Research selection bias and the prevalence of depressive disorders in psychiatric facilities.

Applied a statistical technique to correct for selection bias in estimating the prevalence of depressive disorders in community mental health centers (CMHCs). Approximately 243 Ss completed the screening instruments at 2 CMHCs. Results indicate that the prevalence of depression in total CMHC populations may approach 44% rather than the 25% derived from a censored sample. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alopecia areata and cytomegalovirus infection in twins: genes versus environment?

BACKGROUND: Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease mediated by T cells directed to the hair follicle. Genetic susceptibility may be conferred by HLA, and an environmental trigger, such as a viral infection, is suspected. The incidence of AA in the population is estimated to be 1.7%, with an average of one in four patients having a positive family history. OBJECTIVE: Our purpose was to examine the concordance rate of AA among identical versus fraternal twins and the correlation between stress, cytomegalovirus (CMV) infection, and disease. METHODS: Families with AA were solicited from dermatologists in the United States and through a Website on the Internet. HLA class 2 typing and identification of CMV early and late genes were performed by polymerase chain reaction (PCR) on genomic peripheral blood DNA. Serum antibodies for CMV were determined by enzyme-linked immunosorbent assay. RESULTS: From 114 families, we identified 11 sets of monozygotic twins and 3 sets of dizygotic twins. The concordance rate was 55% for monozygotic twins and 0% for fraternal twins. Most identical twins were male. The severity of the AA phenotype varied and appeared most severe in the first affected twin. Five of 24 twins were CMV seropositive but CMV DNA was not detected in blood lymphocytes of any of the subjects when studied after the onset of AA. The presence of AA in twins was not correlated with evidence of CMV. CONCLUSION: A 55% concordance rate in identical twins and AA occurring in families support a genetic component as well as possible environmental triggers that remain unknown.     

Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California

BACKGROUND: The Mexican American Prevalence and Services Survey presents lifetime prevalence rates for 12 DSM-III-R psychiatric disorders in a sample of 3012 adults of Mexican origin by place of residence and nativity, and compares these results with those of population surveys conducted in the United States and Mexico. METHODS: The stratified random sample included non-institutionalized persons aged 18 to 59 years of Mexican origin, who were residents of Fresno County, California. Psychiatric disorders were assessed using a modified version of the World Health Organization Composite International Diagnostic Interview in face-to-face interviews. RESULTS: Mexican immigrants had lifetime rates similar to those of Mexican citizens, while rates for Mexican Americans were similar to those of the national population of the United States. This difference is attributable to a prevalence rate for any disorder among immigrants of 24.9%, compared with 48.1% among US-born respondents. A higher prevalence for any disorder was reported in urban (35.7%) compared with town (32.1%) or rural (29.8%) areas. Multivariate analyses showed an adjusted effect of country of birth, but not of urban residence. CONCLUSIONS: Despite very low education and income levels, Mexican Americans had lower rates of lifetime psychiatric disorders compared with rates reported for the US population by the National Comorbidity Survey. Psychiatric morbidity among Mexican Americans is primarily influenced by cultural variance rather than socioeconomic status or urban vs rural residence.     

The prevalence of psychiatric disorders at a primary care clinic in Soweto, Johannesburg

A pilot study to assess the prevalence of psychiatric disorders in a primary care clinic in Soweto was carried out at the Zola Community Health Centre in May 1991. Interviews were carried out by trained primary care clinic staff. The findings were reviewed and analysed by the authors. The prevalence of psychiatric disorders was found to be 14.38%. Methodological problems are listed and the results are discussed.     

Sleep disorders presenting as psychiatric disorders

In summary, disordered sleep can present in a complex and atypical fashion in which the primary sleep-related component may not be immediately apparent. A high index of suspicion serves the clinician well in these cases. A careful and systematic evaluation of sleep often proves to be rewarding in terms of diagnostic accuracy and improved treatment outcome.     

