Showing papers on "Psychiatric interview published in 1995"

Social consequences of psychiatric disorders, I: Educational attainment.

Abstract: Objective This is the first in a series of investigations of the social consequences of psychiatric disorders based on the National Comorbidity Survey. Data on the relationship between preexisting psychiatric disorders and subsequent educational attainment are presented. Method The National Comorbidity Survey is a nationally representative survey of 8,098 respondents in the age range 15-54 years. A subsample of 5,877 respondents completed a structured psychiatric interview and a detailed risk factor battery. Diagnoses of DSM-III-R anxiety disorders, mood disorders, substance use disorders, and conduct disorder were generated, and survival analyses were used to project data on school terminations to the total U.S. population. Results Early-onset psychiatric disorders are present in more than 3.5 million people in the age range of the National Comorbidity Survey who did not complete high school and close to 4.3 million who did not complete college. The most important disorders are conduct disorder among men and anxiety disorders among women. The proportion of school dropouts with psychiatric disorders has increased dramatically in recent cohorts, and persons with psychiatric disorders currently account for 14.2% of high school dropouts and 4.7% of college dropouts. Conclusions Early-onset psychiatric disorders probably have a variety of adverse consequences. The results presented here show that truncated educational attainment is one of them. Debate concerning whether society can afford universal insurance coverage for the treatment of mental disorders needs to take these consequences into consideration.

The time course of development of alcohol-related problems in men and women.

Abstract: Objective: A predictable sequence of alcohol-related problems has been hypothesized to be applicable to the clinical course of alcoholism. However, few recent data are available on this question. Method: The age of first occurrence of 44 alcohol-related life experiences was determined for 478 DSM-III-R defined alcohol-dependent (alcoholic) individuals (317 men and 161 women), and for 444 drinking but not alcohol-dependent subjects (183 men and 261 women). Data were gathered through personal interviews with alcohol-dependent subjects and their relatives using a structured psychiatric interview (SSAGA). Results: A high level of similarity (Spearman's rho = .81, p = .0004) was found for the retrospective reports of the order of appearance of alcohol-related problems between the present sample and an analysis of 636 alcoholic male inpatients who participated in a prior study. Within the present group of 478 alcoholics, the order of appearance of alcohol-related problems was similar for men and women (rho = .8...

How does the content of consultations affect the recognition by general practitioners of major depression in women

Abstract: BACKGROUND. Major depression is a common and disabling condition. However, for many reasons, the condition is not recognized in about half of the patients with major depression. AIM. The aim of the study was to establish whether the content of general practice consultations affected general practitioners' recognition of major depressive illness in women patients. METHOD. The 30-item general health questionnaire was used as a first stage screening instrument for psychiatric morbidity. Patients newly recognized as depressed by their general practitioner and those not recognized as depressed who scored 11 or more on the questionnaire were interviewed, usually within three days of consulting their general practitioner, using the combined psychiatric interview. Videorecordings of the consultations for these two groups of women were analysed; analyses were based on mentions of physical, psychiatric and social symptoms and on whether the first mention of a psychiatric symptom was within the first four mentions of any symptoms (early in the consultation) or after four mentions of any symptoms (late) or if psychiatric symptoms were not mentioned. RESULTS. A paired sample of 72 women with major depression was obtained from patients consulting 36 general practitioners, each general practitioner providing one patient whom he or she had correctly recognized as being depressed and one patient whose depression had not been recognized. Women with major depression were about five times more likely to have their depression recognized if they mentioned their psychiatric symptoms early in the consultation compared with those who either left it later to mention such symptoms or never mentioned them. Major depression was more likely to be recognized if no physical illness was present. After adjusting for physical illness, depression was 10 times less likely to be recognized if the first psychiatric symptom was mentioned late in the consultation, or not mentioned at all, than if it was mentioned early in the consultation. CONCLUSION. General practitioners need to remember that patients who present with symptoms of physical illness may also have depression. They also need to remember to give equal importance diagnostically to mentions of symptoms at whatever point they occur in the consultation, regardless of the presence or absence of physical illness.

