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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article describes psychometric assessment instruments that are available for the screening of psychosocial problems that can interfere with patient rehabilitation. Structured assessment of patient depression, anxiety, substance abuse, social support, and willingness to take control and responsibility for health care is important throughout all stages of the patient's treatment. There are psychometrically sound, relatively brief, and nonintrusive measures with which to assess these variables. The hope is that the early and accurate identification of those patients who are in need of psychosocial services can lead to the implementation of services that will ameliorate psychosocial problems and facilitate total patient rehabilitation. Although many excellent measures exist, the most important assessment tool for the screening of psychosocial problems in patients with burns, which has emerged from this review, is the Psychological Adjustment to Illness Scale (PAIS). The PAIS integrates many of the relevant characteristics of psychologic screening and provides normative values that are specific to patients with burns. Ideally, this scale should be supplemented by an assessment of post-traumatic stress disorder, substance abuse, and personality and coping styles, because these critical factors are not adequately covered by the PAIS. Finally, the Burn Specific Health Scale shows promise for the assessment of health status and quality of life in patients with burns. Future clinical research will hopefully compare and contrast the efficacy and relevance of these measures. Furthermore, future clinical evaluation and research will need to relate the influence of psychosocial factors on the patient's total health functioning. Structured psychometric evaluation of the psychosocial and health characteristics will ensure that patients who have been burned will attain the most fulfilling quality of life that is available to them.
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PMID:Psychometric assessment of psychologic factors influencing adult burn rehabilitation. 157 63

Over the past 30 years, adolescents represent the only age group in the United States whose health status has not improved significantly. In this population, major health problems that are becoming increasingly important in regard to preventive intervention include substance abuse, depression, teenage pregnancy, and AIDS. Research in adolescent mental health during the past decade has focused on both the etiology and the prevention of problem behaviors. We review the development and application of various preventive intervention approaches in the field of adolescent mental health and discuss implications for future directions.
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PMID:Adolescent mental health: a review of preventive interventions. 157 82

Patients with borderline personality disorder frequently present to primary care physicians. However, the personality disorder, while complicating medical treatment, is often undetected. Symptoms and clinical presentations of this disorder are described. Common co-morbid psychiatric conditions associated with borderline personality disorder include depression and substance abuse. Physically self-damaging behaviors are also common among patients with this disorder. Guidelines for managing these patients in the hospital and ambulatory care clinic are provided.
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PMID:Borderline personality disorder: diagnosis and management in primary care. 157 12

A discrete-time survival analysis of recovery from major depressive episodes for a sample of married subjects (N = 119) identified several significant predictors of recovery including comorbidity for anxiety disorders or substance abuse, social support, age, and education. Furthermore, the analysis distinguished between different sources and types of social support, documenting that spouses' positive responses to the depression predict rapid recovery whereas the perception that friendships are conflictual predicts slow recovery. Finally, the analysis documented changes in the importance of predictor variables over the course of the episode. Specifically, spouse's negative reactions to the depression and subject's education level became more important predictors of recovery as the episode became longer, and the recovery advantage experienced by younger respondents lessened over time.
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PMID:Speed of recovery from major depressive episodes in a community sample of married men and women. 158 20

Research investigating patterns of familial aggregation of psychiatric disorders has used the family history method in which a single family member reports on the psychiatric history of their relatives. This method is more efficient and less costly than the family study method, in which direct interviews are performed on as many family members as possible. The family history method has been shown to have good specificity, in family studies of depression, but sensitivity has been less acceptable. The present study is the first study to report on the sensitivity and specificity of five psychiatric diagnoses made in a substance abusing population using the family history method. Among substance abusers and their family members, substance abuse is the most accurately diagnosed disorder. However, among family members only, the accuracy of diagnosing substance abuse declines significantly. Spouses and offspring are better informants than parents or siblings, and female relatives are better informants than male relatives. When more than one informant is available and positive diagnoses are determined by any positive family report, sensitivity for most disorders increases significantly. The results are discussed in terms of increasing the accuracy of the family history method.
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PMID:Ascertaining psychiatric diagnoses with the family history method in a substance abuse population. 161 80