Linkage studies of psychiatric disorders

Linkage analysis has been successful in identifying the genetic basis of numerous Mendelian diseases. These successes were due in part to the rapid developments in molecular biology, which have yielded a plethora of informative genetic markers. Although there is strong evidence that the manifestation of schizophrenia and bipolar affective disorders is controlled by genes, no evidence for linkage has been established. For psychiatric disorders, the most important limiting factor is likely to be the lack of single loci with very large effects that occur with any relevant frequency. The difficulties of linkage studies in psychiatric disorders are discussed with reference to non-psychiatric genetic diseases for which linkage to genetic markers has been successful. Recommendations for collecting information to clarify the patterns of transmission of the psychiatric disorders are described.     

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.     

Personality disorders and psychiatric symptoms in psoriasis

Two groups of psoriatic outpatients (ns = 192 and 119) were given, respectively, the Million Clinical Multiaxial Inventory-II and Foulds' Delusions-Symptoms-States Inventory. They were compared with dental (n = 192) and with general surgical (n = 190) patients. The psoriatic group presented clearly higher mean scores and frequencies on most of the personality disorder scales. On Foulds' inventory, psoriatic patients showed higher frequencies of neurotic and psychotic class allocations. A cluster analysis of personality scores provided evidence for 4 different personality clusters of patients with psoriasis: (a) Avoidant, Dependent, Schizoid, and Self-defeating (32.2%), (b) Compulsive, Narcissistic, and Aggressive (30.7%), (c) no personality disorder (18.2%), (d) Borderline, Paranoid, and Schizotypal, etc. (18.8%).     

Fundamental neuroscience and the classification of psychiatric disorders

Non-Darwinian views of evolution of nervous systems (e.g., Jacksonian evolution) conceive the present structure of the human brain as composed of a series of additive layers representing successive phylogenetic stages in evolution, layers which remain static after their emergence. In contrast to this view, recent allometric studies clearly show that limbic structures scale with the growth of the human brain (i.e., they do not remain stable but reach the size expected for the brain of a primate with the weight of a human brain). Data also show that limbic structures are significantly involved in cognitive functions such as memory and attention. Hence overlap of lesions in similar brain loci, especially in limbic regions, in both manic-depression and schizophrenia should come as no surprise. In the psychobiological sphere, the need for cognitive perceptual evaluation of the external world and internal state for emotional experience, further to the necessary visceral arousal, leads to a breakdown of the platonic, essentialist position, emotion vs. cognition at the psychological level, a problematic issue for the Kraepelinean view. Neural networks operation depend upon multiple nonlinear processes at the cellular, synaptic and network levels. Afferent input may serve not only to activate, but also to configure them into one of several circuit modes. These networks have been named polymorphic and can, at least to a measure, account for commonalities in lesion sites, in both affective and schizophrenic diseases. It is proposed that fundamental neuroscience should serve as one of the bases for the classification of psychiatric disorders.     

Comorbidity of psychiatric and communication disorders in children

The co-occurrence of psychiatric and communication disorders in children is considerable. Many children who are treated by mental health professionals are also in need of speech and language services. This article discusses comorbidity and outlines communication problems that accompany a variety of childhood psychiatric conditions. Empiric studies and clinical impressions of these co-occurring problems are described.     

Legal aspects of epilepsy and coexisting psychiatric disorders

Major advances in understanding the neurobiology of epilepsy have led to more precise diagnosis, early rational treatment with new drugs, useful new neurosurgical techniques, etc. This has led to significant control of seizures, a marked reduction in concurrent psychopathology, improved quality of life of the epileptic patient, the almost complete abolition of old-style institutions for these patients, etc. However in spite of greater scientific knowledge about epilepsy, this has not led to an equally great advance socially. Old-fashioned restrictions and limitations based on mistaken ideas as to the nature of epilepsy still remain. Epilepsy is still considered in the same light as the psychopathological disorders seen in some epileptics, as a result of different variables which are not necessarily related to seizures. Current legal rulings on epilepsy, with or without co-existing mental disorder, are reviewed in relation to their effect on driving motor vehicles, carrying out military service, the condition of minusvalia, the possibility of legal incompetence, and the nullity of marriage and of priesthood. It is concluded that although the limitations maintained by some statutory requirements are reasonable, it would be fairest to abolish restrictions which, in view of present scientific knowledge, are out of date and prevent the return to normal and full social integration which should prevail for people with epilepsy.     

