Distress and psychiatric morbidity among women from high-risk breast and ovarian cancer families.

This study assessed psychological distress and psychiatric disorder in high-risk women enrolled in a hereditary breast and ovarian cancer registry, and it evaluated the concordance between self-report data and interview-based psychiatric diagnosis. A sample of 464 women completed the Hopkins Symptom Checklist-25 and were interviewed using modules of the Structured Clinical Interview for DSM-IV. Level of psychological distress and the prevalence of psychiatric disorder were low and in the range that would be expected for a sample of community-residing women. Screening proved inefficient: Less than 10% of distressed women met criteria for a clinical disorder. High-risk women seeking genetic testing in research settings may not require extensive psychological screening and diagnostic assessment. Caution is expressed about possible self-selection biases in women enrolled in hereditary cancer registries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatry and dermatologic neoplasms: results of an experimental study

Psycho-oncology has developed during the past decades in the area of medical oncology directly involved in the study of the psychological aspects of cancer. In this study the authors focused in particular on the psychopathological complications of dermatological cancer, the discovery of a possible history of psychiatric disorders prior to the diagnosis of the tumour, the predictive value of the latter concerning further psychiatric complications during cancer, and lastly the possible correlations between stress and the onset of cancer and between religious belief and adaptive strategies. A total of 30 patients suffering from dermatological neoplasia were examined within the setting of a Psychiatric Liaison Service. HDRS and STAI X-1 and 2 were used as psychodiagnostic aids to evaluate the level of depression and anxiety, together with an interview for the clinical evaluation of the patient ad possible life events of particular importance. It was found that 10% of patients conformed to the criteria for the diagnosis of dysthymia and 10% for adaption disorders, and that there was also a high rate of pathological values for status anxiety (66%). These results show that this type of disease is particularly subject to risk for psychiatric complications.     

Impairment and distress associated with relationship discord in a national sample of married or cohabiting adults.

The clinical importance of relationship discord was examined through evaluating the association between relationship discord and multiple measures of impairment and psychological distress in a population-based sample of married and cohabiting adults (N = 2,677). In comparison to people that were not in discordant relationships, individuals in discordant relationships reported greater social role impairment with relatives and friends and greater work role impairment. They also reported higher levels of general distress and poorer perceived health and were more likely to report suicide ideation. With the exception of suicide ideation, the associations between relationship discord and impairment and psychological distress remained significant when controlling for current mood, anxiety, and substance use disorders, suggesting that relationship discord is incrementally related to impairment and psychological distress over and above the effects of psychiatric disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value of screening for psychiatric disorders in rheumatology referrals

BACKGROUND: Musculoskeletal complaints are common and often unexplained and often lead to rheumatology referrals. The prevalence of psychiatric disease in patients with musculoskeletal complaints is unknown. OBJECTIVES: To determine the prevalence of common psychiatric disorders among patients referred to a rheumatology clinic and the likelihood of establishing a rheumatic diagnosis if a psychiatric disorder is present. DESIGN: Prospective diagnostic survey. SETTING: Two hospital-based rheumatology clinics and a general medicine clinic. PARTICIPANTS: A consecutive sample of newly referred patients (n = 185) and their rheumatologists (n = 9). INTERVENTION: Before their visit, all patients filled out a self-administered version of PRIME-MD (Primary Care Evaluation of Mental Disorders), a questionnaire that makes Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: Primary Care Version, diagnoses of depressive, anxiety, and somatoform disorders. After the visit, the study rheumatologists, who were unaware of the PRIME-MD results, completed a questionnaire regarding their diagnostic assessment. These patients were compared with 210 patients with musculoskeletal complaints who were cared for in a general medicine clinic. MAIN OUTCOME MEASURES: Psychiatric and rheumatic disorders. RESULTS: Compared with patients with musculoskeletal complaints in a general medicine clinic, patients referred to a rheumatology clinic had a higher prevalence of psychiatric disease (40% vs 29%; P = .008), had an almost 2-fold higher prevalence of anxiety disorders, and were more likely to have multiple psychiatric disorders (odds ratio = 2.70, 95% confidence interval = 1.50-5.00). The likelihood of a psychiatric disorder differed among patients with connective tissue disease, nonsystemic articular or periarticular disorders, and nonarticular disorders (27%, 38%, 55%, respectively; P = .006). In a best-fitting logistic regression model, psychiatric disorders markedly decreased the likelihood of a connective tissue disease (odds ratio = 0.24, 95% confidence interval = 0.09-0.62). CONCLUSIONS: Forty percent of patients referred to a rheumatology clinic in this study had a psychiatric disorder, and its presence predicted a lower likelihood of a connective tissue disease. Prospective studies are needed to determine if screening for psychiatric disease before referring patients with unexplained musculoskeletal complaints would reduce costs or improve recognition of potentially treatable psychiatric disorders.     

