Psychiatric Assessment Schedule Research Articles

Personality disorders in people with learning disabilities: follow‐up of a community survey

A sample of community-based service users with intellectual disability (ID) was re-examined after 5 years to determine the impact of a diagnosis of personality disorder (PD). Seventy-five of the original 101 participants were followed up. Of these, 21 people had a PD identified during the original study. Compared with controls, people with a PD were significantly more likely to receive central nervous system (CNS) drugs, have more contact with psychiatric services, show increased offending behaviour, score higher on the Aberrant Behaviour Checklist and score above the threshold on the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD). Participants with PD recorded were more likely to have a recorded psychiatric disorder, have contact with specialist teams, and have more hospital admissions. People with ID and PD are able to live in the community with specialist support but improved assessment, diagnosis and support services need to be targeted more effectively to them.

The reliability and validity of general psychotic rating scales with people with mild and moderate intellectual disabilities: an empirical investigation

Whilst assessment tools have been developed to diagnose schizophrenia in people with mild intellectual disabilities (IDs), little attention has been paid to developing reliable and valid dimensional measures of psychotic experiences with this population. This study investigates the reliability and validity of two such measures developed for the general adult psychiatric population, the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS), with a population of adults with mild IDs. Sixty-two adults with mild IDs were interviewed using the PANSS and PSYRATS, and independently interviewed using the Psychiatric Assessment Schedule--Adults with Developmental Disability (PAS-ADD) to obtain psychiatric diagnoses to the criteria of the International Classification of Diseases--Tenth Revision (ICD-10). On the basis of ICD-10 diagnosis, participants were divided into three groups: psychosis (n=11); other mental health problem (n=14); no mental health problem (n=37). PANSS and PSYRATS subscale scores were compared across these three groups and were correlated with PAS-ADD symptom scores across a number of PAS-ADD symptom domains. All PANSS and PSYRATS subscales showed adequate internal reliability, largely good test-retest reliability, and logical inter-correlations between subscales. The PANSS positive symptoms and the PSYRATS auditory hallucinations subscales differentiated between the psychosis group and the other groups; the PANSS general symptoms subscale differentiated between the psychosis and no mental health problem groups; and the PANSS negative symptoms and the PSYRATS delusions subscales did not differentiate between the three groups. The PANSS and PSYRATS are promising measures for use with people with mild IDs and psychotic experiences, although further investigation of items relating to negative symptoms and delusions is warranted.

Mental Health and Social Care Needs of Older People with Intellectual Disabilities

Background Older people with intellectual disabilities (ID) are a growing population but their age‐related needs are rarely considered and community services are still geared towards the younger age group. We aimed to examine the mental health and social care needs of this new service user group.Methods We identified all adults with ID without Down syndrome (DS) aged 65+ living in the London boroughs of Camden and Islington. The Psychiatric Assessment Schedule for Adults with a Developmental Disability (PASADD) checklist was used to detect psychiatric disorder, the Vineland behaviour scale (maladaptive domain) for problem behaviours and the Dementia Questionnaire for persons with Mental Retardation (DMR) to screen for dementia. Carers reported health problems and disability. Needs were measured with the Camberwell Assessment of Need for adults with Intellectual Disabilities (CANDID‐S).Results A total of 23 older people with ID (13 had mild ID and nine more severe ID) and their carers participated in the survey. In which, 74% had one or more psychiatric symptoms; 30% were previously known with a diagnosis of mental illness. One‐third of the older people screened positive for dementia (range: 17–44%, depending on sensitivity of DMR scores used). Three quarters of the group had physical health problems, 74% had poor sight, 22% had hearing loss and 30% had mobility problems. Carers rated unmet needs for accommodation (22%), day activities, and eyesight and hearing. The people with ID rated unmet needs to be social relationships (44%), information and physical health.Conclusion Older people with ID without DS have considerable prevalence of health problems and psychiatric disorders, including symptoms of functional decline and dementia. Such symptoms are often not recognised and further research into their needs is a priority.

Co-morbid psychiatric disorders in Nigerian patients suffering temporomandibular joint pain and dysfunction.

