Road rage: a psychiatric phenomenon?

Background: Road rage is a concept recently popularised by the press. An association with psychiatric illness is implied from reports of such drivers being “mad”. Previous literature has demonstrated a link between road traffic accidents and mental illness. This study examines the relationship between road rage and psychiatric morbidity. It aims to estimate the prevalence of road rage by self-report and elucidate demographic and psychiatric factors associated with road rage. Method: This is a cross-sectional study of attendees at general practice clinics that examines self-reported road rage and psychiatric morbidity. Assessment was based on the total score on the Clinical Interview Schedule (revised version; CIS-R), Aggression Questionnaire, Screening Test for Comorbid Personality Disorders, Alcohol Use Disorders Identification Test and Life Events Schedule. Results: Fifty-three percent of 131 subjects reported a recent incident of road rage. Perpetrator and victim groups differed from controls. Perpetrators had increased aggression scores and psychiatric morbidity. There was a strong association with male sex and illicit drug use, and a strong negative association with driving experience. A weaker association was found with youth. Victims showed increased psychiatric morbidity and were more likely than perpetrators to seek help for emotional problems. Life events stress, social class, alcohol use and personality disorder had no significant effect. Conclusion: There is an association between road rage and psychiatric morbidity. Accepted: 9 February 2001     

Involvement in the child welfare system among mothers with serious mental illness

OBJECTIVE: This study sought to determine the association between maternal schizophrenia and major affective disorders (serious mental illness) and child custody arrangements in a sample of Medicaid-eligible mothers. METHODS: Medicaid eligibility and claims data were merged with data from the child welfare system in Philadelphia for 1995 to 2000. The sample comprised 4,827 female residents of Philadelphia between the ages of 15 and 45 as of 1996, who were initially eligible for Medicaid through Aid to Families With Dependent Children between 1995 and 1996 and who had at least one family member younger than 18 years at the beginning of the study period. Logistic regression was used to determine association between maternal mental illness and involvement in the child welfare system. RESULTS: Among the 4,827 mothers, 7.2 percent had a serious mental illness and 4.4 percent had other psychiatric diagnoses. More than 14 percent of mothers with serious mental illness received child welfare services, compared with 10.8 percent of those with other psychiatric diagnoses, and 4.2 percent of those without a diagnosis. After the analyses adjusted for a past inpatient episode, race or ethnicity, and age, mothers with serious mental illness were almost three times as likely to have had involvement in the child welfare system or to have children who had an out-of-home placement. CONCLUSIONS: The results suggest the urgent need for increased planning and coordination between the child welfare and mental health systems, including provision of parenting support as part of mental health treatment for mothers.     

Self-reported mental health difficulties and subsequent risk for schizophrenia in females: a 5-year follow-up cohort study

BACKGROUND: Patients with schizophrenia often report a history of premorbid mild to severe psychological distress. We investigated the association between self-reported mental health difficulties and later psychiatric hospitalization for schizophrenia. METHODS: 13,357 females aged 17, mandatory assessed by the Israeli Draft Board were followed up over 5 years for psychiatric hospitalization by means of the Israeli National Psychiatric Hospitalization Case Registry. Seventeen females, judged healthy at Draft Board assessment, were hospitalized for schizophrenia or schizoaffective disorder over the follow-up period. RESULTS: There was a significant monotonic association between increasing self-reported mental health difficulties (psychological distress and increasing need for psychological counseling) and prevalence of schizophrenia [odds ratios over four levels: 1.56; 95% CI:1.04 to 2.34; chi2 (1) = 4.62, p = 0.03], after controlling for low IQ, immigration, SES, and presence of psychiatric disorders at age 17. Increasing severity of self-reported mental health difficulties was related to earlier age of first hospitalization [r = -0.48, p = 0.05]. CONCLUSIONS: Increased undifferentiated self-reported mental health difficulties are associated with increased risk of later hospitalization for schizophrenia prior to age 23 in females. This may reflect the prodromal phase of the illness.     

Mental health service use among hurricane Katrina survivors in the eight months after the disaster

OBJECTIVE: This study examined use of mental health services among adult survivors of Hurricane Katrina in order to improve understanding of the impact of disasters on persons with mental disorders. METHODS: A geographically representative telephone survey was conducted between January 19 and March 31, 2006, with 1,043 displaced and nondisplaced English-speaking Katrina survivors aged 18 and older. Survivors who reported serious and mild-moderate mood and anxiety disorders in the past 30 days and those with no such disorders were identified by using the K6 scale of nonspecific psychological distress. Use of services, system sectors, and treatments and reasons for not seeking treatment or dropping out were recorded. Correlates of using services and dropping out were examined. RESULTS: An estimated 31% of respondents (N=319) had evidence of a mood or anxiety disorder at the time of the interview. Among these only 32% had used any mental health services since the disaster, including 46% of those with serious disorders. Of those who used services, 60% had stopped using them. The general medical sector and pharmacotherapy were most commonly used, although the mental health specialty sector and psychotherapy played important roles, especially for respondents with serious disorders. Many treatments were of low intensity and frequency. Undertreatment was greatest among respondents who were younger, older, never married, members of racial or ethnic minority groups, uninsured, and of moderate means. Structural, financial, and attitudinal barriers were frequent reasons for not obtaining care. CONCLUSIONS: Few Katrina survivors with mental disorders received adequate care; future disaster responses will require timely provision of services to address the barriers faced by survivors.     