The trauma patient: open hospital choice?

Mental-health service utilization among elderly people has been shown to be low relative to younger age groups. This study was done to determine the current proportion of elderly persons served in a university-affiliated psychiatry outpatient clinic, and to better characterize elderly patients who receive specialized mental-health care in this setting. The proportion of visits from elderly patients (aged 60 and over) was found to be 16%. Demographic and clinical characteristics of a sample of 140 consecutive geriatric patients evaluated at the clinic were obtained. The data revealed that the patients had a mean age of 74.7+/-7.5 (SD) years, and were mostly female (72.1%) and white (78.6%). Surprisingly, the age distribution was found to be bell shaped, with a small upper tail. The three most prevalent psychiatric diagnoses were depression (56.4%), dementia (35.7%), and substance use disorder (20%). Overall, 59.3% of geriatric patients had a history of prior psychiatric treatment. Females were significantly more likely than males to have a psychiatric history (69.3% vs. 33.3%, P = .0001). Among patients with a psychiatric history, females were more likely to have a current diagnosis of major depression (P = .0006), while males were more likely to have a current substance use disorder (P = .03). The prevalence of dementia increased with each successive decade above 60, while the occurrence of bipolar and adjustment disorders was confined to younger geriatric patients. Elderly patients receiving psychiatric treatment in the clinic thus formed a heterogeneous group. Gender, age, and presence of a psychiatric history were all associated with differences in prevalence and distribution of various mental disorders in this geriatric psychiatry outpatient clinic.     

The determinants of long-term blood pressure stability: control of trough blood pressure during sleep

Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The following questions are addressed. First, how do patients describe their fatigue 9 months after radiotherapy and is this different from fatigue in a nonselective sample from the general population (n = 139)? Secondly, to what degree is fatigue in patients associated with sociodemographic, medical, physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue 9 months after radiotherapy? Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population. However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46). Fatigue in disease-free patients was significantly associated with: gender, physical distress, pain rating, sleep quality, functional disability, psychological distress and depression, but not with medical (diagnosis, prognosis, co-morbidity) or treatment-related (target area, total radiation dose, fractionation) variables. The degree of fatigue, functional disability and pain before radiotherapy were the best predictors of fatigue at 9-month follow-up, explaining 30%, 3% and 4% of the variance respectively. These findings are in line with the associations found with fatigue during treatment as reported in the preceding paper in this issue. The significant associations between fatigue and both psychological and physical variables demonstrate the complex aetiology of this symptom in patients and point out the necessity of a multidisciplinary approach for its treatment.     

Screening and treatment of distress.

The screening and treatment of psychological distress is an increasingly important aspect of providing comprehensive care to medical patients. The importance of this within oncology was illustrated most recently by the publication of the National Comprehensive Cancer Network's Distress Guidelines (Holland, 1997). Given that measures of general distress assess for symptoms across diagnostic categories, it is not unusual to have a combination of symptoms indicating distress without meeting diagnostic criteria (Derogatis, Morrow, & Petting, 1983). We would suggest that general measures of distress and psychiatric diagnoses not assessed by Coyne et al. (e.g., somatoform or adjustment disorders) may reflect better the distress (health anxiety and somatic preoccupation) of women at increased risk for cancer and be more informative than assessing selectively for mood disorders, anxiety disorders, and alcohol abuse. The authors additionally concluded that if there is not psychiatric disorder, then there is no impairment. We believe it premature at best to reify the DSM in a nonpsychiatric population. Distress exists on a continuum. To wait until patients meet psychiatric criteria before they are seen is not in the spirit of comprehensive medical care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorders and medical care utilization among people in the general population who report fatigue

OBJECTIVE: To study the prevalence of fatigue in the general population and its association with psychiatric disorders, somatization, and medical utilization. SETTING: The public-use data tape from the 1984 National Institute of Mental Health Epidemiologic Catchment Area Study. PARTICIPANTS: Household sample of 18,571 subjects. INTERVENTIONS: Structured psychiatric interviews were reviewed to study the prevalence of complaints of current and lifetime fatigue and their relationship to selected psychiatric disorders. RESULTS: Fatigue has high current (6.7%) and lifetime (24.4%) prevalences in the general population. Medically unexplained fatigue also has high current (6.0%) and lifetime (15.5%) prevalences. When compared with those reporting no current fatigue, subjects who reported current (one-month) fatigue were significantly more likely to have experienced current and lifetime episodes of major depression, dysthymic disorder, panic disorder, and somatization disorder. They also had significantly higher mean numbers of lifetime and current DSM-III psychiatric diagnoses, medically unexplained physical symptoms (not just fatigue-related symptoms), and visits to health care providers than did patients without current episodes of fatigue. CONCLUSIONS: The high prevalence of fatigue in the general population appears to be significantly associated with increased lifetime and current risk for affective, anxiety, and somatoform disorders, as well as increased utilization of medical services. These data suggest that assessment of both medical and psychological health may be essential for the proper care of patients with fatigue.     

