Psychiatric Health Problems Research Articles

24 h urinary free cortisol in large-scale epidemiological studies: short-term and long-term stability and sources of variability.

Function of the hypothalamus-pituitary-adrenal (HPA) axis has been associated with several somatic and psychiatric health problems. The amount of free cortisol excreted in the urine during 24h (24-h UFC) has often been used as a proxy for HPA-axis function. Reference values for 24-h UFC and their stability in the short and long term, as well as sources of variability, are largely lacking. This study was performed in a general population cohort. Participants collected 24-h UFC on two consecutive days (T1), and repeated this collection approximately 2 years later (T2). Cortisol in urine was measured using LC-MS/MS. Height and weight were measured at the research facilities; glomerular filtration rate was estimated using creatinine clearance. Psychological distress (General Health Questionnaire), smoking, alcohol use and exercise were measured by means of questionnaires. 24-h UFC stability on a day-to-day basis was 0.69 (T1, N=1192) and 0.72 (T2, N=963) (both p<0.001). Long-term stability as indicated by correlation between 2-day averages of T1 and T2 was 0.60 (N=972, p<0.001). Multivariable linear regression analysis revealed that 24-h UFC was predicted by urine volume (standardized beta 0.282 (T1, N=1556) and 0.276 (T2, N=1244); both p<0.001) and glomerular filtration rate (standardized beta 0.137 (T1) and 0.179 (T2); both p<0.001), while also sex explained a small part (standardized beta for female sex -0.057 (T1) and -0.080 (T2); both p<0.05). 24-h UFC is moderately stable both in the short and the long term. The effects of urine volume and glomerular filtration rate on 24-h UFC are much stronger than those of sex.

Obese parents--obese children? Psychological-psychiatric risk factors of parental behavior and experience for the development of obesity in children aged 0-3: study protocol.

BackgroundThe incidences of childhood overweight and obesity have increased substantially and with them the prevalence of associated somatic and psychiatric health problems. Therefore, it is important to identify modifiable risk factors for early childhood overweight in order to develop effective prevention or intervention programs. Besides biological factors, familial interactions and parental behavioral patterns may influence children’s weight development. Longitudinal investigation of children at overweight risk could help to detect significant risk and protective factors. We aim to describe infants’ weight development over time and identify risk and protective factors for the incidence of childhood obesity. Based on our findings we will draw up a risk model that will lay the foundation for an intervention/prevention program.Methods/DesignWe present the protocol of a prospective longitudinal study in which we investigate families with children aged from 6 months to 47 months. In half of the families at least one parent is obese (risk group), in the other half both parents are normal weight (control group). Based on developmental and health-psychological models, we consider measurements at three levels: the child, the parents and parent–child-relationship. Three assessment points are approximately one year apart. At each assessment point we evaluate the psychological, social, and behavioral situation of the parents as well as the physical and psychosocial development of the child. Parents are interviewed, fill in questionnaires, and take part in standardized interaction tasks with their child in a feeding and in a playing context in our research laboratory. The quality of these video-taped parent–child interactions is assessed by analyzing them with standardized, validated instruments according to scientific standards.DiscussionStrengths of the presented study are the prospective longitudinal design, the multi-informant approach, including the fathers, and the observation of parent–child interaction. A limitation is the variation in children’s age.

Psychiatric, psychosocial, and physical health correlates of co-occurring cannabis use disorders and nicotine dependence

