Self-medication of the common cold

Assessment of psychiatric disorders encounters unique complexities in homeless populations. Although the use of structured diagnostic instruments has significantly improved research methodology in this area, questions remain about the validity of using cross-sectional diagnostic methods derived from studies of more general populations. In particular, the validity of structured diagnostic instruments in the assessment of schizophrenia, depression, drug use disorder, and antisocial personality disorder (ASPD) in homeless populations has been questioned. The purpose of this study was to examine the association of psychiatric diagnoses with the weather. It was hypothesized that self-report of psychiatric illness may be affected by prevailing weather conditions. Nine hundred homeless subjects randomly sampled from St. Louis shelters, day centers, and unsheltered locations were interviewed over a 1-year period. Official average daily temperature and amount of precipitation on the day of each subject's interview were compared with lifetime and current psychiatric diagnoses ascertained by the Diagnostic Interview Schedule. Similar analyses were performed in general population data from the Epidemiologic Catchment Area study. The study found that among homeless men, inclement weather on the day of interview was associated with lifetime and current diagnoses of major depression, lifetime drug use disorder, lifetime diagnosis of ASPD, and current alcohol use disorder. These findings, however, were not present in homeless women and not reflected in the general population. The results, although limited, suggest that weather may confound cross-sectional, standardized methods of psychiatric diagnosis in homeless men. Weather-related factors among homeless men are associated with ascertainment of both lifetime and current diagnosis of major depression, as well as lifetime drug use disorder and ASPD and current alcohol use disorder. Possible interpretations of these findings are discussed, with implications for intervention strategies for psychiatric disorders in the larger context of homelessness and social problems.     

Assessment of skeletal muscle ventricle function using tissue velocity imaging

Because the visibility of homeless persons congregating in urban areas has increased since the 1980's, the relationship between homelessness and mental illness has caused more and more concern. A multitude of epidemiological surveys have been organized in Great Britain, Australia, Canada, and mainly in United States, and have attempted to evaluate scientifically the psychiatric morbidity of this population. This literature review reveals disparity of epidemiological methods in assessing the type and extent of mental illness among homeless adults. The lack of consensual definition of homelessness, the choice of different settings in which the research is organized (street, health centres, shelters), and the use of diverse instruments of psychiatric evaluation (diagnosis by clinician, by scale or by structured diagnostic interview) lead to a great disparity of the results. Thus, 1/3 of the homeless adults had prior history of psychiatric hospitalisation. Rates of psychosis range to 70% and it is estimated that 4% to 74% of the homeless persons suffer from affective disorders. Substance abuse disorder remains a problem for a significant number of these individuals, with a high frequency of dual diagnosis. Such divergent data highlight the anglo-saxon debate between those who accuse desinstitutionnalisation as a reason of homelessness, and those who blame the socioeconomic background.     

Evaluation of methods for detecting substance use disorder in persons with severe mental illness.

Substance use disorders are frequently undiagnosed in psychiatric settings. One possible reason for this underdiagnosis is the lack of screening procedures designed or validated specifically for psychiatric patients. To evaluate the utility of current detection methods, (a) criterion diagnoses were established of alcohol use disorder and drug (cannabis or cocaine) use disorder on 320 patients with severe mental illness recently admitted to a psychiatric hospital, using a combination of structured diagnostic interviews and clinician ratings, and (b) the classification accuracy of several substance abuse measures developed for the general population was examined. For this particular sample, demographic variables, clinical variables, medical exams, laboratory tests, and collateral reports did not yield accurate detection. Screens based on self-report were superior to these other approaches but still yielded modest sensitivity. The results suggest that many individuals are classified incorrectly with current techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for homelessness among schizophrenic men: a case-control study

OBJECTIVES: To identify risk factors for homelessness among the severely mentally ill, we conducted a case-control study of 100 indigent schizophrenic men meeting criteria for literal homelessness and 100 such men with no homeless history. METHODS: Subjects were recruited from shelter, clinic, and inpatient psychiatric programs in Upper Manhattan. Clinical interviewers employed standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. RESULTS: Homeless subjects showed significantly higher levels of positive symptoms, higher rates of a concurrent diagnosis of drug abuse, and higher rates of antisocial personality disorder. Homeless subjects experienced greater disorganization in family settings from birth to 18 years and less adequate current family support. Fewer homeless subjects than subjects in the never-homeless comparison group had a long-term therapist. These differences remained when demographic variables were adjusted statistically. CONCLUSIONS: Homeless schizophrenic men differed from their domiciled counterparts in all three domains we investigated; family background, nature of illness, and service use history. Findings are discussed in relation to policy and programs for the severely mentally ill.     

