Persistent Psychiatric Disorder Research Articles

Analysis of outcome variables of a token economy system in a state psychiatric hospital: a program evaluation

This study describes the outcome of a token economy treatment applied to 2 distinct patient populations on the same unit of a state psychiatric hospital: individuals with a dual diagnosis of mental retardation and a DSM-IV Axis I diagnosis of either (a) a severe behavior disorder (BD) or (b) a serious and persistent psychiatric disorder (PD). Results showed that patients in the PD group were more likely to complete the treatment (17/20) than those in the BD group (17/31) who were more likely to be terminated from the program (14/31). Individuals who did not complete the program were distinguished early, within the first 3 weeks of treatment. These noncompleters received significantly more fines and earned significantly fewer tokens than those who completed the program. At an average of 2.7 years post-discharge, there was no difference in the proportion of PD (12/16) and BD completers (9/11) and BD noncompleters (3/7) remaining in the community. These data show that diverse populations of patients can be treated within the same token economy program, thereby improving cost effectiveness. Future research should be directed toward characterizing those patients (e.g., BD) less likely to succeed when they enter treatment, and determining if modifications in the program can improve that outcome.

Developing family psychoeducational treatments for patients with bipolar and other severe psychiatric disorders. A pathway from basic research to clinical trials.

Developing family treatments for patients with severe and persistent psychiatric disorder begins at the basic research level, through identifying psychosocial variables that have prognostic significance. Treatment protocols informed by this basic research can then be designed, manualized, and piloted. Next, the efficacy of a new treatment is examined, first in a randomized trial and then, if successful, in a community effectiveness study. We describe this treatment development pathway in a population for whom family attributes have prognostic importance: patients with bipolar affective disorder. The methodological complexities of psychosocial treatment studies are many. Moreover, the results of these studies often reflect interactions between treatment, process, and outcome variables.

An assertive community treatment programme led to improved housing stability in homeless people with severe mental illness

Lehman AF, Dixon LB, Kernan E , et al. A randomized trial of assertive community treatment for homeless persons with severe mental illness. Arch Gen Psychiatry 1997 Nov; 54 :...

Subjective experience of persistent schizophrenia and depression among US Latinos and Euro-Americans.

The aims were to investigate cross-culturally the subjective experience of long-term psychiatric patients to determine whether or not they would define their current life situation predominantly in terms of illness. The design is a two-by-two comparison by ethnicity (Latino and Euro-American) and diagnosis (schizophrenia and unipolar depression) of 80 subjects for DSM-III-R criteria according to the SADS. Patients were interviewed using semi-structured interview (Context of Illness Experience) yielding data coded for qualitative and quantitative analyses. while significant ethnic differences were observed, nearly half the sample did not include illness in their description of their life situation. Other domains (e.g. activities, event) and the extent to which patients perceived themselves as in- or out-of-step with the "rhythm of life" were identified as central patient concerns. Empirical research on the subjective experiences and representations of the life situation of patients offers clues to the course and treatment of persistent psychiatric disorder.

Short-Term Outcome of Major Depression: II. Life Events, Family Dysfunction, and Friendship Difficulties as Predictors of Persistent Disorder

To determine whether there is a pattern of social characteristics that specifically predicts persistent major depression at 36 weeks follow-up. Sixty-eight consecutive cases with a first-episode DSM-III-R diagnosis of major depression completed a life events and friendship difficulties interview at presentation and again at 36 weeks. Four factors were associated with persistent psychiatric disorder in general: lack of a maternal confiding relationship with current partner, family dysfunction and poor friendships at presentation, and severely disappointing events between presentation and follow-up. There was no association between these adverse experiences. No combination of long-term or recent life events or difficulties was, however, specifically associated with persistent depression. Nonsocial factors may need to be taken into account to specifically explain the phenotypic persistence of major depressive disorder in first-episode nonrecovered cases within a year of presentation. Psychosocial interventions with first-degree relatives and current close friendships should be considered as a part of the treatment strategy for first-episode major depression.

