of 1 mg dexamethasone the previous night. The patients were categorized according to DSM-III as suffering from either minor depression (including dysthymic disorder, 300.40; adjustment disorder with depressed mood, 309.00; atypical depression, 296.82) or major depression (without melancholia, 296.X2; with melancholia, 296.X3; with psychotic features, 296.X4). Plasma cortisol levels of greater than or equal to 3.5 micrograms/dl at 8 a.m. were found to be the most sensitive (56.9%) and specific (94.3%) discriminator between minor and major depression. Plasma cortisol levels at 4 p.m. and 11 p.m. or the combination of several cortisol values also differentiated between minor and major depression; however, the results were not so conclusive. According to the ratings on the Hamilton Depression Scale the patients with major depression were more severely depressed (P less than 0.001) than patients suffering from minor depression. Cortisol values at 8 a.m., 4 p.m., 11 p.m. and the highest levels were significantly (P less than 0.001) correlated with the HDRS score. A maximum of 20.2% of the score variance could be explained by the correlation with the highest cortisol value observed. Severity of illness does not exclusively account for the biological differences between minor and major depression.

Adjustment Disorders↗
PubMed1986

Five years of experience with the DSM-III system in clinical work and research: some concluding remarks.

The reliability of the DSM-III is superior to other classification systems available in psychiatry. However, reliability depends on proper knowledge of the system. Some pitfalls reducing reliability of axis 1 diagnosis which commonly are overlooked are discussed. Secondly, some problems of validity of axis 1 and 2 are considered. This is done by discussing the differential diagnosis of organic mental disorders and other psychiatric disorders with concomittant physical dysfunction, and the diagnoses of post-traumatic stress disorders and adjustment disorders among others. The emphasis on health care seeking behaviour as a diagnostic criteria in the DSM-III system, may cause a social, racial and sexual bias in DSM-III diagnoses. The present discussion of the DSM-III system from a clinical point of view indicates the need for validation studies based on clinical experience with the DSM-III. These studies should include more out-patients and patients with psychopathology who do not seek psychiatric treatment. Such studies must also apply alternative diagnostic standards like the ICD-9 and not only rely on structured psychiatric interviews constructed for DSM-III diagnoses. The discussion of axis 4 points to the problem of wanting to combine reliable rating with clinically meaningful information. It is concluded that the most important issue to be settled regarding axis 4 in the future revisions is the aim of including this axis. The discussion of axis 5 concludes that axis 5 is biased toward poor functioning and thus may be less usefull when applied on patients seen outside hospitals. Despite these problems of the DSM-III, our experiences indicate that the use of the DSM-III is fruitful both for the patient, the clinician and the researcher. Thus, the cost of time and effort needed to learn to use the DSM-III properly are small compared to the benefits achieved by using the system.

Adjustment Disorders↗
PubMed1996

Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation.

This study longitudinally evaluates prevalence, clinical characteristics, and risk factors for DSM-III-R Major Depression, Generalized Anxiety Disorder (GAD), associated Adjustment Disorders, and Post-Traumatic Stress Disorder related to the transplant (PTSD-T) in a large, representative sample of heart recipients followed during the first year after transplantation. Lifetime pretransplant prevalence as well as 1-year posttransplant rates were determined for the 154 recipients via standardized clinical interview schedules. Major Depression was the most prevalent disorder posttransplant (1- year rate of 17.3%), followed by PTSD-T (13.7%), and Adjustment Disorders (10.0%). There were no cases of GAD. Specific pretransplant and perioperative factors increased recipients' risk for any psychiatric disorder (vs none) posttransplant, including pretransplant psychiatric history; poor social supports from primary family caregiver, other relatives, and friends; the use of avoidance coping strategies for managing health problems; and low self-esteem early posttransplant. Within diagnostic groups, additional risk factors distinguished recipients with anxiety-related vs depressive disorders posttransplant: those at highest relative risk for anxiety had waited more briefly for a donor heart, were more likely to have a family psychiatric history, had the poorest family and friend support of all recipients, utilized the poorest coping skills, and had a poor sense of mastery. The findings have implications for the development of primary and secondary prevention strategies for psychiatric disorder in heart recipient populations.

Adaptation, Psychological↗
PubMed1994

Emotional states of patients with hematological malignancies: preliminary study.

We conducted a study to demonstrate the kinds and frequencies of psychiatric symptoms among 31 inpatients with malignant hematological diseases. The DSM-III-R (Diagnostic and Statistical Manual for Mental Disorders, third edition-revised, 1987) structured interview and three psychological tests, such as the Self-rating Anxiety Scale, Self-rating Depression Scale and Profile of Mood States, were administered. The structured interview demonstrated 29.0% of the patients to have met the criteria for some form of psychiatric disorder, i.e., two for major depression and seven for adjustment disorder (three with depressed mood, two with anxious mood and two with mixed emotional features). Of the remaining 22 patients (71.0%) none met the criteria for psychiatric disorders. Of the five patients who knew their true diagnoses, three were assessed as having adjustment disorder with depressed mood and one as having major depression. Also, among the five patients on chemotherapy, four met the criteria for psychiatric disorders. Adjustment disorders were fewer among Japanese patients with malignant hematological diseases than among patients from previous studies in western countries, which can be explained by the patients' defense mechanism such as 'denial' and/or the less frequent 'truth-telling' in Japan. In addition, since the diagnostic criteria or psychological scales contain physical symptoms, they should be arranged or revised if applied to patients with life-threatening diseases such as hematological malignancies.

