Comprehensive psychiatry
-
Comprehensive psychiatry · Jul 2001
Review Comparative StudyComparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview.
Increasing attention has been paid to the possibility that a range of disorders, the putative obsessive-compulsive spectrum disorders (OCSDs), may share overlapping phenomenological and neurobiological features with obsessive-compulsive disorder (OCD). The development of a structured clinician-administered interview for the putative OCSDs (SCID-OCSD) is described. This instrument was used to investigate differences between OCD patients with a comorbid putative OCSD and OCD patients without a comorbid putative OCSD. ⋯ Our findings suggest that putative OCSDs have a relatively high prevalence rate in OCD patients. In addition, OCD patients with comorbid OCSDs differ with regard to certain demographic and clinical features. Further research, particularly genetic and neuroimmunological work, may ultimately be useful in validating the obsessive-compulsive spectrum.
-
Comprehensive psychiatry · May 2001
The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity.
The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a self-report scale designed to screen for the most common DSM-IV axis I disorders encountered in outpatient mental health settings. We report the results of four studies of the PDSQ involving more than 2,500 subjects receiving outpatient mental health care. In two studies we examined the understandability of the items on the PDSQ. ⋯ In the other two studies, the reliability and validity of the PDSQ subscales was examined. A priori criteria were established to guide the revision of subscales. The final version of the questionnaire contains 13 subscales (major depressive disorder [MDD], bulimia, post-traumatic stress disorder [PTSD], panic disorder, agoraphobia, social phobia, generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD], alcohol abuse/dependence, drug abuse/dependence, somatization, hypochondriasis, and psychosis), each of which achieved good to excellent levels of internal consistency, test-retest reliability, and discriminant, convergent, and concurrent validity.
-
Comprehensive psychiatry · Mar 2000
Review Randomized Controlled Trial Comparative Study Clinical TrialHazardous alcohol use: its delineation as a subthreshold disorder, and approaches to its diagnosis and management.
The last 20 years have seen a significant paradigm shift in how we view alcohol misuse. The dichotomous model of "alcoholism" and "normal drinking" has now been replaced by the concept of a spectrum of disorders. In this new framework, "hazardous alcohol use" is defined as a repeated pattern of drinking that confers the risk of harmful consequences. ⋯ The findings from a series of World Health Organization (WHO) collaborative studies on brief interventions for hazardous alcohol use are described. This work has resulted in the development of the Alcohol Use Disorders Identification Test (AUDIT) screening instrument, which can detect over 90% of hazardous drinkers in a range of settings, and the demonstration that 5 minutes' structured advice can reduce hazardous consumption by 30%. The later phases of this program of work have examined strategies to promote the dissemination of brief interventions for hazardous alcohol use throughout primary health care, and the nationwide, systematic, and sustained utilization of these interventions.
-
Comprehensive psychiatry · Mar 2000
Outcomes associated with delirium in acutely hospitalized acquired immune deficiency syndrome patients.
The study demonstrates that delirium in acquired immune deficiency syndrome (AIDS) patients is associated with mortality, the need for long-term care, and an increased length of hospitalization. Data were collected prospectively on human immunodeficiency virus (HIV)/AIDS patients admitted to a teaching hospital from January 1996 through December 1996. The data included demographic characteristics of the participants, medical diagnoses, CD4 cell count, Karnofsky functional assessment, mortality during admission, length of stay, and discharge placement. ⋯ Patients with delirium were more likely to die during admission (chi-square [chi2] = 39.1, df = 1, P<.0010), to stay longer in hospital (t = 3.50, df = 12.9, P<.0041), or to need long-term care if discharged alive (chi2 = 12.8, df = 2, P<.0021). Delirium is associated with adverse outcomes in hospitalized AIDS patients. More research is needed to characterize the nature of this association.
-
Comprehensive psychiatry · Nov 1999
Multicenter Study Comparative Study Clinical TrialThree dimensions of depression in patients with acute psychotic disorders: a replication study.
Depressive symptoms in psychotic disorders are of high relevance but seem to be heterogeneous when assessed with a standard rating scale. The present analysis is a replication study on the dimensionality of the Bech-Rafaelsen Melancholia Scale (BRMES) in acutely psychotic patients with substantial depression defined according to a functional approach across the nosological borders of schizophrenia with major affective symptoms, schizoaffective disorder, depressed subtype, and major depression with psychotic features. The baseline data of 123 patients participating in a multicenter pharmacological trial were evaluated with structural equation models. ⋯ The three-dimensional model proved to be superior to one-, two-, or four-factor models with respect to goodness-of-fit (goodness-of-fit index [GFI] = 0.91 and comparative fit index [CFI] = 0.89) and parsimony (adjusted GFI [AGFI] = 0.85). When comparing the present model with the previously reported model, a highly satisfactory correspondence emerged (CFI = 0.87). The results corroborate our previous findings that depression-like symptoms in acutely psychotic patients assessed by the BRMES can best be represented by a three-dimensional model and should not be treated as a homogeneous syndrome.