Secondary Psychiatric Diagnoses Research Articles

Applying the Consensus Criteria for Traumatic Encephalopathy Syndrome Retrospectively to Case Studies of Boxers from the 20th Century.

There are no validated diagnostic criteria for traumatic encephalopathy syndrome (TES). During the early and middle 20th century, TES was described as a clinical condition that was experienced by some high-exposure boxers-and it was believed to reflect chronic traumatic brain injury. Consensus criteria for the diagnosis of TES were published in 2021. We applied the consensus criteria for TES retrospectively to cases of chronic brain damage in boxers described in articles published in the 20th century that were obtained from narrative and systematic reviews. The sample included 157 boxers identified in 21 articles published between 1929 and 1999. Two authors reviewed each case description and coded the criteria for TES. For the core clinical features, cognitive impairment was noted in 63.1%, and in 28.7% of cases the person's cognitive functioning appeared to be broadly normal. Neurobehavioral dysregulation was present in 25.5%. One third (34.4%) were identified as progressive, 30.6% were not progressive, and the course could not be clearly determined in 35.0%. In total, 29.9% met the TES consensus criteria, 28.0% did not, and 42.0% had insufficient information to make a diagnostic determination. TES, in the 20th century, was described as a neurological condition, not a psychiatric disorder-and this supports the decision of the 2021 consensus group to remove primary and secondary psychiatric diagnoses from being a core diagnostic feature. Future research is needed to determine whether, or the extent to which, cognitive impairment or neurobehavioral dysregulation described as characterizing TES are associated with chronic traumatic encephalopathy neuropathological change.

Chronic obstructive pulmonary disease and comorbid psychiatric disorders: preliminary results of an 8-year retrospective study using real data

IntroductionChronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. In Portugal, it is estimated to afflict 14.2% of the population over the age of 45 and is one of the most common causes of morbidity, with a significant social impact and excessive expenses. Moreover, COPD is associated with high levels of psychological distress and diverse psychiatric disorders that heighten the disease burden as they are associated with increased risk of exacerbations and frequent hospitalizations. Despite this overview, psychiatric conditions remain understudied compared to comorbid general medical conditions, and few studies have assessed their effect on COPD hospitalization outcomes.ObjectivesThis study aimed to describe the occurrence of a vast array of psychiatric comorbid diagnoses in COPD hospitalizations and to understand their impact on hospitalization outcomes.MethodsA retrospective observational study was conducted. All inpatient episodes from 2008 to 2015 of patients with at least 40 years and a primary diagnosis of COPD (ICD-9-CM codes 491.x, 492.x and 496) were selected from a national administrative database that included all hospitalizations in mainland public hospitals. From these sampled episodes, secondary psychiatric diagnoses were identified (ICD-9-CM codes 290.x-319.x). Age at hospitalization, sex, psychiatric comorbidities, length of stay (LoS) in days, admission type and date, destination after discharge, in-hospital mortality and hospital charges were analyzed.ResultsFrom a total of 66,661 COPD hospitalizations, 17,652 (26.5%) corresponded to episodes with a secondary psychiatric diagnosis. Patients with a comorbid psychiatric diagnosis were on average younger at admission (70.3 vs. 75.9 years, p<0.001), had a longer median LoS (9.89 vs. 9.33 days, p<0.001) and higher urgent admission rates (96.2% vs. 95.7%, p=0.009). There was also a significant association between discharge destination and psychiatric diagnoses (p<0.001).ConclusionsThese findings suggest that mental disorders have an adverse and quantifiable impact on COPD hospitalization outcomes. With this in mind, to provide optimal treatment for patients with both conditions, psychiatric disorders should become a matter of routine evaluation and follow-up.Disclosure of InterestNone Declared

Mental Disorders and Intimate Partner Femicide: Clinical Characteristics in Perpetrators of Intimate Partner Femicide and Male-to-Male Homicide.