BackgroundSeveral gaps in the literature on individuals with co-occurring cannabis and tobacco use exist, including the extent of psychiatric, psychosocial, and physical health problems. We examine these gaps in an epidemiological study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), of a large, nationally representative sample. MethodsThe sample was drawn from Wave 2 NESARC respondents (N=34,653). Adults with current cannabis use disorders and nicotine dependence (CUD+ND) (n=74), CUD only (n=100), and ND only (n=3424) were compared on psychiatric disorders, psychosocial correlates (e.g., binge drinking; partner violence), and physical health correlates (e.g., medical conditions). ResultsRelative to those with CUD only, respondents with CUD+ND were significantly more likely to meet criteria for bipolar disorder, Clusters A and B personality disorders, and narcissistic personality disorder, and reported engaging in a significantly higher number of antisocial behaviors. Relative to those with ND only, respondents with CUD+ND were significantly more likely to meet criteria for bipolar disorder, anxiety disorders, and paranoid, schizotypal, narcissistic, and borderline personality disorders; were significantly more likely to report driving under the influence of alcohol and being involved in partner violence; and reported engaging in a significantly higher number of antisocial behaviors. CUD+ND was not associated with physical health correlates. ConclusionsPoor treatment outcomes for adults with co-occurring cannabis use disorders and nicotine dependence may be explained in part by differences in psychiatric and psychosocial problems.

Why Do Children With Disruptive Behavior Disorders Keep Making Bad Choices?

Why Do Children With Disruptive Behavior Disorders Keep Making Bad Choices?

Neurodevelopment in perinatally HIV‐infected children: a concern for adolescence

Globally, an estimated 3.4 million children are living with HIV, yet little is known about the effects of HIV and antiretroviral treatment (ART) on the developing brain, and the neurodevelopmental and behavioural outcomes of perinatally HIV-infected (PHIV+) adolescents.We reviewed the literature on neurodevelopmental outcomes in PHIV+ children and adolescents, and summarized the current evidence on behaviour, general cognition, specific domains, hearing and language, school performance and physical disabilities due to neurological problems.Evidence suggests that PHIV+ children do not perform as well as controls on general cognitive tests, processing speed and visual–spatial tasks, and are at much higher risk for psychiatric and mental health problems. Children with AIDS-defining diagnoses are particularly at risk for poorer outcomes.A striking finding is the lack of published data specific to the adolescent age group (10–25 years), particularly from resource-constrained countries, which have the highest HIV prevalence. In addition, extreme heterogeneity in terms of timing and source of infection, and antiretroviral experience limits our ability to summarize findings of studies and generalize results to other settings.Due to the complex nature of the developing adolescent brain, environmental influences and variation in access to ART, there is an urgent need for research on the longitudinal trajectory of neurodevelopment among children and adolescents perinatally infected with HIV, especially in high burden resource-constrained settings.

The disappearance of the "revolving door" patient in Scottish general practice: successful policies.

BackgroundWe describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.MethodsA mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with “revolving door” patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of “revolving door” patients identified from 1999 to 2005 in Scotland.ResultsA “revolving door” patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of “revolving door” patients during the course of the study.Conclusions“Revolving door” patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS.

Bizarre Metal Bezoar: A Case Report

Bezoars are uncommon findings in the gastrointestinal tract and are composed of a wide variety of materials. Large metal bezoars are very rare with only a few case reports till date in literature. We report a case of a metal bezoar in a man with Maniac Depressive Psychosis who had a history of ingesting Nails and screws of sizes varying from 2cm to 15cm for more than 1year without causing any perforation and other acute complication. A 24-year-old man presented with a history of mild dull aching type of abdominal pain of chronic onset and no other GI symptoms. The patient had history of passing small sized nails in the stools and intermittent melena for last 1year. Physical examination revealed mild tenderness in Para umbilical region. Past medical history was remarkable for treatment of Maniac depressive psychosis. Plain radio graphs revealed objects of metal density contained within a dilated stomach at the level of L2-3 vertebrae in the midline. Celiotomy was performed and 27 metal nails and screws of sizes 6cm to 15cm and bent in various shapes were removed from inside the stomach. Post operatively patient recovery was normal and he was referred to psychiatrist. Abdominal pain in patients with psychiatric disorders can result from rare causes such as bezoars and such bizarre metal nails without causing any acute abdominal symptoms. This report alerts surgeons to rule out bezoars in the differential diagnosis of chronic abdominal pain and melenic stools with no abdominal symptoms in patients with psychiatric health problems.