Objectives: To determine the prevalence of psychiatric morbidity among Nigeria patients with temporomandibular joint pain and dysfunction (facial arthromyalgia), to delineate the specific types of co-morbid psychiatric disorders and identify the socio–demographic characteristics of the patients with psychiatric disorders. Design: A two–stage design was adopted to study the prevalence and type of co–morbid psychiatric disorders of identified 24 patients with temporomandidbular joint pain and dysfunction over a period of 5 years. Setting: Pain and Psychiatric clinics of the University of Benin Teaching Hospital Benin City, Nigeria. Methods: The patients were controlled for age gender, and marital status. The State–Trait Anxiety Inventory, 28–item General Health Questionnaires and the Hospital Anxiety and Depression Scales were used for first stage screening while the second stage interview utilised the Psychiatric Assessment Schedule. Results: The prevalence of psychotic morbidity was 37.5 % and 12.5% in the study and control groups respectively. Generalised anxiety disorder and dysthmia were the main forms of psychiatric disorders identified. Temporomandibular joint pain and dysfunction patients with co–morbid psychiatric disorders were significantly older (p Conclusion: The findings highlight the need for multi- disciplinary approach to the assessment and management of patients with temporomandibular joint pain and dysfunction. Key Words : Co: morbid, psychiatric. disorders, temporomandibular joint , pain dysfunction Nigerian Journal of Clinical Practice Vol 8(1) 2005: 23-28

The PAS–ADD Checklist: independent replication of its psychometric properties in a community sample

The development of reliable, valid measures of psychopathology in people with intellectual disabilities is an important task. However, independent replication studies are rarely reported. To report data on the psychometric properties of the Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS-ADD) Checklist. The PAS-ADD Checklist was completed for 226 adults as part of the assessment process for a specialist mental health service for people with intellectual disabilities. Internal consistency was acceptable. Factor analysis revealed one main factor that was characterised by items related to mood. The Checklist was sensitive to differences between diagnostic groups and had an overall sensitivity of 66%; its specificity was 70%. The PAS-ADD Checklist is a quick and easy to use screening tool. Although at present it is the best measure available, it should not be the only method used to identify psychiatric disorders in people with intellectual disabilities.

Social factors associated with chronic depression among a population-based sample of women in rural Pakistan.

Previous studies have reported a high prevalence of depression in women in Pakistan. This paper investigates whether risk factors for chronic depression established in studies performed in Western countries can explain this high prevalence. A two-phase survey using the self-rating questionnaire (SRQ) for common mental disorders and the Psychiatric Assessment Schedule was performed on a general population sample in rural Pakistan. Demographic data and results of the Life Events and Difficulties Schedule were analysed in relation to SRQ score and psychiatric disorder. A total of 145 women were screened. High SRQ score was associated with low educational status, not having a confidant, having four or more children, being older, not being married and living in a house with more than three people per room. Regression analysis demonstrated that the first three of these independently contributed to SRQ score. In the interviewed sample (74 women), only educational level independently contributed to the presence of depression. In addition, the least educated group experienced the greatest number of marked difficulties: 67% of them had experienced both marked housing and financial difficulties compared to 28% and 25% of the other educational groups (p = 0.005). Experiencing both housing and financial difficulties was a significant risk factor for depression in women with secondary education, but not for those without secondary education. This study suggests that high levels of social adversity and low levels of education are strongly associated with depression in women in Pakistan. The other vulnerability factors found in the West (such as lack of a confidant, the presence of three or more young children at home, or loss of mother during childhood) may be of lesser importance in this population.

Prevalence of and Markers for Affective Disorders Among Cancer Patients' Caregivers

This study aimed to establish the prevalence of psychiatric morbidity among cancer patients' caregivers and to identify markers of risk. Using the Psychiatric Assessment Schedule (a standardized psychiatric interview), the authors assessed 222 caregivers retrospectively. Thirty-one caregivers (14%) had developed an affective disorder during the two years since the patients' initial cancer diagnoses. Caregivers who were the patient's partner were more likely to develop anxiety, depression, or both when their ill spouse had developed these symptoms. Notably, the prevalence of affective disorders among female caregivers was comparable to the prevalence among patients (23%). Female nonpartner caregivers developed disorders as frequently as partners did. Female caregivers with a prior history of affective disorder who reported more illness-related concerns appeared to be at particular risk, providing useful markers for clinical practice.

