The American journal of psychiatry
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The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. ⋯ These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.
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The authors examined the volume and predictors of outpatient mental health utilization among primary care patients in a large staff-model health maintenance organization (HMO). ⋯ Among these subjects, use of mental health care was high and services purchased outside the HMO exceeded those inside the HMO. Increasing copayment levels progressively reduced demand without respect to severity of illness. Attempts to control outpatient mental health costs must address equity and clinical need.
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The author reviewed the epidemiology and comorbidity of anxiety disorders in the elderly. ⋯ Epidemiologic data on the prevalence of posttraumatic stress disorder (PTSD) and the first occurrence of generalized anxiety disorder and PTSD in late life are still needed. Further comorbidity studies are needed to determine the extent to which anxiety arises secondary to depression, as well as the optimal treatment and prognosis for this mixed state.
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Two issues that may influence the diagnosis of depression in the medically ill are 1) the severity with which symptoms must be expressed before they are considered clinically significant and 2) how to deal with somatic symptoms that may be caused by medical illness. This study used different approaches to case identification to examine prevalence rates for major and minor depression in a group of terminally ill cancer patients. ⋯ Small differences between investigators in the applications of symptom-severity thresholds can result in large differences in prevalence rates for depression. However, the inclusions of somatic symptoms in the diagnostic criteria inflates the rates of diagnosis only when these symptoms are used in conjunction with a low-threshold approach.
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Review Historical Article
Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience.
The most common indication for electroconvulsive therapy (ECT) is major depression. It is less recognized that ECT is effective also in the treatment of acute mania. This article aims to provide a comprehensive and critical review of the literature on the use of ECT for manic patients. ⋯ ECT is an effective and safe treatment for acute mania. Remission of mania following ECT reflects a primary therapeutic effect rather than a secondary consequence of an ECT-induced organic brain syndrome.