Intimate partner violence against women is a global and persistent public health issue. An extreme manifestation of this problem is intimate partner femicide (IPF), the killing of a woman by a male partner. While declining trends of homicide rates have been observed over decades, rates of femicide and IPF have remained stable. Yet, IPF as a phenomenon has until recently been fairly invisible in Europe, why research from the European countries on rates and characteristics of IPF has been relatively scarce. One area of research, particularly in need of further scrutiny, is to what degree perpetrators of IPF suffer from mental health conditions, and what the clinical features are. The objective of present study was to add to the existing literature by investigating prevalence and types of mental disorders in perpetrators of IPF, and to compare with male-to-male homicide (MMH) perpetrators. Our aim was also to examine life-time contact with psychiatric services, and, with missed opportunities in mind, contacts shortly preceding the homicide. With a retrospective design, this population-based study includes all solved cases of male-perpetrated homicides against intimate female partners (IPF) and other males (MMH) committed in Sweden between January 2007 and December 2009. Primary and secondary psychiatric diagnoses based on ICD, version 8, 9 or 10 from psychiatric inpatient as well as outpatient care have been retrieved. In order to identify mental disorders in perpetrators during commission of the homicidal offense, we also retrieved diagnoses from forensic psychiatric evaluations. Our results demonstrate that approximately one-third of the perpetrators, irrespective of homicide type, had been diagnosed with a mental disorder (excluding substance related disorders) at some point in life. Diagnosis of substance related disorders from psychiatric care was significantly more common in MMH perpetrators (37%) compared to IPF perpetrators (15%). Similarly low rates of major mental disorder were found in both groups (11%) when aggregating life-time diagnoses and diagnoses during commission of the crime. However, homicide-suicide in connection to the offense was relatively common in IPF perpetrators (20%). Thus, our study supports the notion that previous suicide attempts and suicide ideation are important indicators for predicting and possibly preventing IPF.

Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients.

Limited existing data on psychiatric illness in ESKD patients suggest these diseases are common and burdensome, but under-recognized in clinical practice. We examined hospitalizations with psychiatric diagnoses using inpatient claims from the first year of ESKD in adult and pediatric Medicare recipients who initiated treatment from 1996 to 2013. We assessed associations between hospitalizations with psychiatric diagnoses and all-cause death after discharge in adult dialysis patients using multivariable-adjusted Cox proportional hazards regression models. In the first ESKD year, 72% of elderly adults, 66% of adults and 64% of children had at least one hospitalization. Approximately 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis. The most common primary psychiatric diagnoses were depression/affective disorder in adults and children, and organic disorders/dementias in elderly adults. Prevalence of hospitalizations with psychiatric diagnoses increased over time across groups, primarily from secondary diagnoses. 19% of elderly adults, 25% of adults and 15% of children were hospitalized with a secondary psychiatric diagnosis. Hazards ratios of all-cause death were higher in all dialysis adults hospitalized with either primary (1.29; 1.26 to 1.32) or secondary (1.11; 1.10 to 1.12) psychiatric diagnoses than in those hospitalized without psychiatric diagnoses. Hospitalizations with psychiatric diagnoses are common in pediatric and adult ESKD patients, and are associated with subsequent higher mortality, compared with hospitalizations without psychiatric diagnoses. The prevalence of hospitalizations with psychiatric diagnoses likely underestimates the burden of mental illness in the population.

Online sexual solicitation in adolescents; socio-demographic risk factors and association with psychiatric disorders, especially posttraumatic stress disorder

Technological developments and increased use of the internet created some risks for adolescents, such as online sexual solicitation (OSS). The aim of this study is to examine the sociodemographic risk factors of OSS and the association between OSS and psychiatric disorders in a psychiatric clinical sample. The study was conducted with 189 adolescents. The psychiatric evaluation was performed with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) based psychiatric interviews and the Strengths and Difficulties Questionnaire was used. OSS was defined by questions that are used in previous studies and that predict exposure to OSS. The participants were divided into two groups and compared. In addition, the Child Post-Traumatic Stress Disorder Reaction Index was answered by the participants who exposed to OSS. The prevalence of OSS was determined as 21.1%. Depressive disorder, borderline personality disorder, and secondary psychiatric diagnosis are significantly higher in adolescents who exposed to OSS. The rate of post-traumatic stress disorder (PTSD) development after exposure to OSS was determined as 57.8%. These results indicate that OSS is a severe trauma that occurs at a high rate, and it is associated with psychiatric problems, especially PTSD.