This paper examines the association between marital status and psychiatric disorder for Blacks and explores the extent to which these patterns differ from those for Whites. Widowed and separated/divorced Black males and females have higher rates of disorder than the married; never-married Blacks do not have an elevated risk of psychiatric illness. The association between marital status and disorder for White males is similar and stronger than that observed for Blacks. For White women, the separated/divorced have a higher risk of disorder than the married, and unmarried White females have higher rates of the substance abuse disorders, but lower rates of the anxiety disorder than the married. Across all marital status groups, Black males and White males have higher rates of disorder (except for depression), than females. A complex pattern emerges when gender differences in the relative rates of disorder for unmarried Blacks compared to married Blacks are considered. Separated/divorced Black men, widowed Black women, and never-married Black men are worse off than their respective peers. Except for the separated/divorced, opposite patterns are evident for Whites. Directions for further research are outlined.
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PMID:Marital status and psychiatric disorders among blacks and whites. 161 62

This article describes the rationale, aims, and methodology of an epidemiological study of psychosis being conducted in Suffolk County, New York. A sample of first-admission patients is drawn from 10 inpatient and 25 outpatient facilities. Diagnostic psychosocial interviews are conducted shortly after admission to treatment, and at 6- and 24-month followup. Consensus diagnoses are made after each interview. Demographic and clinical background characteristics of the first 250 subjects enrolled over a 2-year period are presented here. The response rate was 76 percent. Based on the initial interview, 75 percent of subjects received a diagnosis involving psychosis. The three most common diagnoses were schizophrenia, bipolar disorder with psychotic features, and major depression with psychotic features. Among subjects with psychosis, 58 percent of males and 29 percent of females had a history of substance abuse/dependence. Gender differences were found on several background and clinical characteristics. Males were somewhat younger, less likely to have ever married, and had less education. Although the median length of hospitalization was the same for females and males (27 days), females were more likely to be hospitalized within 1 month of the occurrence of their first psychotic symptom (60% of females compared to 37% of males). Subjects with schizophrenia-related disorders were significantly more impaired on an assessment of negative symptoms than were affectively ill subjects, but clinical ratings of depression were not significantly different across diagnostic groups.
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PMID:The epidemiology of psychosis: the Suffolk County Mental Health Project. 162 Oct 71

This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psychotherapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders "cross over" and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed.
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PMID:Advances in diagnosis and treatment of anorexia nervosa and bulimia nervosa. 163 54

The survival probability and causes of death before the age of 70 years were analyzed among 3302 inpatients with "pure" anxiety neurosis in Stockholm County, Sweden, who were tracked in case registries by means of automated record linkage during a 14-year period. When all patients with other psychiatric diagnoses and substance abuse were excluded, and marital status controlled for, there was a significant excess of deaths due to verified and undetermined suicides, ie, nearly one third of all deaths. These unnatural deaths preempted any excess in natural causes before the age of 70 years, such as cardiovascular disease. Treatment policy with regard to the use of anxiolytic drugs was not found to influence mortality. We concluded that the risk of suicide in inpatients before the age of 70 years with anxiety disorders may be as high as that in persons with depression or other diagnoses who require inpatient care.
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PMID:Excess mortality among 3302 patients with 'pure' anxiety neurosis. 167 84

We conducted a random-sample survey of homeless children and their mothers residing in Philadelphia (Pa) shelters. One hundred forty-six families were included in the final sample, resulting in an 80% response rate. The aims of the survey were to characterize the child's current and past health status, to determine access to and use of medical services, and to determine the serum erythrocyte protoporphyrin levels and tuberculin skin test status of the children. In addition, psychological tests were administered to both child and parent to assess developmental level and psychological problems. Finally, detailed questions were asked concerning the reasons for the homeless condition. The important reasons for homelessness cited in the survey included physical abuse, substance abuse, disagreements with landlords, and poor living conditions. The children's health problems included a high incidence of reported accidents and injuries, burns, and lead toxicity; the parents suffered from depression, physical abuse, and substance abuse. School-aged children tended to have low scores on tests of expressive vocabulary and word decoding, and preschoolers seemed to be below age expectations in receptive vocabulary and visual motor skills. The findings of this study suggest that homeless children tend to score poorly on developmental and psychological tests and tend to sustain serious burns and accidents. Policy implications of the survey include suggestions for health screening, rehabilitation, and education.
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PMID:A survey of the health of homeless children in Philadelphia shelters. 171 Apr 21


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