Investigating the Relationship Between Neighborhood Experiences and Psychiatric Distress for Individuals with Serious Mental Illness

The present study examined the relationships between how research participants experienced their neighborhood, their neighborhood social climate, and psychological well-being. Participants (n = 525) were residents of supported housing programs who used mental health services at one of 17 community mental health centers in South Carolina. Hierarchical regression and mediation analyses were employed to answer research questions. Results suggest that neighbor relations, perceptions of neighborhood safety, and neighborhood satisfaction were significantly associated with perceptions of neighborhood social climate; and neighborhood social climate accounted for a significant amount of the variance in psychiatric distress. Of particular interest, perceptions of neighborhood social climate fully mediated the relationship between the specific reported neighborhood experiences and psychiatric distress. These findings have implications for interventions and policy aimed at promoting integration of individuals with serious mental illness into community settings.     

Al Ain Community Psychiatric Survey. I. Prevalence and socio-demographic correlates

  Background: Psychiatric community stud- ies are essential for the planning and development of psychiatric services, as well as being helpful in examining the socio-demographic correlates of mental disorders in a given community. Few such studies have been carried out to date in the Arabian peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in A1 Ain in the United Arab Emirates. The findings regarding lifetime prevalence and psychiatric morbidity are reported. Methods: A total of 1394 (n= 1394) adults systematically sampled from Al Ain community were assessed with a modified version of the Composite International Diagnostic Interview (CIDI) as well with other instruments: the new screening psychiatric instrument, Self-Reporting Questionnaire (SRQ-20), and the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID) screening module. Lifetime prevalence and 1-week prevalence rates of mental distress as measured by screening instruments were estimated as well as the lifetime prevalence rate of CIDI ICD-10 psychiatric disorders. The sensitivity of the CIDI interview to correctly pick up distressed subjects, as well as those who had undergone previous treatment for a psychiatric disorder, was also calculated. Associations between socio-demographic risk factors and ICD-10 psychiatric disorder as well as with mental distress were also examined by bivariate and multivariate analyses. Results: Overall lifetime prevalence of ICD-10 psychiatric disorder was found to be 8.2% (95% CI: 6.7–9.7), while the 1-week prevalence rate of mental distress as measured by the SRQ-20 was 15.6% (95% CI: 11.8–19.5) and the lifetime prevalence rate of mental distress as measured by the new screening instrument was 18.9% (95% CI: 11.5–25.9). The CIDI interview correctly picked up 42% of subjects who had received previous psychiatric treatment and 51% of the distressed. Mood disorders and anxiety (neurotic) disorders were more common in women and alcohol and substance use disorders were exclusively confined to men. Female sex, young age, quality of marital relationship, life events over past year, chronic life difficulties, physical illness, family history of psychiatric disorders and past history of psychiatric treatment were found to be significantly associated with ICD-10 psychiatric disorder. Multivariate analysis revealed that age, sex, exposure to chronic difficulties and past history of psychiatric treatment were the most significant predictors of ICD-10 psychiatric disorders, and exposure to chronic difficulties, past history of psychiatric treatment and educational attainment were the significant predictors of lifetime ever and current mental distress. Conclusion: The pattern and trend of psychiatric morbidity found in this survey is in line with those reported by other surveys that utilized similar assessment instruments. Differences in rates are explained by different methodologies used. Accepted: 3 October 2000     

Mental, physical and functional status in primary care attenders

OBJECTIVE: The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status. METHODS: The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life. RESULTS: The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering from ICD-10 full-fledged and subthreshold disorders. Severity of impairment increased from sub-threshold cases to full-fledged cases, and among the latter according to the severity of depressive and anxious symptoms, assessed using Hamilton scales. The most frequent psychiatric disorders were associated with significant worsening in health related quality of life, with relevant differences between psychiatric diagnoses regarding the domains affected. Impairment associated with mental disorders was greater than that associated with physical illness. CONCLUSIONS: The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.     