Self-injurious behaviour in patients with anorexia nervosa: a quantitative study

BackgroundMany patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136).MethodsA cross-sectional design using a self-report questionnaire. Mann–Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests.ResultsOur results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in “feeling relieved” and a significant decrease in “feeling angry at myself”, “feeling anxious” and “feeling angry at others”. This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts.ConclusionsProfessionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.

From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account

This paper tells the story of one man’s experience of terrifying hallucinations and nightmares in an intensive care unit (ICU), drawing attention to the reality that intensive care treatment induces...

Low Vocational Outcome Among People Diagnosed With Borderline Personality Disorder During First Admission to Mental Health Services in Denmark: A Nationwide 9-Year Register-Based Study.

Earlier studies report that although people with borderline personality disorder (BPD) experience symptom reduction in the long term, they continue to have difficulties in work recovery. This nationwide 9-year register-based study (N = 67,075) investigated the long-term labor-market attachment of all individuals diagnosed with BPD during first admission to Danish mental health services in comparison with other psychiatric disorders. Controlling for baseline characteristics and co-occurring secondary psychiatric diagnoses, the BPD group had 32% lower odds (OR = 0.68; 95% CI [0.61, 0.76]) of being in work/under education after 9 years. Individuals diagnosed with BPD also showed more impairment in long-term vocational outcome than other personality disorders, and lower labor-market attachment than other psychiatric disorders except for schizophrenia, schizotypal and delusional disorders, and mental and behavioral disorders due to psychoactive substance use. Intervention programs addressing social psychiatric aspects of BPD in terms of work functioning is henceforth an important area for future research.

Bridging the gap for patients with mental illness

A metropolitan hospital system has developed and implemented a transition-of-care program focusing on patients with mental illnesses and high risk for hospital readmissions or emergency department visits. Currently, the transition period between care settings creates a state of vulnerability for patients and their caregivers. Poor care coordination negatively affects patient outcomes and results in a major economic burden. Patients with mental illnesses are particularly sensitive to transition-of-care issues including confusion about which medications to start and stop. This program aims to design, implement, and evaluate interventions to improve care transitions at 3 hospitals for individuals with a primary or secondary psychiatric diagnosis. In the inpatient setting, the clinical pharmacist, nurse practitioners, and social workers collaborate to identify medication-related problems. After patients are discharged from the hospital, nurse practitioners, the clinical pharmacist, and educators follow up with patients for 30 days via home health aide visits and telephone calls. Evidence-based tools and assessments are used to drive the program's interventions. From June 2014 to September 2014, 770 patients were identified as high risk. Readmissions data are pending. The patient outcomes data will fill the gap in the literature with essential information on transition-of-care issues within the mental health population. This program has implications to affect health care policy because it uses multiple evidence-based practices with the ultimate goal of decreasing economic burden for health systems and patients. New pharmacist roles in transition of care may emerge from this program.

Self-poisoning with medications in adolescents: a national register study of hospital admissions and readmissions

ObjectiveTo examine characteristics of hospital admissions and risk factors associated with rehospitalization for self-poisoning with medications in adolescents aged 10–19 years. MethodThis study used data from the Norwegian Patient Register from 2008 to 2011. The main outcome was hospital readmission within the observation period. A complementary log–log regression model was used to assess the effect of characteristics at index hospital admission on readmission. ResultsOf 1497 patients, 76.4% were females and 89.8% were aged 15–19 years. At their first hospital admission, about one third received a secondary psychiatric diagnosis. Females (47.5%) were registered with an E-code for intentional self-harm more often than males (33.7%), and females were more often than males discharged to further treatment (27.8% vs. 21.5%). As many as 18.4% were rehospitalized for self-poisoning by medications. Significant predictors for hospital readmission were female sex [hazard ratio (HR)=2.4, 95% confidence interval (CI) 1.7–3.6], discharge to further treatment (HR=2.3, 95% CI 1.8–2.9) and psychiatric secondary diagnoses (HR=1.5, 95% CI 1.2–1.9). ConclusionThis national study demonstrated significant sex differences in adolescents treated in hospital for self-poisoning with medications. Psychiatric secondary diagnoses had a strong predictive effect on readmission, which indicates the importance of psychiatric/psychosocial assessment of adolescents who are admitted to hospital for self-poisoning with medications.