A preliminary classification system for homeless veterans with mental illness.

The purpose of this study was that of defining psychiatric profiles among veterans based on a structured interview of 3,595 individuals administered by outreach mental health clinicians to individuals who were presently or recently homeless. The interview included ratings of presence or absence of current psychiatric disorders; alcoholism, drug abuse, psychosis, mood disorders, personality disorders, PTSD, and adjustment disorders. We identified three subgroups using cluster analysis each showing different diagnostic profiles that were characterized as "addiction" (n = 3,061), "psychosis" (n = 218), and "personality" disorders (n = 54). Cluster membership was related to demographic characteristics, living situation, length of homelessness, and symptoms and complaints including cognitive difficulties, suicidality, violence, and depression. Group comparison statistics were used to compare intercluster differences in demographics, homeless situation, symptoms, and subjective complaints. There were no major intercluster differences in socioethnic, demographic, and homeless situation variables. Differences occurred in complaints of depression, positive symptoms of psychosis, and suicidality. It was concluded that despite the disproportionate sizes of the clusters homeless veterans with mental illness are nevertheless heterogeneous with regard to their psychiatric profiles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential patterns of mental disorders among the homeless in Madrid (Spain) and Los Angeles (USA)

In this paper we compare rates of mental disorders (major depression, dysthymia, cognitive impairment, and schizophrenia) among homeless people in Madrid and Los Angeles (LA) and examine the ordering of the onset of both conditions (i.e., homelessness and mental disorders). In the Madrid study, 262 homeless persons were interviewed using the CIDI. In the LA study, 1563 homeless persons were interviewed with the DIS. To make an item-by-item comparison, we companied the databases from both studies to submit a single database to statistical analyses. Results showed no significant differences in DSM-III-R life-time prevalence rates of mental disorders between both samples. However, the Madrid sample showed higher 12-month prevalence rates of dysthymia and cognitive impairment as compared to the LA sample. Most subjects across both cities first experienced symptoms of their mental disorders before first becoming homeless. The only significant difference was that all of the depressed adults in Madrid experienced depression prior to first becoming homeless, whereas this was the case for only 59.1% of LA depressed homeless people. We discuss the reasons for these cultural differences and their implications for cross-national public health research and intervention.     

Pneumonitis after radiotherapy of bronchial carcinoma: incidence and influencing factors

The main purpose of the study was to describe the characteristics of homeless psychiatric patients, and to compare the treatment they are offered to that offered to domiciled patients by the psychiatric services. Another purpose was to analyse the prevalence of homelessness among psychiatric patients before and after the introduction of community mental health centres in Copenhagen. Cross-sectional studies were conducted in two intervention and two control districts before and after introduction of the new treatment modalities. In 1991, 80 of 1008 patients (8%) were homeless. Male sex, young age, living on general welfare, schizophrenia and alcohol or substance abuse were the factors that most markedly differentiated homeless from domiciled patients. Compared with the treatment of domiciled patients, the homeless were more likely to be offered no further treatment after consultation in a psychiatric emergency and, if admitted, they were more likely to be placed in locked wards, given compulsory medication, and medicated with depot neuroleptics. The homeless were also less likely to be offered psychotherapy and consultation with a social worker. Schizophrenia and alcohol or substance abuse characterised the majority of the patients discharged homeless. In the intervention districts, the number of homeless patients in contact with the psychiatric services was found to increase at the same rate as the number of all patients in contact with the psychiatric services. In the control districts, no changes in prevalence of homeless patients or other patients in contact with the psychiatric services occurred. It is concluded that homeless psychiatric patients comprise a difficult patient group, with problems of schizophrenia, substance abuse and lack of motivation for treatment. It is recommended that special efforts be made to create housing facilities that fit the needs of different types of homeless patients, and that the homeless mentally ill are assisted in obtaining and maintaining an acceptable housing situation.     

