Presence Of Psychiatric Diagnosis Research Articles

An exploratory analysis of personality factors contributed to suicide attempts.

Background:People who attempt suicide have certain individual predispositions, part of which is contributed by personality traits.Aims:The present study was conducted to identify the psycho-sociodemographic and personality related factors contributing to suicide attempts.Materials and Methods:104 suicide attempters admitted in various departments and referred to the department of psychiatry of IQRAA Hospital formed the study sample. They were evaluated with a self designed socio-demographic proforma, Eysenck's Personality Questionnaire Revised, Albert Einstein College of Medicine-Impulsivity Coping Scale, and Past Feelings and Acts of Violence Scale.Statistics Analysis:The data was initially analyzed by percentage of frequencies. Association between socio-demographic and selected psychological factors was analyzed using t-test and Chi-square test. Intercorrelation among psychological factors was calculated by Pearson's correlation coefficient “r”.Results and Conclusion:Factors such as young age, being married, nuclear family, feeling lonely and burden to family, inability to solve the problems of day to day life, and presence of psychiatric diagnosis and personality traits such as neuroticism, impulsivity, and violence were contributed to suicide attempt. A significant positive relationship between these factors was also identified. Findings of the present study call the attention of mental health professionals to identify these high risk factors in susceptible individuals and to modify these factors to prevent them from attempting suicide.

Associations Between Mental Health and Surgical Outcomes Among Women Undergoing Mastectomy for Cancer

Following diagnosis of breast cancer, many women experience serious psychological distress, which can adversely affect their cancer care and outcomes. We conducted this study to examine the association between mental health conditions and hospital outcomes and costs among women undergoing mastectomy for invasive breast cancer. Using nationally representative data from the 2005 to 2008 Nationwide Inpatient Sample, we identified women aged ≥18 years with invasive breast cancer who underwent inpatient mastectomy (N = 40,202). Individuals with a psychiatric diagnosis (major depressive, posttraumatic stress, panic, adjustment, or generalized anxiety disorder) or substance abuse were compared with those without a mental health condition. Outcomes included risk of complications, prolonged hospitalization (>3 days), and direct costs of care. Multivariable logistic and linear regression analyses were performed to control for sociodemographic and clinical characteristics. Overall, 4.5% of patients had a mental health condition. Patients with substance abuse were more likely than those without to experience both complications (8.5% versus 4.8%; adjusted odds ratio [AOR] = 1.61 [1.30-2.00]) and prolonged hospitalization (26.4% versus 13.6%; AOR = 2.25 [1.95-2.59]), and to have higher average costs ($9,855 versus $9,128, p = 0.009). Presence of psychiatric diagnoses was also significantly associated with increased complications (5.9% versus 4.8%; AOR = 1.21 [1.10-1.34]), prolonged hospitalization (8.5% versus 4.8%; AOR = 1.40 [1.32-1.49]), and higher average costs ($9,723 versus $9,108, p < 0.001). Mental health conditions are associated with poorer outcomes and higher costs in breast cancer patients undergoing inpatient mastectomy. Greater efforts are needed to identify and manage these patients with psychiatric and substance use disorders during the perioperative period.

Psychiatric Diagnoses and Neurobehavioral Symptom Severity among OEF/OIF VA Patients with Deployment-Related Traumatic Brain Injury: A Gender Comparison

Background Traumatic brain injury (TBI) has substantial negative implications for the post-deployment adjustment of veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF); however, most research on veterans has focused on males. This study investigated gender differences in psychiatric diagnoses and neurobehavioral symptom severity among OEF/OIF veterans with deployment-related TBI. Methods This population-based study examined psychiatric diagnoses and self-reported neurobehavioral symptom severity from administrative records for 12,605 United States OEF/OIF veterans evaluated as having deployment-related TBI. Men ( n = 11,951) and women ( n = 654) who were evaluated to have deployment-related TBI during a standardized comprehensive TBI evaluation in Department of Veterans Affairs facilities were compared on the presence of psychiatric diagnoses and severity of neurobehavioral symptoms. Findings Posttraumatic stress disorder (PTSD) was the most common psychiatric condition for both genders, although women were less likely than men to have a PTSD diagnosis. In contrast, relative to men, women were 2 times more likely to have a depression diagnosis, 1.3 times more likely to have a non-PTSD anxiety disorder, and 1.5 times more likely to have PTSD with comorbid depression. Multivariate analyses indicated that blast exposure during deployment may account for some of these differences. Additionally, women reported significantly more severe symptoms across a range of neurobehavioral domains. Conclusion Although PTSD was the most common condition for both men and women, it is also critical for providers to identify and treat other conditions, especially depression and neurobehavioral symptoms, among women veterans with deployment-related TBI.