BEHAVIOR IN DEGENERATIVE DEMENTIAS: MOOD DISORDERS, PSYCHOTIC SYMPTOMS AND PREDICTIVE VALUE OF NEUROPSYCHOLOGICAL DEFICITS

We studied mood disorders (MD) and psychotic symptoms (PS) in patients with fronto -temporal dementia (FTD) and Alzheimer's disease (AD) by means of different diagnostic instruments. These were: a subjective scale (subsets of survey psychiatric assessment schedule: SPAS), an objective scale (subsets of neuropsychiatric inventory: NPI) and a projective task (Wartegg completion task: WCT). A general tendency of NPI to over estimate the presence of symptoms compared to SPAS was observed, but distribution and severity of symptoms were quite homogeneous in the two dementia-groups, independently of the diagnostic scales. At variance with the scales, the WCT showed a more severe impairment in FTD than in AD. The regression analysis selected neuropsychological models able to predict behavioral disorders only in FTD, in particular, a planning deficit predicted PS. These data confirm the hypothesis that a damage in the frontal areas constitutes the neurobiological basis of PS in degenerative brain diseases. Furthermore, they suggest that mostly in FTD, behavioral disorders, as well as cognitive deficits, should be considered a direct expression of neural damage.

Screening for psychiatric symptoms: PAS-ADD Checklist norms for adults with intellectual disabilities.

The Psychiatric Assessment Schedule for Adults with Developmental Disabilities Checklist (PAS-ADD Checklist) is a screening instrument designed to help carers recognize likely mental health problems in people with intellectual disabilities (ID). To date there are no published PAS-ADD Checklist data on a large nonpsychiatric population of adults with ID, an important step towards developing norms for comparative purposes. Informants who had known participants for a median 24 months completed the PAS-ADD Checklist on 1155 adults with ID living in community, residential care and hospital settings in a county district in the North-east of England. Normative data were obtained for the PAS-ADD Checklist for the study population with reference to gender, age, and type of residence. The overall prevalence of mental health problems was 20.1%, and the rates for affective/neurotic, organic and psychotic disorders were 14%, 3.9%, and 10.2%, respectively. Significant differences in the rates for particular disorders were found across gender, age and, residence type. The rates of mental disorders found in the study population were consistent with previous studies of general populations of people with ID using over-inclusive screening instruments. The PAS-ADD Checklist appears to be an easy-to-use and sensitive tool for identifying mental health cases in ID populations, but further investigation is required concerning the specificity of the instrument.

Factors affecting the family support system of patients with schizophrenia: A survey in the remote island of Tsushima

Possible support for home-cared schizophrenic patients and their families was investigated on Tsushima, one of the many isolated islands in Japan. The psychopathologic symptoms of the patients were evaluated using the Brief Psychiatric Rating Scales (BPRS), their social adjustment using the Psychiatric Disability Assessment Schedule (DAS), mental states of the families using the General Health Questionnaire (GHQ), and the quality of life (QOL) using the Life Satisfaction Rating Scales (LSR). The family support systems for the patients were evaluated with regard to: (i) family support for the patient's daily life (FS), (ii) hardships of family life caused by living with the patient (HF), and (iii) empathic attitude of the family toward the patient (EA). Psychotic symptoms of schizophrenic patients were closely related to the mental state and QOL of their families. Family support was significantly correlated with HF and EA. Moreover, the family support system was shown to be related both to the psychotic symptoms of the patient and the mental state of the family. These results suggest that an approach to improve the family support system for the patient may exert positive effects on the patient's psychotic symptoms and his/her social adjustment. We also consider that intervention by a public organization is necessary to improve the family support system on islands.

An investigation of the effects of bereavement on mental health and challenging behaviour in adults with learning disability

SummaryThe purpose of the present study was to investigate the impact of bereavement on people with learning disability. Twenty adults with learning disabilities who had experienced the death of a primary caregiver in the previous 2 years were compared with a matched control group on measures of psychiatric disturbance and challenging behaviour. With regard to psychiatric disturbance, significant differences were found for ‘neurotic disorder’ and for ‘organic condition’ among the bereaved group on the Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS‐ADD). No difference was found for ‘psychotic disorder’ on the PAS‐ADD. As regards challenging behaviour, significant differences were found for ‘irritability’, ‘lethargy’ and ‘hyperactivity’ among the bereaved group on the Aberrant Behavior Checklist (ABC). No differences were found for ‘stereotypy’ or ‘inappropriate speech’ on the ABC. The clinical implications of these findings are outlined, and recommendations for supporting people with learning disabilities who experience bereavement are presented.

Determinants of consultation rate in patients with anxiety and depressive disorders in primary care.