Long-term mental health effects of the Chernobyl disaster: an epidemiologic survey in two former Soviet regions

OBJECTIVE: This study assessed the long-term mental health effects of the nuclear accident at Chernobyl. METHOD: Two population samples (N = 3,044), one from the Gomel region, close to the accident site, and one from Tver, 500 miles away, were studied 6 1/2 years after the event with the use of a variety of self-report questionnaires and a standardized psychiatric interview. RESULTS: The prevalence of psychological distress and DSM-III-R psychiatric disorders was exceptionally high in both regions. Scores on the self-report scales were consistently higher in the exposed region; however, a higher risk of DSM-III-R psychiatric disorders could be demonstrated only among women with children under 18 years of age in the exposed region. CONCLUSIONS: A substantial long-term mental health effect of the Chernobyl incident was demonstrated, mainly at a subclinical level.     

Epidemiological study of sleep disorders in patients in Swiss general practice

The aim of the study was to assess the prevalence, severity, associated factors and diagnosis of sleep disorders in general practice. Over 700 patients were investigated with a multiple choice questionnaire in 24 general practices in Switzerland. To assess sleep disorders, criterion A for insomnia according DSM-III-R was applied. The prevalence of sleep disorders was 44%, 64% of these were classified as mild, 31% as moderate and 5% as severe. 50% of the female patients complained about insomnia compared to 36% in males. Retrospectively, 74% of the patients stated having suffered from sleep disorders for more than one year (mild 76%, moderate 69%, severe 75%). 70% of patients with mild, 42% with moderate and 30% of patients with severe insomnia didn't inform their physicians about their sleep difficulties on the occasion of an earlier consultations. Patients with moderate or severe insomnia felt moderately or markedly disabled in their quality of life (71%) and work (58%). To estimate general anxiety and depressive state, self-rating scales were used (STAI, D-S). In comparison to reference values for healthy volunteers, insomniac patients had significantly higher scores on both scales, which were associated with the severity of sleep disorders, corroborating the association of sleep disorders with anxiety disorders and depressions. The physicians diagnosed in 18% of insomniacs a psychiatric disease, in 52% a psychoreactive disorder and in 26% a somatic etiology. The study shows that sleep disorders are a frequent syndrome in general practice and often not reported to the physician; therefore, the patients should routinely be questioned about sleep problems, and associated psychiatric diseases should be considered.     

Psychological symptoms in individuals successful at long-term maintenance of weight loss

Set point theory suggests that successful maintenance of weight loss ("weight suppression") may be associated with psychological distress. This study examined the association between psychological symptoms and body weight suppression by using a registry of 629 women and 155 men who lost at least 13.6 kg (mean loss = 30 +/- 15 kg) and maintained the loss for at least 1 year (mean duration = 5.5 +/- 6.8 years). Participants completed measures of mood, distress, restraint, disinhibition, bingeing, and purging. Maintainers' levels of distress and depression were lower than those of psychiatric samples and resembled those of community-based samples. Binge-eating and purging rates were comparable to rates of community samples. Maintainers' levels of restraint and disinhibition were markedly different from those of eating-disordered samples, resembling levels found in patients recently treated for obesity. There was no evidence that long-term suppression of body weight is associated with psychological distress.     

Regulation by nitric oxide of prostaglandin E synthesis and spontaneous motility in rat uterine tissue

BACKGROUND: Psychological distress is frequently observed, however, it is underestimated in cancer patients. The aim of this study is to develop a simple battery for screening for psychological distress, adjustment disorder and major depressive disorder in Japanese cancer patients. METHODS: One hundred and twenty-eight cancer patients were interviewed by psychiatrists and tested using the Hospital Anxiety and Depression Scale (HADS), a 14-item self-assessment questionnaire. Psychiatric diagnoses were performed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised. RESULTS: Cronbach alpha values of the Japanese version of the scale were 0.77 for the subscale for anxiety and 0.79 for depression. By a receiver operating characteristic analysis, we determined that an optimal cut-off point for screening for adjustment disorder and major depressive disorder was 10/11, which gave high enough sensitivity and specificity (91.5 and 65.4%, respectively). To screen for major depressive disorder alone, 19/20 was an optimal cut-off point with 82.4% sensitivity and 96.3% specificity. The subscales of HADS (anxiety and depression) also had high screening performance. CONCLUSIONS: The Japanese version of HADS is a sensitive and specific tool for screening for psychological distress in Japanese cancer patients. This scale can be used for an early detection of patients' psychological distress which may be followed by psychiatric interventions.     

Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey

There have been a number of national surveys of psychiatric morbidity which have included questions on drugs, alcohol and tobacco. These surveys have helped delineate the overlap between substance use and dependence and other psychological morbidity. There is a strong association reported between high substance consumption and other measures of psychological problems. This article provides an overview of a national household survey, a survey of institutional residents with psychiatric disorders and a national survey of a homeless population. All three surveys used comprehensive and complex sampling strategies and lay interviewers to conduct structured diagnostic interviews. The household survey included over 10,000 households, the institutional survey interviewed 755 individuals and the homeless survey of hostels, night-shelters, day centres and private-sector leased accommodation interviewed 1,061 individuals. This overview looks at patterns of nicotine, alcohol and other drug use in the different samples and examines interactions with other psychiatric morbidity. The survey reports that substance-related disorders are some of the commonest disorders in the community, with 5% of the household sample alcohol dependent, 7% alcohol dependent in the institutional sample and over 21% in the homeless sample recorded as alcohol dependent. Tobacco, alcohol and other drug use and dependence were dramatically higher in the homeless sample than in either of the other two samples. Substance use was significantly associated with higher rates of psychological morbidity as measured by the Clinical Interview Schedule Revised. Future service planning needs to take account of the striking disparity of prevalence of psychiatric disorders in different subsections of the population.     

Validation of the hospital anxiety and depression scale in a gastro-intestinal clinic

This study examined the validity of the Japanese version of the hospital anxiety and depression scale (HAD) in a gastro-intestinal outpatient clinic. One hundred and twenty-three men and 142 women consulting a gastro-intestinal outpatient clinic at a primary care hospital in Kyoto during 1995 were surveyed. Item-remainder correlation and internal consistency were examined for reliability. Concurrent validities were examined using the stait-trait anxiety inventory (STAI) and Zung's self-rating depression scale (SDS). The prevalence of psychiatric disorder in this population ranged from 27% to 39%. Cronbach's coefficients were greater than 0.8 for the anxiety subscale and more than 0.7 for the depression subscale. Spearman's correlation of the anxiety subscale scores and the STAI were r = 0.678 for men, and r = 0.717 for women. The correlation of depression subscale scores and SDS were r = 0.457 for men, and r = 0.565 for women. It is suggested that the use of the HAD to general hospital outpatients clinic would facilitate detecting emotional disorders in outpatients.     

Alcohol Use Disorders and Psychological Distress: A Prospective State-Trait Analysis.

The present study examined the association between alcohol use disorders (AUDs) and psychological distress over an 11-year period using a sample of 378 young adults (46% men, 54% women: baseline age = 18.5; 51% with paternal history of alcoholism). The authors examined this relation using a state-trait model, which decomposes variance in a given construct into a general traitlike factor that spans measurement occasion and more situational, occasion-specific variability. Trait AUD and trait distress were correlated (r = .43), suggesting that the tendency to meet criteria for an AUD is associated with the tendency to experience psychological distress. Much of this association was due to 3rd variables (primarily neuroticism but also childhood stressors and behavioral undercontrol), supporting a common 3rd-variable influence model of comorbidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of free radical production and scavengers on occlusion-reperfusion induced arrhythmias

The DSM-IV section of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) was used to screen for personality disorders in 448 subjects from three clinical samples (general and forensic psychiatric patients and candidates for psychotherapy) and a sample of 139 healthy volunteers. Differences between the samples with regard to patterns of personality pathology in relation to concurrent Axis I disorders and sociodemographic variables were analysed. The prevalence of personality disorders according to DIP-Q was 14% among the healthy volunteers, compared to 59% in the general psychiatric sample, 68% in the forensic psychiatric sample and up to 90% among psychotherapy candidates. Moreover, from a dimensional perspective (i.e. the number of fulfilled Axis II criteria), all clinical groups differed significantly from the control group in all specified personality dimensions and clusters. Dimensional DIP-Q cluster scores also discriminated significantly between the three clinical samples. Unexpectedly, the odds ratio for an Axis II disorder was nearly five times higher among psychotherapy applicants than among general psychiatric patients, independent of concomitant Axis I disorders, gender or age. The strongest association between DIP-Q score and Axis I disorders was found for depressive disorders, which more than doubled the odds ratio for a personality disorder diagnosis. This association could result from high true comorbidity, but could also be due to the fact that a concomitant depressive state can increase self-reported personality difficulties. The high prevalence among psychotherapy candidates may to some extent reflect help-seeking exaggeration of problems. These are aspects to consider when using the DIP-Q, which overall appears to discriminate well between different samples.     