Identifying demographic and language profiles of children with a primary diagnosis of attention deficit hyperactivity disorder

As the language presentation of children with attention deficit (hyperactivity) disorder (ADHD) is highly complex, this study aims to delineate the profile of a cohort of 40 children with ADHD, aged between 9 and 12 years, attending a child and adolescent mental health service (CAMHS). Speech and language therapists (SLTs) assessed the children on formal language tests (including tests of verbal comprehension/expression, vocabulary, reading and communication) over three one-hour sessions. Group demographics showed a predominance of males, with a greater number of children presenting with the combined subtype of ADHD over other subtypes (i.e. predominantly inattentive or hyperactive-impulsive type). The majority of the children also had a secondary psychiatric diagnosis. Test findings revealed some common trends in the overall group’s performance, but a general ADHD-specific language profile was not discernible. Almost three-quarters of the study cohort had previously undetected language difficulties, with over 70% of those having both receptive and expressive language difficulties. Just under one-third of the cohort demonstrated reading difficulties. Relatively high correlations were found across performance on measures of verbal comprehension when compared to vocabulary and reading comprehension and expressive language. Most parents reported communication difficulties on completed questionnaires. The range, extent and complexity of the language difficulties of children with ADHD is demonstrated in our findings, with the heterogeneity of this population an obvious feature. Implications for further research and SLT clinical practice are discussed.

Are Children With “Pure” Generalized Anxiety Disorder Impaired? A Comparison With Comorbid and Healthy Children

Despite the approach of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), generalized anxiety disorder (GAD) of childhood continues to face questions as to whether it should be considered a distinct clinical disorder. A potentially critical issue embedded in this debate involves the role of functional impairment which has yet to be demonstrated in children with “pure” GAD. Participants included 41 children between the ages of 6 and 11 years who met diagnostic criteria for primary GAD. Children with pure GAD (n = 17) were compared to children with comorbid GAD (n = 24) as well as a healthy control group (n = 20) in terms of clinician-rated severity and impairment and child-reported adaptive functioning across four domains. On average, children with pure GAD were more likely to be male and younger than children with comorbid GAD. Based on traditional significance testing, global impairment was greater in the comorbid compared to pure GAD group, although functioning in both groups was in the “variable” range. Both clinical groups reported less adaptive family relationships than controls, whereas only the comorbid group reported lower levels of home-based functioning. Equivalence testing nonetheless indicated a lack of comparability (i.e., nonequivalence) across the three groups for each of the domains examined. Findings indicate children with pure GAD to be functionally impaired compared to their healthy peers, though not to the same extent as children with secondary psychiatric diagnoses. Child functioning within the family domain specifically may be among the most vulnerable when GAD is present. Results support consideration of childhood GAD as a distinct clinical disorder.

Contributors to suicidality in rural communities: beyond the effects of depression

BackgroundRural populations experience a higher suicide rate than urban areas despite their comparable prevalence of depression. This suggests the identification of additional contributors is necessary to improve our understanding of suicide risk in rural regions. Investigating the independent contribution of depression, and the impact of co-existing psychiatric disorders, to suicidal ideation and suicide attempts in a rural community sample may provide clarification of the role of depression in rural suicidality.Methods618 participants in the Australian Rural Mental Health Study completed the Composite International Diagnostic Interview, providing assessment of lifetime suicidal ideation and attempts, affective disorders, anxiety disorders and substance-use disorders. Logistic regression analyses explored the independent contribution of depression and additional diagnoses to suicidality. A receiver operating characteristic (ROC) analysis was performed to illustrate the benefit of assessing secondary psychiatric diagnoses when determining suicide risk.ResultsDiagnostic criteria for lifetime depressive disorder were met by 28% (174) of the sample; 25% (154) had a history of suicidal ideation. Overall, 41% (63) of participants with lifetime suicidal ideation and 34% (16) of participants with a lifetime suicide attempt had no history of depression. When lifetime depression was controlled for, suicidal ideation was predicted by younger age, being currently unmarried, and lifetime anxiety or post-traumatic stress disorder. In addition to depression, suicide attempts were predicted by lifetime anxiety and drug use disorders, as well as younger age; being currently married and employed were significant protective factors. The presence of comorbid depression and PTSD significantly increased the odds of reporting a suicide attempt above either of these conditions independently.ConclusionsWhile depression contributes significantly to suicidal ideation, and is a key risk factor for suicide attempts, other clinical and demographic factors played an important role in this rural sample. Consideration of the contribution of factors such as substance use and anxiety disorders to suicidal ideation and behaviours may improve our ability to identify individuals at risk of suicide. Acknowledging the contribution of these factors to rural suicide may also result in more effective approaches for the identification and treatment of at-risk individuals.