Quality of general movements and psychiatric morbidity at 9 to 12 years

Background General movements (GMs) form the basic motility of young infants. The quality of GMs may predict neurological outcome, but little is known about relationships between GM-quality and behavioral problems, including those resulting in overt psychiatric morbidity. Aim To explore relationships between abnormal GMs and behavioral problems, in particular relationships between abnormal GMs and Attention Deficit Hyperactivity Disorder (ADHD) with or without psychiatric co-morbidity at school-age. Methods Twenty-five low-risk full term infants and 16 infants at high risk for neurodevelopmental disorder but without cerebral palsy were studied prospectively. GM-quality was assessed during ‘writhing’ age (around term till 2 months post-term) and ‘fidgety’ age (2–4 months post-term). GMs were classified into normal and abnormal movements. When the children were 9–12 years, parents completed the Child Behavior Checklist (CBCL) and provided information on the presence of psychiatric diagnoses; teachers completed the Teachers Report Form (TRF). Both parents and teachers completed a questionnaire on ADHD-like behavior. Results Abnormal GMs at ‘writhing’ and ‘fidgety’ age were related to the presence of ADHD with psychiatric co-morbidity ( p < 0.05), but not to isolated ADHD. Abnormal GMs at ‘fidgety’ age were weakly related to problematic behavior at school (TRF-scores) and hyperactive behavior at home (ADHD-questionnaire). Conclusions This explorative study suggests that abnormal GMs in early infancy may be associated with an increased risk for behavioral problems, in particular for ADHD with psychiatric co-morbidity at school-age.

No: Efforts to relieve human suffering deserve rewards

The US News and World Report cover story, “How Shy Is Too Shy?” captured the debate about the pharmaceutical industry's role in bringing social anxiety disorder to the forefront of public awareness. Drug companies have been accused of fabricating this disorder to boost sales of selective serotonin reuptake inhibitors (SSRIs). This is untrue and does a great disservice to patients. In fact, the pharmaceutical industry was a reluctant participant in this area, funding studies in the mid-1990s only on the repeated urging of the academic research community. Social anxiety disorder is a chronic, debilitating condition that has long been trivialized and even ignored. The high prevalence of social anxiety disorder became apparent after publication of the National Comorbidity Survey (NCS) data in 1994.1 This congressionally mandated survey measured the presence of psychiatric diagnoses in more than 8,000 randomly selected American adults living in the community. As a result of this landmark study, social anxiety disorder was recognized as a condition to be taken seriously. The NCS study found that social anxiety disorder has a lifetime prevalence of 13.3%. It is the third most common disabling psychiatric disorder, after major depression (17.1%) and alcohol dependence (14.1%), and is the single most common disabling anxiety disorder in the United States. Persons with social anxiety disorder dread scrutiny and embarrassment in social and performance situations. Symptoms are often so severe that they either avoid interpersonal interactions or endure them with dread. This leads to academic underachievement, poor performance at work, and isolated, lonely living. Social anxiety disorder is a persistent, lifelong condition with an insidious onset in childhood or adolescence. The development of social anxiety disorder in a child or teenager is a harbinger of a lifetime of suffering and comorbidity. Most persons with social anxiety disorder later develop major depression, and many will abuse or become dependent on alcohol. The combination of social anxiety disorder and depression is particularly deadly and is associated with a 6-fold greater risk of suicide attempts.2 Dysfunction and missed opportunities are hallmark sequelae of social anxiety disorder. Compared with control subjects, individuals with social anxiety disorder are 8.4% less likely to graduate from college, 14.5% less likely to secure a professional, technical, or managerial job, and will earn wages that are 14% lower.3 The good news is that social anxiety disorder is treatable. Monoamine oxidase inhibitors are effective,4 but concerns about adverse effects limit their use. It was not until late in the past decade that the SSRIs were shown to be a safe and effective treatment.5 The need for early recognition and intervention is clear and compelling. Yet, why is this condition so overlooked and undertreated? There are numerous barriers to care. Social anxiety disorder, by definition, makes patients hesitant to seek treatment for this disability. Many have had symptoms for decades and believe that this is the way life is supposed to be. Physicians and other health care professionals do not actively look for social anxiety disorder and often do not take it seriously. Following the Food and Drug Administration's approval of the use of paroxetine for the treatment of social anxiety disorder, the pharmaceutical industry went to great lengths to educate the mental health community, primary care providers, and the public about this disorder. For this, they are to be applauded, not condemned. Medical luddites, in failing to embrace scientific advances, and even obstructing them, only perpetuate human suffering and contribute to scientific malfeasance. We should economically reward any successful effort to relieve human suffering, not disparage it. It will encourage others to invest more in finding effective treatments for medical illnesses. This is a more successful and a more compassionate strategy.