Although it is recognized that anxiety and depression are associated with frequent attendance in primary care, not all patients with these disorders attend frequently. The factors associated with general practice consultation in the important group of patients with anxiety and depressive disorders are not clear. Our aim was to determine prospectively the factors which predict consultation rate in a cohort of patients with anxiety and depressive disorders in primary care. A total of 148 adult patients with a depressive, anxiety or panic disorder (DSM-III criteria) were studied prospectively for 6 months to determine the factors which predicted consultation rate during this time. Measures at baseline included: the Psychiatric Assessment Schedule, Hamilton Depression Rating Scale, Life Events and Difficulties Schedule, Clinical Anxiety Scale, details of substance misuse and demographic data. The principal outcome measure was the number of consultations recorded in the GP records over the following 6 months. The variables associated with consultation rate were assessed by multiple regression analysis, with number of consultations as the dependent variable. The median consultation rate during the 6 months of the study was five (range: 1-22). Thirty per cent of the sample consulted seven or more times during the 6 months and 10% consulted 12 or more times. The regression analysis demonstrated that the following variables contributed to the best model: prior consultation rate, past psychiatric history, ongoing social difficulties, current level of alcohol consumption, total psychiatric symptom score and total anxiety score. These variables together accounted for 41% of the variance in consultation rate. The detection and rigorous treatment of psychiatric disorder, the provision of social support and interventions for alcohol dependence may help to reduce the frequency of consultation of anxious and depressed patients in primary care. Future research to identify additional variables which explain the major part of the variance in consultation rate may pave the way for novel treatment approaches to the phenomenon of frequent attendance.

Hospital-dia: para quem e para quê?

OBJETIVO: Estudar prospectivamente a população internada em um hospital-dia (HD) em relação a fatores que poderiam influenciar na melhora e na duração da internação. MÉTODOS: Foram entrevistados, para obtenção de dados sociodemográficos e avaliação da evolução, 34 pacientes internados no Hospital-Dia da Faculdade de Medicina de Botucatu, Unesp, durante um ano. O diagnóstico psiquiátrico foi avaliado pela CIDI (Composite International Diagnostic Interview), a sintomatologia psiquiátrica pela BPRS (Brief Psychiatric Rating Scale) e a incapacitação psicossocial pela DAS (Psychiatric Disability Assessment Schedule). Todos os pacientes foram acompanhados, e seus familiares, entrevistados. RESULTADOS: Predominaram mulheres (76%), jovens (61,8%), sem vínculo conjugal (71%), sem trabalho (82,4%), com diagnóstico de transtornos afetivos (44,1%) e com internações psiquiátricas prévias (44%). Apenas quatro (12%) pacientes apresentavam uma "síndrome maior" segundo BPRS. Houve considerável incapacitação psicossocial dos pacientes em alguns papéis sociais. Maior renda per capita foi um fator associado à melhor evolução. As internações duraram em média 74 dias. Pacientes com internações prévias tenderam a permanecer menos tempo no HD. CONCLUSÕES: Portadores de transtornos afetivos e quadros "não-psicóticos" geralmente não necessitam de internação por período integral em hospital psiquiátrico. Contudo, os pacientes deste estudo tiveram um elevado número de internações psiquiátricas prévias, provavelmente por necessitarem de um nível de atendimento além das possibilidades dos ambulatórios. Entretanto, pacientes com maior número de internações -- em tese mais graves -- tenderam a permanecer menos tempo no HD, o que suscita dúvidas quanto à sua adesão a serviços abertos, bem como aos possíveis fatores facilitadores dessa adesão. Em um momento de crescimento expressivo no número de serviços de internação parcial no Brasil, como nos últimos anos, mais estudos são necessários a fim de esclarecer para quem e para quê são destinados esses serviços.

Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years.