Short-Term Outcome of Major Depression: I. Comorbidity and Severity at Presentation as Predictors of Persistent Disorder

To determine whether there is a pattern of clinical characteristics at presentation that specifically predicts persistent major depression at 36 weeks follow-up. Sixty-eight consecutive cases with a first episode DSM-III-R diagnosis of major depression were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode version and completed the mood and feelings self-report depression questionnaire (MFQ) at presentation and again at 36 weeks. At presentation, 63 (93%) had one or more comorbid psychiatric disorders (median = 3). At 36 weeks, 17 (25%) cases were recovered; 17 (25%) continued to meet criteria for one or more psychiatric disorder but not major depression; 34 (50%) still met criteria for DSM-III-R major depression, of whom 25 (73%) had been persistently depressed and 9 (27%) had recovered and subsequently relapsed. Major depression at follow-up was specifically predicted by the additive effect of three features at presentation, comorbid obsessive-compulsive disorder, higher MFQ score, and being older. Comorbid oppositional defiant disorder at presentation was a significant predictor of persistent psychiatric disorder. Individuals with persistent depression (n = 25) were more likely to have a longer duration of illness before presentation. Systematic assessment of comorbid psychiatric conditions at initial interview, together with the use, in older subjects, of a self-report questionnaire to determine subjective severity, will provide valid clinical information concerning the potential short-term outcome of major depression.

Cognitive responses and psychiatric disorder in women with operable breast cancer

AbstractThe relationships between patient characteristics, cognitive responses and psychiatric disorder have been examined in 105 women with operable breast cancer in the 6 months around the time of diagnosis. Patients underwent interview‐based psychosocial assessments at approximately 6 and 20 weeks post diagnosis. Information concerning patient characteristics was obtained at the 6 week assessment. Cognitive responses were assessed using a newly developed schedule at both the 6 and 20 week assessments. Psychiatric disorder from one month prior to diagnosis to five months post diagnosis was assessed at 20 weeks using the Present State Examination and Bedford College Rating Criteria. The point prevalence of psychiatric disorder (borderline and full case) was 48% at 6 weeks and 17% at 20 weeks post diagnosis. The period prevalence for the 6 months around the time of diagnosis was 66%, with 37% of women experiencing psychiatric disorder which was unresolved 6 weeks after diagnosis (persistent psychiatric disorder).The patient characteristics independently associated with psychiatric disorder included age < 50 (p = 0.05), lack of an intimate relationship (p = 0.05) and having previous psychological difficulties (p = 0.07). The frequencies of the cognitive responses assessed were generally similar at 6 and 20 weeks. So too was the extent to which each individual response was reported by each patient at each time point. Lack of optimism was significantly associated with psychiatric disorder at 20 weeks (p = 0.04), but not at 6 weeks post diagnosis. None of the other cognitive responses assessed were related to psychiatric disorder at either assessment.

Neurological soft signs. Their relationship to psychiatric disorder and intelligence in childhood and adolescence.

Sixty-three male and 27 female adolescents known to have had neurological soft signs at the age of 7 years were compared with controls with no soft signs at age 7. Adolescents with early soft signs had significantly lower IQs and were more likely to have a psychiatric disorder characterized by anxiety, withdrawal, and depression. All the girls and 80% (12/15) of the boys with an anxiety-withdrawal diagnosis showed early soft signs. There was no relationship between early soft signs and attention deficit or conduct disorders. Examination of the relative contributions of anxiety at age 7, IQ, and social and family disadvantage to later diagnosis showed that most of the variance was accounted for by soft signs independently of IQ. Soft signs and anxious dependent behavior at age 7 were strongly predictive of persistent psychiatric disorder characterized by anxiety and withdrawal.

The long-term outcome of psychiatric morbidity detected in general medical patients

Abstract Psychiatric disorder detected in general medical patients was found in many cases to persist during an 18 month follow-up period. This was likely in patients with a history of psychiatric referral in the past. Although physicians referred to psychiatrists the majority of their patients likely to develop persistent psychiatric disorder, they failed to refer several such patients. The presence of psychiatric disorder during hospital admission, as well as older age, was associated with an increased subsequent mortality rate. Clearly psychiatric disorder detected in general patients has important implications. Further research is required to identify clinically important sub-groups of such patients, to evaluate the provision of psychiatric intervention for them, and to elucidate the nature of the association between psychiatric distrubance and increased risk of dying.