Alcoholism among four aboriginal groups in Taiwan : high prevalences and their implications

Abstract: An epidemiological study of alcohol use disorders was conducted on population samples from four aboriginal groups in Taiwan (a total of 993 subjects). The survey involved ethnographic observation and a semistructured psychiatric interview. The interview covered a detailed symptom profile that allowed diagnoses to be made according to different diagnostic criteria. The lifetime prevalences of alcoholism according to the ICD-10 (research criteria) and the DSM-III-R criteria were found to be 42.2-54.7% and 44.2-55.5%, respectively, much higher than the rates found in an earlier study (0.11-0.16%) conducted 40 years ago. Men in all groups were found to have higher prevalences, a lower mean age at onset, and a longer mean duration (except in one group) of alcoholism than women. Differences in the distribution of sociodemographic correlates (age, sex, marital status, education, and ethnicity) of ICD-10 harmful use of alcohol and alcohol dependence were examined by case-control analysis with logistic regression. The lifetime prevalences of alcohol use disorders were higher than in recent epidemiological surveys conducted elsewhere. Possible biological and sociocultural explanations for the high prevalence of alcoholism among the study populations are discussed.

Assessing Diagnostic Approaches to Depression in Medically Ill Older Adults: How Reliably Can Mental Health Professionals Make Judgments About the Cause of Symptoms?

Abstract: OBJECTIVE: To evaluate the reliability of the DSM-IV approach and five other schemes for counting symptoms toward the diagnosis of depression in hospitalized medically ill older patients and to examine whether mental health professionals can reliably make judgments about the etiology (medical or psychological) of depressive symptoms. METHOD: A sample of 38 patients aged 60 years or older admitted to the general medicine, cardiology, or neurology services at Duke University Medical Center were evaluated for depression using a structured psychiatric interview and the Hamilton Depression Scale. Interrater reliability for the diagnostic schemes, for unstructured clinical diagnoses, and for determinations of the causes of individual depressive symptoms was assessed by three pairs of mental health professionals. RESULTS: Agreement between raters for structured diagnoses was high regardless of diagnostic strategy, with the DSM-IV approach being only slightly less reliable than the strict inclusive approach (Kappa 0.88 vs Kappa 1.0, respectively). For all diagnostic approaches, there was perfect agreement between raters for eight cases of major depression. Agreement for unstructured clinical diagnoses of depression (K = 0.50) was much lower than for the structured diagnoses. Agreement between raters on the etiology of individual depression criterion symptoms assessed by structured interview was greater than 80% for 14 of 19 symptoms. Correlation between raters' depression severity ratings on the Hamilton Scale using the DSM-IV etiologic approach was equivalent to that using the strict inclusive approach (0.98 vs 0.95, respectively). CONCLUSIONS: Mental health professionals can be trained to make judgments reliably about the cause (medical or psychological) of symptoms in hospitalized older medical patients. The “strict inclusive” and other diagnostic schemes for counting symptoms toward the diagnosis of depression have only marginal, if any, benefit compared with the the current DSM-IV approach.

Chest pain in children referred to a cardiology clinic.

Abstract: One hundred consecutive patients (54 girls, 46 boys) referred to a pediatric cardiology department with the primary complaint of chest pain were evaluated. The age distribution was 2.5–16.0 years (mean 11.3 years for girls and 9.9 years for boys). The history showed 17% of patients with chest pain, 22% with heart disease, and 19% with recent death in the family. The time course of the pain was longer than 1 week in 92 patients. Localization was on the left precordium in 60 patients, and there was no radiation from the original site in 66 cases. Ninety-two percent of cases were idiopathic in origin. Of the 74 patients who had a psychiatric interview, 55 (74%) had psychiatric symptoms and 5 required psychiatric care. Anxiety, conversion disorder, and depression were the main psychiatric symptoms.