Factors associated with working status among workers assessed at a specialized worker's compensation board psychological trauma program

Psychological morbidity following trauma occurring in the workplace can impact return to work but few studies have investigated this. This study was a secondary analysis of administrative data from a specialized workers' compensation board psychological trauma program in Toronto, Canada. Unadjusted and adjusted logistic regression analyses were used to examine factors associated with working status at the time of assessment for workers referred within 1 year of traumatic event. Having a disrupted marriage (OR = 3.06, 95% CI 1.14-8.20), sustaining a permanently impairing physical injury (OR = 2.76, 95% CI 1.01-7.55) and the presence of secondary psychiatric diagnoses (OR = 2.55, 95% CI 1.34-4.83) were significantly associated with not working at the time of assessment. When the analyses were subset to workers without permanently impairing physical injuries, only the presence of additional psychiatric diagnoses was significantly associated with not working (OR = 3.81, 95% CI 1.48-9.83). Return to work after trauma can be a complicated and difficult to treat problem. Social supports, physical rehabilitation and treatment of complex mental health problems likely play a crucial role in improving outcomes.

Prevalencia de trastornos psiquiátricos en pacientes ingresados por el Servicio de Psiquiatría en el Módulo Penitenciario del H.U.M.S.

recent epidemiological studies highlight an increase in the prevalence of psychiatric disorders amongst prison inmates. The objective of this study to determine the most prevalent primary and secondary psychiatric disorders, socio-demographic data and average stay period amongst patients admitted to the Prison Unit of a general hospital as charges of the Psychiatric Service. retrospective cross-sectional descriptive study. The sample group consisted of a number of patients admitted into the Prison Unit as charges of the Psychiatric Service during a five year period (n=136). 90,4% were men and 9,6% were women. The average age was 34,18 years. The most prevalent primary psychiatric diagnoses were: Personality Disorder 22%, and Schizophrenic Disorder 16,3%. The most prevalent secondary psychiatric diagnoses were: Personality Disorder 11,9%, Substance Abuse 10,7%. the most prevalent primary and secondary psychiatric diagnosis was personality disorder. The existence of a high level of comorbidity of substance abuse-dependence was recorded. Prisons currently lack Mental Health multidisciplinary teams. This often means that the inmate must be transferred to a hospital with the increased work load and financial cost that this implies.

MENTAL ILLNESS AND PRINCIPAL PHYSICAL DIAGNOSES AMONG ASIAN AMERICAN AND PACIFIC ISLANDER USERS OF EMERGENCY SERVICES

The stigma of mental illness is one of the factors that prevents Asian Americans/Pacific Islanders (APIs) from seeking formal mental health services. A somatic complaint is more acceptable in expressing psychiatric/emotional distress. Admission diagnoses in API emergency service users with secondary psychiatric diagnoses were identified from the 2001 National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). The sample consisted of 10,623 adult APIs. The study examined the differences in the six leading principal physical admission diagnoses between API emergency service users with psychiatric diagnoses and those without psychiatric diagnoses. Several of the study findings create concern (e.g., the higher percentage of APIs with psychiatric diagnosis who were discharged against medical advice, the high percentage admitted with medication intoxication). Further study is needed to provide guidance for clinical practice.

Repeated assaults by patients in VA hospital and clinic settings.