Associations between social potential and emotional and behavioural difficulties in Egyptian children

A number of Egyptian children experience psychiatric or mental health problems owing to a variety of internal and external qualities in their social context. These problems may mask strengths, particularly their social potential represented in their prosocial behaviour (PB). Research on emotional and behavioural difficulties (EBDs) should thus consider their strengths. The present study focuses on the PBs of Egyptian children. Teachers of 454 children from 6 schools completed the Strengths and Difficulties Questionnaire (SDQ) to identify the children's EBDs as well as their PBs, together with Conners' Teacher Rating Scale (CTRS-39) to identify EBDs alone. The investigation entailed examining gender differences in strengths and difficulties, frequency of prosociality categories and associations between high versus low levels of PB with EBDs. Descriptive statistics, bi-variate and regression analyses, and t-test statistics were employed to answer the research questions. Results showed that boys were reported to show more EBDs than girls, whereas girls showed better PBs than did the boys. Caring was the most prevalent PB among both girls and boys. EBDs composed a significant and fit model for predicting PBs. Implications of the present study regarding the assessment of social behaviours in schools are discussed.

Initial evidence that polymorphisms in neurotransmitter-regulating genes contribute to being born small for gestational age.

Being born small for gestational age (SGA) is a putative risk factor for the development of later cognitive and psychiatric health problems. While the inter-uterine environment has been shown to play an important role in predicting birth weight, little is known about the genetic factors that might be important. Here we test the hypothesis that neurotransmitter-regulating genes implicated in psychiatric disorders previously shown to be associated with SGA (such as attention-deficit hyperactivity disorder) are themselves predictive of SGA. DNA was collected from 227 SGA and 319 appropriate for gestational age children taking part in the Auckland Birthweight Collaborative Study. Candidate single nucleotide polymorphisms in genes regulating activity within dopamine, serotonin, glutamate and gamma-aminobutyric acid pathways were genotyped. Multiple regression analysis, controlling for potentially confounding factors, supported nominally significant associations between SGA and single nucleotide polymorphisms in COMT, HTR2A, SLC1A1 and SLC6A1. This is the first evidence that genes implicated in psychiatric disorders previously linked to SGA status themselves predict SGA. This highlights the possibility that the link between SGA and psychiatric disorders such as attention-deficit hyperactivity disorder may in part be genetically determined - that SGA marks pre-existing genetic risk for later problems.

Specificity in the association of anxiety, depression, and atopic disorders in a community sample of adolescents

The specificity of relationships between anxiety and depressive symptoms, with each of the major atopic disorders of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) was systematically investigated within a single study sample. Participants included 367 adolescents who participated in a community, longitudinal study investigating risk factors for the development of psychiatric and physical health problems. Mental health symptoms were assessed at 7, 9, 11, and 13 years of age. Lifetime history of atopic disorders was assessed by parent report at age 13. Analysis of variance was used to investigate the specificity of the associations between anxiety and depression, and each of the atopic disorders. Results indicated that anxiety was associated with a lifetime history of atopic disorders as a group. The association was significantly strengthened when controlling for depression and externalizing psychiatric symptoms. Among atopic disorders, “pure” anxiety was associated with asthma and AR, and having both asthma and AR strengthened the association compared to having either disorder alone. The association of “pure” anxiety with asthma and AR is consistent with existing data suggesting a relationship between anxiety and respiratory disorders. Having both asthma and AR appeared to confer an additive “dose effect” on the strength of the association. The lack of an association with depression suggests that other factors may contribute to the differential expression of anxiety and depression with atopic disorders. Findings demonstrate the importance of assessing the impact of co-morbid psychiatric symptoms and atopic disorders within individual studies to determine the specificity of underlying relationships between these conditions.