Comparison of the Alcohol Dependence Scale and diagnostic interview schedule in homeless women

The Alcohol Dependence Scale (ADS) is a 25 item self-report instrument designed to evaluate the degree of severity of alcohol dependence. Although previous studies have reported on the validity of the ADS, no studies using the ADS have been done on the homeless population, a special and rapidly growing population. To assess the utility of the ADS in a population of homeless, substance-abusing women, the ADS questionnaire was compared with the DSM-III-R alcohol use disorder diagnosis as measured by the Diagnostic Interview Schedule (DIS). Both the ADS and the DIS were administered to 149 homeless, substance-abusing women by trained, lay interviewers. There was good agreement between the ADS and the past-year DIS diagnosis of alcohol use disorder. The level of agreement between the ADS and DIS, as well as sensitivity and specificity, for various ADS cutoff scores are reported to facilitate selection of cutoff scores by clinicians and future researchers.     

Quantitative analysis of polychlorinated biphenyls, organochlorine insecticides, polycyclic aromatic hydrocarbons, polychlorinated hydrocarbons and polynitrohydrocarbons in spiked samples of soil, water and plasma by selected-ion monitoring gas chromatography-mass spectrometry

The current study assesses the relationship between presenting symptomatology of the self-labeled Hispanic popular diagnosis of ataques de nervios and the specific co-morbid psychiatric diagnoses. Hispanic subjects seeking treatment at an anxiety disorders clinic (n = 156) were assessed with a specially designed self-report instrument for both traditional ataque de nervios and panic symptoms, and with structured or semistructured psychiatric interviews for Axis-I disorders. This report focuses on 102 subjects with ataque de nervios who also met criteria for panic disorder, other anxiety disorders, or an affective disorder. Distinct ataque symptom patterns correlated with co-existing panic disorder, affective disorders, or other anxiety disorders. Individuals with both ataque and panic disorder reported the most asphyxia, fear of dying, and increased fear during their ataques. People with ataques who also met criteria for affective disorder reported the most anger, screaming, becoming aggressive, and breaking things during ataques. Ataque positive subjects with other anxiety disorders were less salient for both panic-like and emotional-anger symptoms. The findings suggest that (a) ataque de nervios is a popular label referring to several distinct patterns of loss of emotional control, (b) the type of loss of emotional control is influenced by the associated psychiatric disorder, and (c) ataque symptom patterns may be a useful clinical marker for detecting psychiatric disorders. Further study is needed to examine the relationship between ataque de nervios and psychiatric disorders, as well as the relationship to cultural, demographic, environmental, and personality factors.     

Patterns of psychiatric diagnosis in a county mental health system

This article examines concordance in psychiatric diagnoses received by 280 clients of a county mental health system throughout their history with the system. Automated Information System records from all episodes of care since the first admission to the county system were analyzed, and diagnoses for each client for the first 5, first 10, last 5, and last 10 episodes were compared with generalized kappa. Sequential patterns of diagnosis were also examined. Overall concordance for diagnoses for the last 5 episodes was fair (kappa = .46), and concordance for major depression, bipolar disorder, and paranoid schizophrenia was good. Sequential patterning showed some tendency for more of the clients with a given modal diagnosis to be assigned that diagnosis in the middle of the sequence, and then fewer toward the end of the sequence, possibly because of effects of homelessness. Overall, the degree of concordance was quite high for some of the major disorders and compared favorably with concordance in more rigorous research settings. However, clinicians need to be more aware of the potential for assigning diagnosis based on stereotypical views of clients, as well as the effects of substance abuse and homelessness, in arriving at their diagnoses.     

Validation of a mental health assessment in an African conflict population.

We studied the validity of the assessment of posttraumatic stress disorder (PTSD) and depression within the context of an epidemiological mental health survey among war-affected adolescents and young adults in northern Uganda. Local language versions of the Posttraumatic Diagnostic Scale (PDS) and the Depression section of the Hopkins Symptom Checklist (DHSCL) were administered by trained local interviewers. Correlations with probable predictor variables (i.e., trauma exposure), outcomes (e.g., impaired functioning), and local idioms of distress (i.e., spirit possession) were determined to estimate criterion-related construct validity. To assess convergent validity, expert clinicians reinterviewed a subsample using structured interviews (the Clinician Administered PTSD Scale [CAPS] and the Mini International Neuropsychiatric Interview [MINI]). Depression and PTSD symptoms as assessed by the local interviewers correlated with the context variables as predicted. After optimizing the scoring algorithm, we found good agreement between the PDS-based diagnoses and expert diagnoses. However, the concordance for depression diagnoses was not satisfactory. Results show that mental health assessments in African languages can produce reliable and valid data but that caution is warranted in the unevaluated transfer of cutoff scores and scoring algorithms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders

OBJECTIVE: Primary insomnia and insomnia related to mental disorders are the two most common DSM-IV insomnia diagnoses, but distinguishing between them is difficult in clinical practice. This analysis was performed to identify clinical factors used by sleep specialists to distinguish primary insomnia from insomnia related to mental disorders. METHOD: Clinicians evaluated 216 patients referred for insomnia at five clinical sites, rated a list of clinical factors judged to contribute to each patient's presentation, and assigned diagnoses. Analysis of variance was performed, with contributing factors as the dependent variable and diagnostic group and clinic location as independent variables. RESULTS: Sleep specialists rated a psychiatric disorder as a stronger factor for insomnia related to mental disorders and rated negative conditioning and sleep hygiene as stronger factors for primary insomnia. However, a psychiatric disorder was rated as a contributing factor for 77% of patients who received a first diagnosis of primary insomnia. CONCLUSIONS: While neither sleep hygiene nor negative conditioning is a diagnostic criterion in DSM-IV, these results support the face validity of these clinical factors distinguishing between primary insomnia and insomnia related to mental disorders. The use of a psychiatric disorder as an inclusion criterion for insomnia related to mental disorders and an exclusion criterion for primary insomnia reinforces a categorical distinction between the two diagnoses, but the contribution of psychiatric symptoms in primary insomnia appears to be a clinically relevant one. These findings suggest the need for studies on the validity of negative conditioning and sleep hygiene in the etiology of primary insomnia, as well as on the significance of psychiatric disorders, especially depression, in primary insomnia.     

Linking inpatients with schizophrenia to outpatient care

OBJECTIVE: This study focused on inpatients with schizophrenia or schizoaffective disorder who were scheduled to begin outpatient care with clinicians who had not previously treated them. The authors evaluated the effects of communication between the patients and their outpatient clinicians before discharge on patients' referral compliance, psychiatric symptoms, and community function at follow-up three months after discharge. METHODS: A total of 104 adult inpatients with schizophrenia or schizoaffective disorder who were scheduled to receive outpatient care from clinicians who had not previously treated them were evaluated at hospital discharge and again three months later. Comparisons were made between patients who had telephone or face-to-face contact with an outpatient clinician before hospital discharge and patients who did not have such contact. RESULTS: About half (51 percent) of the inpatient sample communicated with an outpatient clinician before leaving the hospital. Compared with patients who had no communication, those who spoke with an outpatient clinician were significantly more likely to complete the outpatient referral. After baseline scores and other covariates were controlled for, predischarge contact with an outpatient clinician was associated with a significantly lower total Brief Psychiatric Rating Scale score at follow-up and less self-assessed difficulty controlling symptoms. Nonsignificant trends toward improved medication compliance and a lower rate of homelessness were also found. The two patients groups did not significantly differ in the proportion who were readmitted to the hospital or who made a psychiatric emergency room visit during the follow-up period. CONCLUSIONS: Direct communication between inpatients and new outpatient clinicians may help smooth the transition to outpatient care and thereby contribute to improved control of clinical symptoms.     

Trauma exposure among children with oppositional defiant disorder and attention deficit–hyperactivity disorder.

Consecutive admissions to an outpatient child psychiatry clinic diagnosed with oppositional defiant disorder (ODD), attention deficit-hyperactivity disorder (ADHD), or adjustment disorder were assessed for trauma exposure by a structured clinical interview and parent report. Controlling for age, gender, severity of internalizing behavior problems, social competence, family psychopathology, and parent–child relationship quality (assessed by parent report), an ODD diagnosis, with or without comorbid ADHD, was associated with increased likelihood of prior victimization (but not nonvictimization) trauma. ADHD alone was not associated with an increased likelihood of a history of trauma exposure Traumatic victimization contributed uniquely to the prediction of ODD but not ADHD diagnoses. Children in psychiatric treatment who are diagnosed with ODD, but not those diagnosed solely with ADHD, may particularly require evaluation and care for posttraumatic sequelae. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology on the streets: Psychological assessment of the homeless.