Adult↗
PubMed2004

[Scientific background of psycho-oncology].

UNLABELLED: We discussed the future direction of studies on psycho-oncology by reviewing relevant previous findings regarding treatment, early detection, and prevention of psychiatric disorders experienced by cancer patients. PSYCHIATRIC DISORDERS IN CANCER PATIENTS: It is reported that the common psychiatric disorders among cancer patients are adjustment disorder, major depression, and delirium. In addition, prevalence of adjustment disorder and major depression is higher among advanced cancer patients than that among patients with early stage cancer, and that delirium is the most common disorder among patients with terminally ill cancer. TREATMENT: Some meta-analytical studies reveal an effectiveness of psychotherapy for anxiety and depression among cancer patients however, several systematic reviews do not. Three randomized clinical trials indicate the efficacy of pharmacological treatments, anti-depressants, for major depression in cancer patients. It is suggested that delirium in advanced/terminally ill cancer patients can be ameliorated by detection and management of underlying causes of delirium and concurrent symptomatic treatment such as pharmacotherapy. EARLY DETECTION: Several brief screening instruments have been developed to detect adjustment disorder, major depression, and delirium among cancer patients. PREVENTION: One randomized clinical trial indicates the efficacy of SSRI for preventing depression occurring after interferon therapy among patients with malignant melanoma. No other effective strategy for prevention of psychiatric disorders among cancer patients has been clarified. CONCLUSION: There are not enough findings for effective treatments for ameliorating the common psychiatric disorders experienced by cancer patients, and very few studies for prevention while there are several available findings regarding early detection of their psychiatric disorders. Thus future studies on developing novel treatments including prevention and studies on mechanism should be encouraged. Psycho-oncology group in National Cancer Center are now conducting several clinical studies such as biological studies (neuro-imaging studies), studies to establish novel treatment strategy (n-3 poly unsaturated fatty acid), and multi-faceted intervention study (screening and individually tailored psychotherapy and pharmacotherapy).

Antineoplastic Agents↗
PubMed2002

The importance of psychosocial factors, gender, and severity of depression in distinguishing between adjustment and depressive disorders.

BACKGROUND: This study evaluated the severity of depressive symptomatology as it relates to: (a) sociodemographic factors and (b) the occurrence and type of acute and chronic psychosocial triggers or life events before admission. METHODS: In total, 718 psychiatric inpatients were assessed with the AMDP-system by the treating psychiatrist within the first 2 days after admission. RESULTS: In the females, sociodemographic factors (being married, children in the household, higher education and the quality of interactions) but not psychosocial stressors or life events were found to be related to severity of depression on admission. Females showed more severe depressive syndromes than males, however, depression severity in males was independent of sociodemographic factors, life events or psychosocial triggers. LIMITATIONS: Clinical assessment was based on retrospective history taking. The sample consisted of inpatients only, the results require replication using larger and more diverse samples. CONCLUSION: Gender differences and life conditions such as familial distress are related to severity of depression. The present criteria for the differentiation between depressive disorders and adjustment disorders are not independent and should be substituted by a multiaxial assessment.

Acute Disease↗
PubMed2005

Psychiatric disorders following first breast cancer recurrence: prevalence, associated factors and relationship to quality of life.

OBJECTIVE: The purpose of this study was to investigate the prevalence of and factors associated with psychiatric disorders and the impact on quality of life (QOL) in patients with first breast cancer recurrence. METHODS: We analyzed the baseline data on 50 consecutively enrolled recurrent breast cancer patients, participating in a feasibility study of multifaceted psychosocial intervention. Psychiatric disorders, including major depressive disorder (MDD), dysthymic disorder, panic disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder and adjustment disorders (AD), were evaluated according to the Structured Clinical Interview for the DSM-III-R and IV. The patients' demographic data, biomedical factors, social support, mental adjustment to cancer, personality traits and QOL were also evaluated. RESULTS: Eleven (22%) met the DSM-III-R and IV criteria for MDD, PTSD or AD (MDD, 2%; PTSD, 2%; AD, 20%). Univariate analysis indicated that current doxorubicin/cyclophosphamide, presence of a confidant, past history of MDD, helplessness/hopelessness and neuroticism were significantly associated with psychiatric disorders. On multivariate logistic regression analysis, past history of MDD and helplessness/hopelessness were significant associated factors. Psychiatric disorders were significantly associated with lower functional scales ('emotional functioning', 'body image' and 'future perspective') and higher symptom scales ('appetite loss', 'diarrhea', 'fatigue' and 'nausea-vomiting') in QOL. CONCLUSIONS: The result suggests that asking about history of depression and appropriate intervention, including psycho-education, are needed for patients with first breast cancer recurrence in order to detect and manage psychological distress. Although further studies are needed to clarify causal links between psychiatric disorders and QOL, patients' psychiatric disorders were associated with QOL.

Adaptation, Psychological↗