Seizure disorders presenting with psychiatric symptomatology

Seizure disorders can be mistaken for psychiatric disorders and, the two have a number of poorly understood interrelations. Disruptions of consciousness, motor activity, hallucinations, and abrupt mood and anxiety changes can all be seizure manifestations caused by cortical neuronal discharges. This article presents the classification and proposed psychopathology of seizure disorders. It then reviews the psychiatric conditions that frequently mimic elements of such seizure disorders, giving hints that will allow the clinician to correctly identify seizures that are creating psychiatric presentations. Finally, this article makes clear the situations in which anticonvulsant medications may be of value when nothing else seems to be working.     

Mental health and psychiatric disorders in older women

An increase in the number and diversity of resources designed to optimize psychosocial function in people and especially women over age 65 is inevitable in the next decade as both the size and political influence of this group increase. The successful implementation of such programs is dependent on widespread change throughout society, involving many disparate groups, including older people themselves, politicians, health care administrators, and researchers from a range of disciplines. Clinicians in medicine and allied professions have a pivotal role in this regard. At present there are many reversible causes of psychiatric morbidity in the elderly, including depression, anxiety, cognitive defects, sensory impairment, malnutrition, and adverse effects of alcohol abuse and polypharmacy that are often not recognized or treated appropriately. It is therefore essential that family practitioners receive both undergraduate and postgraduate training to recognize and manage the wide range of psychosocial disorders prevalent in older women. Intervention may require little more than an opportunity for the women to ventilate concerns or obtain information and advice about community resources. In other circumstances in which there are complex interactions of physical, social, and psychological factors, optimal management may involve interventions that require specific skills beyond the scope of the individual practitioner. Referral to a psychogeriatric team is likely to be helpful in such situations. The team, with its access to a full range of health professionals and community resources, is well placed to deal economically with complex issues. The special care units are best equipped to manage the tertiary care of the chronically ill who do not have adequate community-based support available. Increased information derived from research relating to the spectrum of mental ill health and mental health is essential to adequately address the causes, correlates, and treatments of illness, and to answer questions about the positive aspects of mental health that may have implications for all age groups and both sexes. For example, it is intriguing that older women maintain a high level of psychological health despite greater social disadvantages than any other major section of the community. It is likely that psychological factors, such as better coping skills and ability to adapt to stressful life events, influence both the quality of life in older women and possibly also its duration. Alternatively, it is possible that the commonly held view that the life expectancies of women and men will converge as women undertake more of the roles and activities currently the province of men may occur.(ABSTRACT TRUNCATED AT 400 WORDS)     

Kidney transplantation and liaison psychiatry, part I: anxiety before, and the prevalence rate of psychiatric disorders before and after, transplantation

We examined psychiatric problems before and after kidney transplantation in a sample of 36 patients with end-stage renal failure. The prevalence rate of psychiatric disorders was 11.1% (4 of 36 cases) before the transplantation and 36.1% (13 of 36 cases) within 2 months after the transplantation. Except for a patient with schizophrenic disorder, no patients were found to have a psychiatric disorder from 2 to 6 months after the transplantation. In this study, we also examined anxieties and/or conflicts related to the transplantation using the synthetic house-tree-person (HTP) drawing test, a measure of mood states by means of a non-verbal expression method. The upper part of the tree trunk was not drawn in 25% of this sample (5 of 20 cases). In the HTP drawing tests immediately after the transplantation, however, trees missing the upper part of trunk were not drawn. Based on these findings, we discussed psychiatric problems in kidney transplantation.     

Assessing communication in children with psychiatric and communication disorders

This article presents issues related to the communication assessment of children with psychiatric and communication disorders. Challenges inherent in assessing this population are discussed. Frequently used assessment instruments and procedures are described. Consideration is given to the assessment of very young or low-functioning children and older or high-functioning children.