The study aim was to determine the prevalence of repeated assaults on staff and other patients and characteristics of patients who commit repeated assaults in the Veterans Health Administration of the Department of Veterans Affairs. Patients in VA medical centers and freestanding outpatient clinics who committed two or more assaults in fiscal years 1995 and 1996 were identified through a survey of facility quality or risk managers. For each repeatedly assaultive patient, structured information, including incident reports, was obtained for all assault occasions. A total of 153 VA facilities responded, for a response rate of 99 percent. The survey identified 8,968 incidents of repeated assault by 2,233 patients, for a mean of 4.02 assaults per patient in the two-year study period. In 92 percent of the incidents, the assaultive patient had a primary or secondary psychiatric diagnosis. The mean age of the repeat assaulters was 62 years. Ninety-eight percent of the repeat assaulters were male, and 76.6 percent were Caucasian. At least 16 percent of the assaulters, 22 percent of the patients assaulted, and 20 percent of the staff assaulted required medical attention for injuries, which, along with the number of lost work days, indicates that repeated assaults are costly. Repeatedly assaultive patients represent major challenges to their own safety as well as to that of other patients and staff. Identifying patients at risk for repeated assaults and developing intervention strategies is critically important for ensuring the provision of health care to the vulnerable population of assaultive patients.

Comorbidity of drug dependence and other mental disorders: a two-phase study of prevalence at outpatient treatment centres in Italy

A cross-sectional multicentre study aimed at evaluating the prevalence of DSM III-R Axis I morbidity among drug addicts seeking treatment. Consecutive outpatients of the National Health Service's treatment units (aged 18–60 years, fulfilling criteria for drug dependence and without primary diagnosis of alcohol dependence) were enrolled at intake. In the first phase of the study, professional staff members evaluated current psychiatric morbidity of 317 clients clinically. In the second phase, trained interviewers administered the Composite International Diagnostic Interview and a European adaptation of the Addiction Severity Index to 65 probands. Some current psychiatric morbidity was found in 26.2% of subjects recruited during the first phase and in 22.2% during the second; lifetime comorbidity was ascertained in 32.3% of probands recruited in the second phase. Unfortunately, remarkable rates of undetermined diagnostic assessment during the second phase are due to refusers. The distribution of categorical diagnoses is somewhat different between the two samples, but the most frequent are Anxiety and Mood disorders in both. Primary versus secondary psychiatric diagnoses were also distingushed when evaluated over a lifetime. The rates of psychiatric comorbidity are low in this study as compared with previous investigations, but suffer from a poor compliance with structured diagnostic procedures by unselected probands. Other methodological factors may also affect this kind of research. Prospective studies are needed to evaluate the validity of comorbid diagnostic constructs and their prognostic significance. Also, a concurrent assessment of Axis II disorders may be helpful to explain symptomatic polymorphism in case of multiple Axis I comorbidity.

The Computerized Psychiatric Severity Index as a Predictor of Inpatient Length of Stay for Psychoses

The Computerized Psychiatric Severity Index (CPSI), developed by Susan D. Horn and colleagues at The Johns Hopkins University School of Hygiene and Public Health, was used to study the severity of mental illness of 304 patients with discharge diagnosis of schizophrenia or affective disorder, and no secondary psychiatric diagnoses (DRG 430). The CPSI explained 13.7% of the variation in length of stay for these patients (14.31% of the variation in length of stay for affective disorders and 10.04% for the schizophrenia). Length of stay was an appropriate measure of the dependent variable resource use since it correlated 0.96 with total charges.

Patterns of performance on the Fuld Object Memory Evaluation in elderly inpatients with depression or dementia.

The Fuld Object Memory Evaluation (Fuld, 1981) was administered to 80 elderly adults (aged 60 to 90 years) who were hospitalized for evaluation and treatment of primary degenerative dementia (PDD), other organic disorders (e.g., Parkinson's disease or multi-infarct dementia), or major depression. Although mean performance in each of the diagnostic groups was below normative levels reported by Fuld (1981), PDD patients performed significantly more poorly than those with depression or other organic disorders. Analysis of subscore patterns failed to support the hypothesis of a selective memory deficit in depression, and substantial overlap in scores was observed between the depressed group and patients with organic disorders other than PDD. Object Memory Evaluation performance was influenced by global mental status and secondary psychiatric diagnoses, but not by education, age, or physical health.