Predictors of starting to smoke cigarettes in patients with first episode psychosis

IntroductionCigarette smoking is common in psychotic disorders and may be initiated in an attempt to control features of illness. However, genetic, obstetric and early life conditions are risks for starting to smoke in the general population but their role in psychotic patients is unclear. MethodSmoking history and the putative predictors of starting to smoke were assessed in a community-wide sample of 115 first episode psychosis patients. The proportion that initiated smoking was compared with that from population surveys and the impact of risk factors was assessed within the patient sample. ResultsMost patients began smoking before illness onset and the proportion who initiated smoking was significantly high by the onset of a functional decline. Gestational tobacco exposure was a risk for smoking and was also associated with low birthweight, poor academic achievement, and obesity. Low familial socioeconomic position but not familial psychiatric problems also predicted smoking initiation. DiscussionIn most cases, smoking preceded illness onset and was not a response to early features of illness. General population predictors of starting to smoke were also associated with smoking initiation in psychotic patients. Of these risks, exposure to tobacco during gestation is noteworthy in that it affects brain development and is associated with cognitive, behavioral, psychiatric and general health problems. In addition, nicotine interacts with other substances of abuse. The initiation of smoking before illness onset and the association with developmental problems raises the question of whether cigarette smoking influences some aspects of illness in patients with psychosis.

Pasienter med selvpåført forgiftning i medisinsk avdeling

Patients harm themselves for different reasons; some attempt suicide, others are more ambivalent and their actions can be regarded as acts of appeal. This presentation focuses on self-poisoning with special emphasis on prevalence, treatment and prognosis. The paper is based on 30 years clinical experience and research on patients with self-poisoning. The incidence of self-poisonings treated in Norwegian hospitals is between 100 and 200 per 100 000 person-years. About 1 % die in association with hospitalization, usually due to complications before arrival. Mortality is highly increased 20 years after discharge from hospital. Thorough assessment of somatic, psychiatric and social health problems is necessary. Suicide risk has to be assessed systematically and documented. Follow-up should preferably be organized within one week after a suicide attempt if the patient is not transferred to a psychiatric department. Patients that are admitted to hospital with non-suicidal poisonings also have significant health problems that call for more systematic follow-up. Clinical follow-up and research activities do not reflect the seriousness of the health problems associated with self-poisoning.

Beyond Generic Support: Incidence and Impact of Invalidation in Peer Services for Clients With Severe Mental Illness

Beyond Generic Support: Incidence and Impact of Invalidation in Peer Services for Clients With Severe Mental Illness

Predictive Validity and Early Predictors of Peer-Victimization Trajectories in Preschool

From the time of school entry, chronic levels of victimization by one's peers predict a multitude of psychiatric and physical health problems. However, developmental trajectories of peer victimization, from the time children first begin to socially interact, are not currently known nor are early familial or child predictors. To describe preschool trajectories of peer victimization, assess continuity of preschool victimization after school entry, and examine early child- and family-level predictors of preschool trajectories of victimization. A longitudinal, large-scale, multiple-informant, population-based study. Québec Longitudinal Study of Child Development. One thousand nine hundred seventy children (51% boys). Developmental trajectories were described using mothers' reports of peer victimization at 4 times from 3(1/3) to 6(1/6) years of age. In first grade (mean age, 7.2 years), teacher and child reports of peer victimization were collected. Family-level predictors, mostly at age 17 months, included measurements of family adversity (insufficient income [when the infant was aged 5 months], single-parent family, low education, or teenaged mother) and harsh, reactive parenting. Child-level predictors at age 17 months were the mother's ratings of physical aggression, hyperactivity, and emotional problems. Three preschool trajectories of peer victimization were identified (low/increasing, moderate/increasing, and high/chronic). In first grade, children following high/chronic and moderate/increasing preschool trajectories were highest in teacher- and child-rated peer victimization. High levels of harsh, reactive parenting predicted high/chronic peer victimization over and above other child- and family-level variables. Insufficient parent income and child physical aggression predicted the high/chronic and moderate/increasing peer-victimization trajectories. Early childhood preventive interventions should target parenting skills and child behaviors, particularly within families with insufficient income. Together, these risks confer a heightened likelihood for continued peer victimization as rated by mothers, teachers, and the children themselves.