The prevalence of depression in the carers of dementia sufferers

Abstract: The survey aims to evaluate psychiatric morbidity in the carers of dementia sufferers using a semi-structured psychiatric interview. The case notes of consecutive referrals to four psychiatric services for the elderly in the West Midlands and a memory clinic service in Bristol were reviewed. All referrals who fulfilled the CAMDEX criteria for mild or moderate dementia and had a carer in contact at least once a week were contacted. Participants were assessed using a detailed package which included a Geriatric Mental State Schedule for the carers. More than 90% of those contacted agreed to participate. Altogether 125 patients with dementia were assessed of whom 109 had family members of friends as the main carer. Thirty-one (28.4%) of the carers had a case level of depression and three (2.75%) had a case level of anxiety. In addition, 36 (33.2%) carers had subcase levels of morbidity. First-degree relatives showed a trend to be more likely to suffer from depression than friends or more distant relatives. The prevalence of depression was similar among carers in the two different service settings. There was good agreement between AGECAT and RDC diagnosis of depression.

Cross district comparison of applications to research ethics committees

Abstract: Meade has criticised the current need to obtain approval for multicentred research from many different ethics committees.1 Variability between committees has led to research having to be modified or even abandoned in some districts but not others.2 I report the results of applying to 13 ethics committees with in a region for approvalof a study of young people. A regional study of the mental health needs of young offenders was proposed in which adolescents aged 13 to 17 were to be identified by health, social, and juvenile justice agencies. They were to be studied by means of a social and psychiatric interview, an educational assessment, an interview with staff, a postal questionnaire from parents, and a study of notes. The regional health authority identified 14 ethics committees. Approval for the study …

Psychiatric symptoms associated with dementia in older people with learning disability.

Abstract: BACKGROUND This paper describes a study of non-cognitive features of dementia in a population of 105 people over 50 years of age, with learning disability. METHOD The study involved psychiatric assessment using the Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS-ADD), a semi-structured psychiatric interview developed specifically for people who have learning disability. Dementia was diagnosed using a combination of informant interviewing and observation of cognitive change over a three year period. RESULTS Sample members with definite dementia had higher levels of sleep difficulty, hypersomnia, irritability, inefficient thought, loss of interest and anhedonia. Discriminant function analysis showed that non-cognitive features could help discriminate between definite and probable cases. CONCLUSIONS Results support the previously reported observation for the general population that cognitive and non-cognitive features are only weakly related. The study suggests that psychiatric symptom information may be useful in screening for dementia in people with learning disability.

Attention-Deficit Disorder: Born to Be Hyperactive?

Abstract: SELECTED CASES Patient 1 An 8-year-old boy was evaluated in the National Institutes of Health outpatient clinic in Bethesda, Md, for participation in research. The patient history was positive for 12 of the 14 criteria of attention-deficit hyperactivity disorder (ADHD) listed in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R ) 1 (Table 1). Symptoms displayed by this patient included major disability due to poor attention span, impulsivity, distractibility, increased motor activity, and poor social skills. A structured psychiatric interview with his parents revealed no other causes of these symptoms by excluding the possibility of anxiety disorder or mood disorder, among others. (See Table 2 for differential diagnosis.) The physical examination yielded normal findings, and an evaluation of mental status revealed restlessness and poor impulse control characterized by the patient's repeated interruptions of the interviewer. A laboratory examination and psychometric testing indicated no learning disability but revealed

Diagnosing depression after stroke.

Abstract: Neurobehavioral sequelae of strokes can limit a patient's ability to describe or express emotion, can cause him to give "yes" answers to the clinician who expects them, or can directly cause apathy or crying spells. Also, anosognosia for depressive signs can cause the patient to deny depressive signs that are objectively observable. These diagnostic confounders have not been adequately assessed in previous research on poststroke depression; thus many studies are of doubtful validity, as shown by studies of the dexamethasone suppression test for melancholia in stroke patients. Future studies on depression after stroke must prospectively rule out fluent aphasia, motor aprosody, and amnesia before relying on diagnostic information from the psychiatric interview, and the interview should always be supplemented by direct observation of vegetative signs and other behavior. With this extended information, major depression can and should be diagnosed using accepted symptom and duration criteria.