The reported prevalence of psychiatric illness among adults with intellectual disability (ID) varies widely between 10 and 39%; however, many methodological problems exist. The aims of the present study were to establish the prevalence of functional psychiatric illness among adults with ID who live in the community, in order to compare the overall rate and types of psychiatric illness between the population with ID and the general population without ID, and to establish the risk factors associated with psychiatric illness in adults with ID. The study was done in two stages. In the first part, a trained psychiatrist interviewed 101 randomly selected adults with ID and their carers using the Mini Psychiatric Assessment Schedule for adults with Developmental Disability (Mini PAS-ADD) to screen for psychiatric caseness. Out of these 101 adults, 90 had sufficient communicative abilities that made the administration of Mini PAS-ADD possible. A second trained psychiatrist interviewed 19 out of the 20 adults who were diagnosed as psychiatric cases according to the initial Mini PAS-ADD interview. This psychiatrist interviewed patients and their carers in line with the full PAS-ADD interview. The second psychiatrist was blind to the initial diagnoses made according to the Mini PAS-ADD questionnaire. A final psychiatric diagnosis was made according to International Classification of Diseases - 10th Revision (ICD-10) criteria. Some 14.4% (95% confidence interval = 7.4-21.4%) of the cohort had a psychiatric diagnosis according to ICD-10 criteria: 4.4% had schizophrenia, 2.2% depressive disorder, 2.2% generalized anxiety disorder, 4.4% phobic disorder and 1% delusional disorder. The overall rate of functional psychiatric illness (point prevalence) was similar to that found in the general population (16%). However, the rates of schizophrenic illness and phobic disorder were significantly higher in the study cohort compared with those in the general population (0.4% and 1.1%, respectively). Increasing age and the presence of physical disability were significantly associated with the occurrence of psychiatric illness. Out of the 11 remaining adults with severe ID, two (18%) had a diagnosis of a psychiatric illness (one mania and one anxiety disorder) according to the Diagnostic Assessment for the Severely Handicapped (DASH) questionnaire.

Structured psychiatric assessment schedules – treating the case notes and the patient

Aims and MethodWe surveyed the usefulness of a structured method of recording history and mental state examinations with a treatment plan in terms of conveying information about diagnosis and management, compared with informal methods of recording data. A survey of admission records by nursing and medical raters was followed by introduction of a standardised assessment format for use by trainees and a re-audit. Initial psychotropic medication was also scrutinised.ResultsThe assessment schedule improved clarity of diagnosis for the medical and nursing raters alike, but improvement in management plan quality was mainly apparent for the medical rater. The audit also exposed widespread use of hypnotic agents.Clinical ImplicationsIt is suggested that structured assessment schedules facilitate adherence to good standards of clinical practice and may benefit trainees undertaking professional exams as well as having a multi-disciplinary and medico-legal relevance.

The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan.

Although native faith healers are found in all parts of Pakistan, where they practice in harmony with the cultural value system, their practice is poorly understood. This study investigated the prevalence, classification and treatment of mental disorders among attenders at faith healers. The work of faith healers with 139 attenders was observed and recorded. The mental status of attenders was assessed using a two-stage design: screening using the General Health Questionnaire followed by diagnostic interview using the Psychiatric Assessment Schedule. The classification used by faith healers is based on the mystic cause of disorders: saya (27%), jinn possession (16%) or churail (14%). Sixty-one percent of attenders were given a research diagnosis of mental disorder: major depressive episode (24%), generalized anxiety disorder (15%) or epilepsy (9%). There was little agreement between the faith healers' classification and DSM-IIIR diagnosis. Faith healers use powerful techniques of suggestion and cultural psychotherapeutic procedures. Faith healers are a major source of care for people with mental health problems in Pakistan, particularly for women and those with little education. Further research should assess methods of collaboration that will permit people with mental health problems to access effective and culturally appropriate treatment.

Depression and social stress in Pakistan.

The high prevalence of depression in developing countries is not well understood. This study aimed to replicate the previous finding of a high prevalence of depression in Pakistan and assess in detail the associated social difficulties. A two-phase survey of a general population sample in a Pakistani village was performed. The first-phase screen used the Personal Health Questionnaire (PHQ) and the self-rating questionnaire (SRQ). A one in two sample of high scorers and a one in three sample of the low scorers were interviewed using the Psychiatric Assessment Schedule (PAS) and Life Events and Difficulties Schedule (LEDS). A total of 259 people were screened (96% response rate). The second stage yielded 55 cases, of whom 54 had depressive disorder, and 48 non-cases. The adjusted prevalence of depressive disorders was 44-4% (95% CI 35.3 to 53.6): 25.5% in males and 57.5% in females. Nearly all cases had lasted longer than 1 year. Comparison of the cases and non-cases indicated that cases were less well educated, had more children and experienced more marked, independent chronic difficulties. Multivariate analysis indicated that severe financial and housing difficulties, large number of children and low educational level were particularly closely associated with depression. This study confirms the high prevalence of depressive disorders in Pakistan and suggests that this may be higher than other developing countries because of the high proportion of the population who experience social adversity.

High rates of schizophrenia in adults with velo-cardio-facial syndrome.