Implications of comorbid alcohol dependence among individuals with social anxiety disorder

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUD) yet the nature of this comorbidity remains unclear. To better understand these associations, we first examined whether SAD was related to AUD above and beyond relevant covariates. Second, we examined the psychosocial impairment associated with the comorbidity of SAD and AUD versus SAD without AUD. Third, the temporal sequencing of SAD and AUD among comorbid individuals was examined. Participants included 5,877 (50% females) adults from the National Comorbidity Survey. As predicted, SAD was related to alcohol dependence (not abuse) after controlling for relevant conditions, indicating that SAD is linked to more severe alcohol impairment and that this link is not better accounted for by other pathology. Results also supported the hypothesis that the addition of alcohol dependence to SAD resulted in greater impairment across a variety of domains relative to SAD without alcohol dependence (e.g., greater rates of health care utilization, other psychiatric diagnoses, health problems, and greater interpersonal stress). Additionally, for the majority of comorbid individuals, SAD onset predated alcohol dependence onset, suggesting SAD increases vulnerability for misusing alcohol. Together, these data lend support for the contention that SAD may serve as a risk for alcohol dependence and indicate that the co-occurrence of these two conditions may result in greater personal and public health care costs.

Clinical Manifestation and Psychopharmacotherpy of Pediatric Bipolar Disorder

Pediatric bipolar disorder(BD) is one of the significant psychiatric health problems, which begins in childhood, has chronic persisting clinical course and leads impairs academic, occupational and legal problems of the patients. Fortunately, there has been increasing recognition of pediatric bipolar disorder during the past 10 years, even there are still controversy about clinical features and diagnosis. The clinical presentation of pediatric BD is greatly different to classic BD, relatively higher percentage of mixed, rapid cycling subtypes, not episodic and chronic lasting nature. In addition, pediatric BD has many comorbid psychiatric conditions such as attention deficit hyperactivity disorder, anxiety disorder and that makes more difficult to treat the patients with pediatric BD. To reduce confusion about diagnosis, the National Institute of Mental Health Research Roundtable divided pediatric BD into narrow and broad phenotype. 1) Given the paucity of medication trial studies of pediatric BD, no psychotrophic medications have been approved by U.S. Food and Drug Administration, except lithium. There have been a few open trials and retrospective chart reviews on the efficacy and side effects of mood stabilizers, anticonvulsants and atypical antipsychotics. More short and long-term randomized, double blind, well controlled trials of medication for pediatric BD are needed.

Welfare Shame, Economic Hardship, and Drug Use: Their Relationship to the Psychological Distress Observed in TANF Recipients

BACKGROUND: Recent studies conducted in Temporary Assistance to Needy Families (TANF) populations show that TANF recipients are more likely to suffer from persistent psychiatric disorders and mental health problems than are non—TANF recipients. It has been estimated that approximately 35% of TANF recipients have psychological distress symptoms, with depression being the most commonly reported disorder. OBJECTIVE: To determine if drug use may modify the welfare-distress relationship by forming an interaction with shame, economic hardship, or both. STUDY DESIGN: A survey design consisting of 534 female recipients was used. RESULTS: Drug users demonstrated higher levels of anxiety, depression, and lower self-esteem than nonusers. Neither welfare shame nor economic hardship had direct effects on psychological distress; economic hardship significantly modified the effect of drug use. CONCLUSIONS: Contrary to previously published reports, welfare shame was not associated with the psychological distress observed in this sample of welfare recipients. J Am Psychiatr Nurses Assoc, 2007; 13(5), 275-284. DOI: 10.1177/1078390307307256