Stress and managerial work: organizational culture and technological changes: a clinical study.

Abstract: The impact of technological and organizational changes on strategies, structures, criteria of success, leadership styles, work relations and role interactions has complex and contradictory consequences for today′s work environment. Considers all the potential and interacting stressors in working life and personal living conditions, within the framework of the biographical background and relevant experiences of subjects, in order to understand and explain the multifactoral pathogenesis of mental stress and its many side‐effects. Pursues this integrated consideration through an interdisciplinary approach, involving psychiatry and mental hygiene, organizational psychology and occupational medicine. Research is carried out on a sample of 292 subjects – male and female managers – the basic framework being an epidemiological approach, both descriptive (study of distribution) and analytical (study of determinants), which uses medical anamnesis, biographical questionnaire and psychiatric interview.

Clinical and psychometric findings in spasmodic torticollis

Abstract: In a previous study screening for psychopathological symptoms in a sample of 256 patients with spasmodic torticollis had resulted in 27% of patients, whose mean score of the GSI of the SCL-90-R was above the double standard deviation of the control group of normals (Scheidt et al. 1994). In this study the self-reported psychopathology of a subsample of 19 TS patients was controlled for its agreement with a clinical assessment in a psychiatric interview. The results of the study confirm the validity of the SCL-90-R as a screening instrument for psychological distress and psychopathology. However a tendency for social desirability in a subgroup of patients might lead to underestimate the degree of psychological distress in this patient group and might als account for some of the discrepant findings concerning psychological distress and psychopathology in TS in former studies. Furthermore the clinical assessment revealed a high psychiatric and psychosomatic morbidity prior to the onset of the spasmodic torticollis as well as a high frequency of traumatic life events (e.g. bereavement) in the patients premorbid history. In addition to coping with a crippling neurological condition concurrent psychopathology in TS therefore should be considered also in terms of the individuals premorbid psychological vulnerability.

Prevalence and correlates of major depressive episode among the elderly in a community in Japan

Abstract: A random sample of 205 persons from a community of about 45,500 residents, aged 65 years or older, in a city in Japan, was surveyed using an interview schedule including a structured psychiatric interview to analyze prevalence of major depressive episode (DSM-III-R). A total of 157 (77%) participated in the study. Results were as follows: 1) The Prevalence of major depressive episode during the past 6 months was 2.1% for males and 3.7% for females among the 155 respondents who completed the psychiatric interview. 2) Significantly higher prevalence during the past 6 months was observed in those who were physically inactive in the past year than in those physically active (p < 0.05). 3) Levels of satisfaction with available social support were significantly lower in those who experienced major depressive episode during the past six months than in those who experienced no depressive episode (p < 0.05). 4) Levels of life satisfaction (PGC scale score) and cognitive functioning were significantly lower in those experienced major depressive episode during the past six months than in those who experienced no depressive episode (p < 0.05).

Co-occurrence of Psychiatric Disorders and Alcoholism in Untreated Alcoholic Patients in a VA Medical Walk-in (Triage) Clinic Population

Abstract: The authors identified 1,836 male veterans who were seeking treatment for various medical disorders at a walk-in (triage) clinic and screened these patients for the presence of alcohol problems by administering a brief interview and the CAGE questionnaire. Patients who screened positive for alcohol problems and who had little or no prior treatment for these problems were then interviewed using a structured psychiatric interview to establish the presence of alcohol dependence and cooccurring psychiatric disorders. The rate of alcohol dependence and co-occurring disorders was substantial, and the pattern was consistent with studies of veteran patients surveyed in other clinical settings.

Sexual dysfunction in African males in Nairobi, Kenya.