Velo-cardio-facial syndrome (VCFS), a syndrome characterized by an increased frequency of schizophrenia and bipolar disorder, is associated with small interstitial deletions of chromosome 22q11. We evaluated 50 adults with VCFS using a structured clinical interview (Schedules for Clinical Assessment in Neuropsychiatry or Psychiatric Assessment Schedule for Adults With Developmental Disability if IQ <50) to establish a DSM-IV diagnosis. The schizophrenia phenotype in individuals with VCFS and schizophrenia was compared with a matched series of individuals with schizophrenia and without VCFS (n = 12). The King's Schizotypy Questionnaire was administered to individuals with VCFS (n = 41), their first-degree relatives (n = 68), and a series of unrelated normal controls (n = 316). All individuals with VCFS deleted for the N25 probe (n = 48) were genotyped for a genetic polymorphism in the COMT gene that results in variations in enzymatic activity. Fifteen individuals with VCFS (30%) had a psychotic disorder, with 24% (n = 12) fulfilling DSM-IV criteria for schizophrenia. In addition, 6 (12%) had major depression without psychotic features. The individuals with schizophrenia had fewer negative symptoms and a relatively later age of onset compared with those with schizophrenia and without VCFS. We found no evidence that possession of the low-activity COMT allele was associated with schizophrenia in our sample of individuals with VCFS. The high prevalence of schizophrenia in this group suggests that chromosome 22q11 might harbor a gene or genes relevant to the etiology of schizophrenia in the wider population.

Physical and psychological needs of patients dying from colo-rectal cancer.

Sixty-one patients suffering from terminal colo-rectal cancer were interviewed in depth by trained research nurses. The nurses used a semistructured interview, a concerns checklist and the Psychiatric Assessment Schedule to determine patients' key physical complaints, their main concerns and whether or not an affective disorder was present. The interviewers' estimates of these aspects were then compared with the assessments of 48 carers and 58 general practitioners (GPs). The congruence between patients' and carers' reports was reasonable for appetite loss (77%), nausea and vomiting (75%) and pain (72%), and the rate of false positive reporting was low. However, there was much less congruence for breathlessness (48%) and pyrexia (32%). There was even less congruence between the estimates of patients' physical symptoms and GPs' perceptions. The highest congruence was for pain (42%). The congruence was low for appetite loss (8%) and breathlessness (5%). The congruence between patients' and carers' perceptions of the patients' major concerns was low, being at best 33% for patients' concerns about their physical illness. The rate of false positive reporting by carers was high. The carers' major concerns included the patients' illness (47%), the future (33%) and the emotional demands being put on them (23%). Thirteen (22%) of the 59 patients completing a full interview were suffering from an affective disorder. This had been recognized by the GP in only five cases and six patients who had a normal mood were wrongly diagnosed as being depressed. Of the carers interviewed, 22 (46%) considered symptom control had been inadequate and 23 (48%) felt they had no relief from the burden of caring or had too little help. Sixteen (33%) had recently suffered from a major depressive illness, generalized anxiety disorder or adjustment disorder. It is concluded that it is unreliable to rely on carers' proxy reports of the symptoms experienced by terminally ill patients; more accurate personal assessments are needed where possible. It is likely that this will only be achieved by ensuring that those health professionals involved in palliative care have training in the relevant assessment skills.

Persistent somatization in cancer: A controlled follow-up study

Nature and frequency of somatic complaints, severity of anxiety and depression, and nature of psychiatric symptoms and disorders were evaluated in 81 adequately treated cancer patients, disease-free or with residual disease, using a controlled, prospective follow-up design. Patients were included in the index group n=60 if they had persistent somatic complaints or unexplained nature or severity of somatic complaints, or the control group n=21 , if they did not report somatic complaints. Instruments used for evaluation were the Scale for Assessment of Somatic Symptoms, Hospital Anxiety and Depression Scale, Psychiatric Assessment Schedule, and DSM-III-R. Common somatic complaints in the index group were pain (19%), fatigue (17%), sensory symptoms (30%), and mixed symptoms (27%). Subjects in the index group significantly ( p<0.001) more often had depressive or anxiety disorder (19%) and atypical somatoform disorder (15%). Patients were treated appropriately with psychotropic medications and counseling. Follow-up at 4–6 months revealed a significant reduction in the number of somatic symptoms ( p<0.001) and anxiety ( p<0.001) and depression ( p<0.05) scores. The observations confirm that somatic symptoms may persist in cancer patients, which are related to concomitant psychopathology, and require psychiatric intervention.