Dual diagnosis: prevalence of psychiatric disorders in a large state residential facility for individuals with mental retardation

The prevalence of psychiatric disorders in a large residential population (N = 1,273) of individuals with mental retardation was examined. We found that the point prevalence rate for dual diagnoses based on DSM-III-R criteria was 15.55% (n = 198). Rates for specific psychiatric disorders were also provided by level of retardation and sex. Results were compared to similar epidemiological studies and discussed in light of factors hypothesized to affect diagnosis of psychiatric disorders among individuals with mental retardation.     

The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders

BACKGROUND: The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. METHODS: A multistage, overlapping cohorts design was used, in which 4500 of the 11758 children aged 9, 11, and 13 years in an 11-county area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n = 1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N = 323 at wave 1). RESULTS: The 3-month prevalence (+/-SE) of any DSM-III-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3% +/- 1.7%. The most common diagnoses were anxiety disorders (5.7% +/- 1.0%), enuresis (5.1% +/- 1.0%), tic disorders (4.2% +/- 0.9%), conduct disorder (3.3% +/- 0.6%), oppositional defiant disorder (2.7% +/- 0.4%), and hyperactivity (1.9% +/- 0.4%). CONCLUSIONS: The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.     

Psychiatric assessments of nursing home residents under OBRA-87: should PASARR be reformed? Pre-Admission Screening and Annual Review

OBJECTIVE: As part of nursing home practice reforms, OBRA-87 mandates formal psychiatric assessments (PASARR) of nursing home residents suspected of having mental disorders, a responsibility it delegates individually to states. We describe the initial year of implementation of the PASARR process in King County, Washington, and characterize the mental disorders and mental health services needs of nursing home residents referred for psychiatric screening. DESIGN: Cross-sectional study. SETTING: The 54 Medicare-certified King County nursing homes (total beds = 7013). PARTICIPANTS: All patients referred for psychiatric evaluation under PASARR (n = 510). MEASUREMENTS: A systematic, multidimensional evaluation including a semistructured psychiatric diagnostic examination, validated measures of cognitive dysfunction, depression, and global psychopathology, functional variables relevant to need for nursing home care, and selected mental health services indicators. RESULTS: Fewer than 10% of all nursing home residents were referred for psychiatric evaluation. A primary mental illness, evenly divided between psychoses and mood disorders, was found in 60% of the sample, and a psychiatric disorder associated with dementia or mental retardation was found in 25%. Six percent had complex neuropsychiatric features defying classification, and 4% had no mental disorder. Other disorders, such as substance abuse, were rare. Cognitive impairment and global psychopathology were prevalent in all diagnostic groups, and depressive symptoms were common even in patients without affective diagnoses. Eighty-eight percent of the sample were appropriately placed, based on their needs for daily care. Fifty-five percent had unmet mental health services needs. CONCLUSIONS: The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.     

Investigation into the repeated recovery of coagulase-negative staphylococci from blood taken at the end of cardiopulmonary by-pass

The assessment of needs has been put forth as an important dimension in both the planning, development and evaluation of psychiatric services. A needs assessment tool for routine use should ideally be brief, not require additional staff, be valid and reliable with respect to setting, gender and culture, and also be sensitive to changes in needs and differences in needs between subgroups of patients. In this study, the interrater reliability of the Swedish version of the Camberwell Assessment of Needs instruments (CAN), measuring needs in 22 areas, was investigated in a cross-sectional sample consisting of 119 psychiatric inpatients and outpatients. The prevalence and severity of needs, prevalence of unmet needs, as well as current help received was also investigated. The interrater reliability of the instrument was found to be good both measured as total percentages of agreement in ratings, where an agreement of 80% or above was found in 90% of the comparisons, and as measured by Cohen's kappa. Predominant needs in the sample were in addition to clinical needs concerning psychological distress and psychotic symptoms, social needs such as the need for company, daytime activities and information concerning condition and treatment. The CAN seems to be a instrument with a high interrater reliability also when used under routine conditions as in this study. It also seems to have a high degree of feasibility with regard to different types of patients and settings and a sensitivity concerning differences in needs in subgroups of patients.