Abstract: Out of a total of 295 subjects referred to the Pangani Clinic for psychiatric assessment, between January 1990 and December 1993, 49 were studied. All were males and aged between 16 and 55 years. Using a cross-sectional design study, they were consecutively assessed for sexual dysfunction. Each subject was studied using, the Self Rating Questionnaire, the Standardized Psychiatric Interview and WHO Audit Instrument for Alcohol abuse. The final diagnoses of sexual dysfunction were made according to DSM-R categories. A matched analysis using Chi-squared (X 2 ) test were carried out. The finding was that erectile disorder was the major disorder seen in 57.1% of the subjects. The peak age for sexual dysfunction was between 26 and 36 years. In an African setting, questions pertinent to bewitchment and age (husband versus wife) are very important with regard to sexual dysfunction.

Psychiatric effects of hysterectomy

Abstract: An excess of psychiatric symptoms in post-hysterectomy women have been reported by some authors but denied by others. Thirty six women undergoing hysterectomy for non-malignant pathologies were compared with equal number of comparable patients who underwent other gynaecological operations. Patients were assessed pre- and post-operatively by semi-structured psychiatric interview, Sinha's anxiety scale and Hamilton's depression rating scale. Patients undergoing hysterectomy were significantly more anxious and depressed both pre- and post-operatively as compared to the control patients. Hysterectomy was not associated with significantly higher psychiatric morbidity.

[Somatization disorders in primary care: differential clinical aspects. Study Group of Psychic and Psychosomatic Morbidity of Zaragoza, Primary Care Section].

Abstract: BACKGROUND To identify specific sociodemographic and psychopathological features of somatization disorder (SD) patients in relation to other patients with psychiatric and organic morbidity in primary care (PC) setting. METHODS A group of SD patients from PC was compared with other two control groups: the first one made of patients with psychiatric morbidity (with or without organic disease) and the second group of patients with only organic disease without psychiatric morbidity. Polivalent standardized psychiatric interview (PSPI), a specific psychiatric interview for PC settings, was used as diagnostic instrument. RESULTS 1) there is a female predominance in SD statistically significant compared with organic patients and with a trend to significance in relation to psychiatric patients. Age, marital status and educational level show no significant differences among the groups; 2) in relation to psychopathology, SD patients show, in relation with organic patients, statistically higher levels in all items measured by PSPI. On the contrary, SD overwhelmed psychiatric patients in just four items: somatic symptoms, fatigue, reported anxiety and hystrionism as well as sexual problems and lack of social support, and 3) high psychiatric morbidity (85%) in SD, most of them affective and anxiety diagnosis, make it difficult to differentiate from the other patients suffering from psychiatric morbidity in PC. CONCLUSION Patients with SD show a very different profile compared with those with organic disease in relation to psychiatric symptoms and social problems. On the other hand, when compared with patients with psychiatric disorders, differences are rather scarce. In addition, affective and anxiety comorbidity associated make it difficult the diagnosis. For this reason, the use of screening instruments for SD seems mandatory.

[Psychiatric morbidity in connection with surgical treatment of epilepsy. A short-term follow-up of patients with amygdalohippocampectomy].

Abstract: The aim of the study was to examine the occurrence of psychiatric disorders in epilepsy patients who had received surgical treatment, especially amygdalohippocampectomy (AHE), for the relief of medically intractable seizures. Forty-seven subjects, treated during the period 1987-1991 in the Danish epilepsy surgery programme (EPIKIR), entered a retrospective interview study. Of these, 37 had undergone AHE. Preoperative psychiatric morbidity was assessed through interview and available case notes, including a routine psychiatric interview. Postoperative psychiatric morbidity was assessed by the use of the Present State Examination. A total of six subjects (five AHE subjects) developed depressive disorders of various duration and severity after operation. In three subjects this occurred "de novo". No paranoid-hallucinatory psychoses developed within the follow-up period (a minimum of one year), and the presence of psychiatric disorders could not be associated with either lateralization of cerebral dominance of histopathological findings. Thus, depression appears to be the most frequent psychiatric problem following epilepsy surgery. Although the present study mainly deals with AHE, this finding is in accordance with the results of recent findings concerning anterior temporal lobe resection.