Influence of gender on Attention-Deficit/Hyperactivity Disorder in Europe – ADORE

Attention-deficit/hyperactivity disorder (ADHD) in girls in Europe is poorly understood; it is not known whether they exhibit similar symptom patterns or co-existing problems and receive the same type of treatment as boys. To examine gender differences for referral patterns, social demographic factors, ADHD core symptomatology, co-existing health problems, psychosocial functioning and treatment. Baseline data from the ADHD Observational Research in Europe (ADORE) study, a 24-month, naturalistic, longitudinal observational study in 10 European countries of children (aged 6-18 years) with hyperactive/inattentive/impulsive symptoms but no previous diagnosis of ADHD, were analysed by gender. Data from 1,478 children were analysed: 231 girls (15.7%) and 1,222 boys (84.3%) (gender data missing for 25 patients). Gender ratios (girl:boy) varied by country, ranging from 1:3 to 1:16. Comparisons showed few gender effects in core ADHD symptomatology and clinical correlates of ADHD. Compared with boys, girls had significantly more parent-rated emotional symptoms and prosocial behaviour and were more likely to be the victim of bullying and less likely to be the bully. Girls and boys had similar levels of co-existing psychiatric and physical health problems, and received the same type of treatment. Fewer girls than boys are referred for ADHD treatment, but they have a similar pattern of impairment and receive similar treatment.

Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9- to 4-year follow-up

Earlier studies have indicated poor long-term outcomes for patients with anorexia nervosa. To study health and social outcomes of adolescent in-patients with anorexia nervosa in relation to prognostic factors. A register study based on based on socio-economic and health data was conducted for a national cohort of female residents in Sweden born between 1968 and 1977, including 748 in-patients with anorexia nervosa. At follow-up 9-14 years after hospital admission, 8.7% of patients with anorexia nervosa had persistent psychiatric health problems demanding hospital care and 21.4% were dependent on society for their main income; the stratified relative risks were 5.8 (95% CI 4.7-7.6) and 2.6 (2.3-3.0) respectively, compared with the general female population. The mortality rate for patients with anorexia nervosa was 1.2% and the stratified risk ratio for maternity was 0.6 (95% CI 0.5-0.7). Long duration of hospital care and psychiatric comorbidity were predictors of persistent psychiatric problems and financial dependency on society. The outcome in this cohort of adolescent in-patients with anorexia nervosa was considerably better than that reported in previous studies.

Problem of nonadherence in chronically ill adolescents: strategies for assessment and intervention

Nonadherence to medical treatment is a significant problem for adolescents with chronic illness, with significant morbidity and mortality. Yet efforts to assess and treat the problem have been limited. We reviewed the literature on the factors associated with nonadherence and focused on nonadherence in a series of interviews with staff at a pediatric transplant program. This paper describes some of our findings, offers guidelines for assessing nonadherence in a primary care setting, and discusses strategies and interventions aimed at enhancing adherence. We refer to clinical cases derived from our interviews with renal transplant staff and our own clinical practice. Nonadherence to treatment recommendations occurs in approximately one-third of adolescents with a chronic illness. Factors that have been associated with nonadherence include psychiatric illness, psychological factors, family issues, and health problems. Although extensive research has been done on the problem of poor patient adherence in pediatric chronic illnesses, the prevalence of nonadherence remains high, and the research itself is problematic because of different definitions and methods of assessment used. Novel treatment strategies to improve adherence have been proposed, and data on these are emerging. Nonadherence in adolescents with chronic illness is a serious problem in need of greater recognition and intervention and further research. The primary care physician may be able to reduce nonadherence by routinely evaluating for adherence issues and initiating a targeted strategy to combat nonadherence when it is found. This review describes strategies and specific approaches for identifying and treating nonadherence in adolescents and their families.