Reported rates of mental illness and substance abuse in homeless populations vary widely and are frequently based on clinical impressions. Using structured interviews and objective measures of pathology, including the Minnesota Multiphasic Personality Inventory-168 (MMPI-168) and specified criterion of disorder, we surveyed demographics, psychopathology, and substance abuse in a homeless population. The population was relatively young, male, and White. Serious alcohol abuse was indicated in about a third of the cases, and serious street drug abuse in a quarter. Severe psychopathology as indicated by scores three standard deviations about the mean on the MMPI psychotic scales was found in a third of the cases. With overlap among categories of disorder considered, over 50% of the population met criterion for severe psychological disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptom scales of the Diagnostic Interview Schedule: Factor results in Hispanic and Anglo samples.

The Diagnostic Interview Schedule (DIS) was designed for use in large-sample surveys of mental health to produce categorical diagnoses according to criteria such as those found in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, based on structured information about lifetime symptoms provided to nonclinician interviewers. Using symptom data from a probability sample of community residents in Puerto Rico who ranged in age from 18 to 64 (N?=?1,513), we examined five clusters of items (those associated with diagnoses of affective disorders, schizophrenia, phobic disorder, somatization disorder, and alcoholism) and formed quantitative measures of psychopathology from each. We checked the factor structure of these five scales in two probability samples obtained in Los Angeles, one composed of Mexican-Americans (N?=?1,113) and one of Anglo-Americans (N?=?975). Both Los Angeles samples were restricted to persons aged 18 to 64 for these analyses. Evidence of the cross-cultural stability of the DIS Affective Symptoms and Alcoholism scales was obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generic psychotherapy case formulation training improves formulation quality.

Psychotherapy case formulations written by 20 clinicians who received a 2-hr training session in case formulation were compared with those of 23 clinicians not receiving training. Formulations based on intake interviews conducted at a university-based psychiatric outpatient clinic, two to three per clinician, were reliably coded for quality and content. Clinicians in the training group produced formulations rated as higher in overall quality and as more elaborated, comprehensive, complex, and precise. These formulations were also more likely to address precipitants, predisposing factors, and an inferred mechanism to explain symptoms and problems. Effect sizes indicated that the average clinician in the training group produced a better formulation than 86% of those in the control group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosis proneness and clinical psychopathology: Examination of the correlates of schizotypy.

The present report examined the associations between the Perceptual Aberration Scale (PAS), a prominent psychometric index of hypothetical psychosis proneness, and several measures of clinical psychopathology in a nonpsychotic psychiatric sample (N?=?101). Patients were examined by experienced clinicians using structured psychiatric interviews to assess Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) Axis I and II conditions and rated for anxiety, depression, severity of illness, and current adult social competence. Elevated scores on the PAS were most closely associated with anxiety and depression as well as schizotypal, schizoid, avoidant, and obsessive–compulsive personality disorder symptomatology. Hierarchical regression analysis identified schizotypal symptoms and anxiety as the two underlying psychopathological processes most useful in explaining variance in PAS scores. Results are interpreted as supporting both the clinical relevance and research utility of the PAS and enhancing the construct validity of Meehl's model of schizotypy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeless men and women: Differential associations among substance abuse, psychosocial factors, and severity of homelessness.

Latent variable multiple-group confirmatory factor analyses assessed gender differences in relationships among drug and alcohol use, measures indicating severity of homelessness, criminal history, prior institutionalization, and mental illness (N?=?531 homeless persons; 386 men and 145 women). Severity was indicated by length of time homeless, housing quality, and victimization. Men reported more substance use, a longer time homeless, poorer housing quality, greater criminal involvement, and less likelihood of living with a child. Constrained multiple-group models surfaced 5 significantly different relationships between latent constructs. Men had stronger relationships between mental illness and prior institutionalization, drug use and mental illness, and drug use and victimization, whereas women had stronger relationships between drug use and alcohol use, and criminal involvement and drug use. Service delivery implications and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinic observations of structured parent–child interaction designed to evaluate externalizing disorders.

Observing structured parent–child interaction in clinic analogs has been a tradition in child clinical assessment since the 1960s. The clinic analog is designed to re-create important conditions from natural contexts such that dysfunctional parent–child patterns can be observed and modified. To those basic goals, the modern clinician would add diagnosis and treatment evaluation. Three classes of parent–child clinic analogs designed to evaluate preadolescent children with externalizing disorders were reviewed: free play, parent-directed play, and parent-directed chores. Free play analogs and parent-directed chore analogs were found to have merit, but remain psychometrically underdeveloped. Practitioner reliance on questionnaires and interviews appears likely to continue until observational analogs have attained sufficient psychometric qualities to facilitate routine clinical decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)