Use of Interpreters in Psychiatry

Abstract: There Is A Surprising Lack of discussion in the psychiatric literature on the problems of conducting a psychiatric interview through an interpreter. This is an increasingly important area of concern, given the multicultural mix of our society.

How doesthecontentofconsultations affectthe recognition by generalpractitioners ofmajor depressioninwomen

Abstract: SUMMARY Background. Majordepression isacommonanddisabling condition. However, formanyreasons, thecondition isnot recognized inabouthalf ofthepatients withmajordepression. Aim.Theaimofthestudywastoestablish whetherthe content ofgeneral practice consultations affected general practitioners' recognition ofmajordepressive illness in womenpatients. Method.The30-item general health questionnaire was usedasafirst stagescreening instrument forpsychiatric morbidity. Patients newlyrecognized asdepressed bytheir general practitioner andthosenotrecognized asdepressed whoscored11ormoreonthequestionnaire wereinterviewed, usually within three daysofconsulting their general practitioner, usingthecombined psychiatric interview. Videorecordings oftheconsultations forthese twogroups ofwomen wereanalysed; analyses werebasedonmentions ofphysical, psychiatric andsocial symptomsandon whether thefirst mentionofapsychiatric symptomwas within thefirst four mentions ofanysymptoms(early inthe consultation) orafter fourmentions ofanysymptoms(late) orifpsychiatric symptomswerenotmentioned. Results. A paired sampleof72womenwithmajordepressionwasobtained frompatients consulting 36general practitioners, eachgeneral practitioner providing one patient whomheorshehadcorrectly recognized asbeing depressed andonepatient whosedepression hadnotbeen recognized. Womenwithmajordepression wereaboutfive timesmorelikely tohavetheir depression recognized if theymentioned their psychiatric symptomsearly inthe consultation compared withthosewhoeither left itlater to mention suchsymptomsornevermentioned them.Major depression wasmorelikely toberecognized ifnophysical illness waspresent. Afteradjusting forphysical illness, depression was10timeslesslikely toberecognized ifthe first psychiatric symptomwasmentioned late intheconsultation, ornotmentioned atall, thanifitwasmentioned early intheconsultation. Conclusion. General practitioners needtorememberthat patients whopresent withsymptomsofphysical illness may

Emotional reactions inwomen attending aUK colposcopy clinic

Abstract: Studyobjective -Toassesstheemotional responsesofwomen attending a colposcopyclinic forinvestigation ofanabnormnal cervical smear,andtoelicit the women'sviewson thescreening service andcolposcopy clinic. Design -Over12monthsallnewattenders atacolposcopy clinic wereinvited tojoin the study.They were assessed psychiatrically fourweeksbeforetheirfirst clinic appointment, andfourweeksand32 weeksafter their first clinic appointment. Setting -Colposcopy clinic, JohnRadcliffe Hospital, Oxford. Patients - Of 114women attending the colposcopy clinic forinvestigation ofan abnormalcervical smear,102agreedto enterthestudy. Measurements - Psychiatric symptoms wereassessed witha standardised psychiatric interview, thepresent stateexamination; andwithfourself ratedmood scales:- thegeneral health questionnaire, theBeckdepression inventory, theLeeds depression scale, andtheLeedsanxiety scale. Mainresults - On allthesemeasures, in thewholepatient group,psychiatric morbidity wasfoundtobetransient andrelatively minor.Thusratings onthepresent stateexamination werenotsignificantly higher thantheratefoundinacommunity sampleof520women inOxford, whileon thefourself ratedmoodscales, meantotal scoreswerelowerthanthecutoffvalue usedtodistinguish cases.Patient satisfaction withthecolposcopy services was generally highbuttherewas some dissatisfaction withdelays. Conclusions -After anabnormalcervical smear,further investigation bycolposcopy isgenerally associated withlowlevels of anxiety anddepression.