Psychogeriatric consultation services: effect and effectiveness.

To determine the nature of referrals to a psychogeriatric consultation/outreach service, the types of interventions provided, and the effects and effectiveness of the service. The study used a prospective approach in which 67 consecutive patients referred for psychogeriatric assessment were followed up 6 to 8 weeks after the initial assessment and then again 6 months after initial contact. Patients were rated at the time of referral and at follow-up on presence of psychiatric diagnosis, need for institutional care, and placement outcome. Of the 67 patients initially seen, 51 (76%) experienced memory problems and 46 (69%) had depressed mood. Consistent with this finding, 36 (54%) were diagnosed by consultants as having a dementia, and 15 (22%) received a diagnosis of depression. The most frequent recommendations included medication changes in 34 cases (50%) and further assessments in 37 cases (55%). Although information at 6-week follow-up was available for only 58% (n = 38) of the sample, 18 (46%) patients were generally improved. Interestingly, only 12 (31%) of referring physicians indicated that they had followed the advice of the consultants. Cognitive impairment and depressive symptoms were major concerns among referring physicians. The most common recommendation made involved pharmacotherapy. While compliance of family doctors to recommendations made was poor, patients improved over time. Patients requiring inpatient assessment were very old, living alone, experiencing behavioural problems, and not depressed. Psychogeriatric consultations appear most useful in cases where patients are more severely affected and/or are suffering from a greater range of symptoms.

A Cohort Study of Drug Users' Compliance With Zidovudine Treatment

Determine whether patients who have acquired the human immunodeficiency virus through injecting drug use receive less antiviral medication (zidovudine) than comparable patients of other risk groups considering access to, acceptance of, and compliance with treatment. Historical cohort study. Human immunodeficiency virus outpatient clinic. Human immunodeficiency virus-infected subjects eligible for zidovudine treatment between January 1, 1989, and January 1, 1992, comparing injecting drug users (IDUs) with non-IDUs ("others"). Proposal, acceptance, start of, and compliance with zidovudine treatment. One hundred fifty-one IDUs and 162 other human immunodeficiency virus-positive subjects became eligible for zidovudine treatment between January 1, 1989, and January 1, 1992. Both groups were proposed zidovudine as often, but zidovudine treatment was refused by 14.9% of IDUs compared with 7.1% of others (P = .029). The IDUs needed considerably more time than other subjects to accept zidovudine therapy (median delay between indication and start of zidovudine treatment, 61 days vs 30 days, P = .0001). After accepting, IDUs were as compliant with treatment as others: 81.3% vs 83.2% were good compliers, and rises of mean corpuscular volume of erythrocytes after 3 and 6 months of treatment were similar in both groups. Former drug users and IDUs receiving methadone were started on zidovudine treatment more often and complied better with treatment than active drug users. Absence of housing and presence of psychiatric diagnosis (both more prevalent in IDUs) were associated with less zidovudine treatment and worse compliance. Injecting drug users tend to delay the start of zidovudine treatment. However, once they have started, their compliance is no worse than the compliance of patients from other risk groups. These results have important implications for clinical trials, medical care, and public health.

Falls in the rehabilitation setting: incidence and characteristics.

A prospective six-month study was conducted to determine a high-risk index for medical rehabilitation patients who fall. Variables studied for all patients included demographics, medical conditions, associated symptoms, orthostatic blood pressure measurements, physical function, posture control, proprioception, use of physical restraints, and medications, A detailed examination of the fall events was also conducted. Of the 143 patients studied, 46 (32%) fell at least once, making a total of 84 falls. Impaired ability to follow directions, impaired judgment, impaired proprioception, presence of physical restraints, use of major tranquilizers, use of sedatives, and presence of psychiatric diagnosis were all individually associated with patients who fell. Males fell more than females. Logistic regression identified altered proprioception as the only major predictor of falling. Of those who fell, only 26% called for assistance prior to the fall. Sixty-eight percent of the falls were from wheelchairs. Importantly, no patients had serious injury or morbidity from the falls.