Injury risk in young psychiatric outpatients

BACKGROUND: Studies investigating the association between injuries and mental health have mainly focused on mental health sequelae of injuries. The aim of this prospective cohort study was to assess the incidence and risk factors of physical injury hospitalisation and poisoning hospitalisation among adolescent psychiatric outpatients. SUBJECTS AND METHODS: Data on 302 consecutively referred Finnish psychiatric outpatients aged 12-22 years (mean 16) were collected at treatment entry. The end-point of the average 11-year follow-up was death or end of follow-up on 31 December 2005. The main outcome variables were physical injury hospitalisation and poisoning hospitalisation. RESULTS: Altogether 111 physical injury hospitalisations occurred in 65 (22% of all) persons during follow-up, incidence being 27.9 (95% CI: 22.7-33.1) per 1,000 person-years. Poisoning hospitalisation occurred in 22 (7.3%) persons, altogether 50 times, incidence being 12.6 (95% CI: 9.1-16.0). Seven injury-related deaths occurred, incidence being 1.8 (95% CI: 0.5-3.1) per 1,000 person-years. The most common physical injury types were fractures (40%), followed by distortions (10%) and wounds (10%), while poisoning for drugs accounted for 72% of the poisonings. Previous inpatient care, psychotropic medication, suicidality, and major depression were associated with poisoning hospitalisation during the follow-up while only gender was associated with physical injury hospitalisation. CONCLUSION: Injuries cause significant morbidity among psychiatric outpatients, but only poisonings seem to be related with suicidality in Finnish adolescent psychiatric outpatients. The high frequency of injuries seems to justify clinicians' attention to these aspects when assessing the need for care among young people.     

Psychotic-like ideations among a group of young normal subjects in Iran

BACKGROUND: Recent studies show that self-reported psychotic-like experiences in general population samples are quite common and on a continuum with psychotic symptoms in clinical samples. However, most evidence comes from western settings and there is a dearth of research in developing countries. Examination of these experiences across different cultures adds to their validity. AIMS: : To assess psychotic-like ideations and its association with poor mental health in a group of young normal individuals in Iran. METHODS: A total of 150 medical students with no history of a psychiatric disorder completed the Peters et al. Delusions Inventory (PDI-40) and the General Health Questionnaire (GHQ-28). Psychotic-like ideations were rated on the basis of their presence, as well as their levels of distress, preoccupation and conviction (PDI sub-scores). RESULTS: On average, 9.4 psychotic-like ideations were reported by the subjects (range 0-28). More frequent psychotic-like ideations and higher distress and preoccupation associated with these ideations were correlated with poor mental health as assessed by the GHQ. CONCLUSION: Frequency of psychotic-like ideation and its dimensions, as well as its association with poor mental health, were comparable to the studies on healthy subjects conducted in Europe.     

Intimate Partner Violence,Cumulative Violence Exposure,and Mental Health Service Use

Intimate partner violence (IPV) leaves victims with serious mental healthconsequences; some victims do not seek help even though they suffer from adverse mental health symptoms. Victims’ use of mental health services seems to be affected by sociocultural factors and their history of experiences with violence. This study used the collaborative psychiatric epidemiology surveys to examine the effects of cumulative violence on IPV victims’ mental health service use. The results showed that victims’ mental health needs were the most prominent predictor of their use of mental health services, and that cumulative violence exposure also predicted mental health service use.     

Psychiatric aspects of pain

PURPOSE OF REVIEW: Pain is a common reason for seeking healthcare. Chronic pain is commonly comorbid with psychiatric disorders. New evidence provides fresh insights into the nature of the link between pain and mental disorders and offers opportunity to refine treatment approaches. RECENT FINDINGS: Even though depression is the most commonly studied comorbid psychiatric disorder, new studies show that other mental disorder, especially anxiety disorders, are also common. Comorbid conditions, including other chronic physical conditions, account for a substantial proportion of the disability associated with chronic pain conditions. The causal link between chronic pain and mental disorders may vary depending on the specific mental disorder, but the link may be mediated by biological, psychological, and social factors. Recent findings also suggest that the evolution of the comorbidity may differ between the sexes. Promising interventions for chronic pain that also target contextual psychosocial problems have been recently described. SUMMARY: The frequent occurrence of mental disorders among patients with pain, especially those whose pain is chronic, has implications for the management of such patients. Current understanding of the complexity of this link not only provides opportunities for designing appropriate interventions but also raises new questions for further research.     

Food Insecurity and Mental Health: A Pilot Study of Patients in a Psychiatric Emergency Unit in Israel

The objective of this study was to examine food insecurity among psychiatric patients and as a concern for mental health practitioners. Food security and psychological distress were measured among 113 patients hospitalized in a psychiatric emergency unit. Of 113 respondents 67 (59.3%) enjoyed food security and 46 (40.7%) lacked food security. Food insecure respondents showed a higher level of psychological distress than food secure respondents. A large proportion of in-patients may be suffering food insecurity which is negatively associated with their psychological well being. Mental health practitioners need to be aware of the potential association of food insecurity and mental distress among psychiatric patients.     

Suicide in the Montreal subway system: characteristics of the victims, antecedents, and implications for prevention.

OBJECTIVE: To understand the characteristics of persons who commit suicide in the Montreal subway system (the Montreal Metro), their personal and psychiatric histories, and the nature of the event in order to develop better prevention strategies. METHOD: Systematic analysis of coroner's office investigations of the 129 suicides in the Montreal Metro from 1986 to 1996. RESULTS: Of the 129 people who committed suicide, 81% had expressed a prior suicidal intention, 66% had previously attempted suicide, and 9% had attempted suicide in the metro. One hundred and five of the victims had serious mental health problems, most frequently depression; 73% had had inpatient psychiatric treatment, and at the time of death, 27% resided in a mental health treatment institution. Recent adverse life events included failed relationships, work problems, and family difficulties. CONCLUSIONS: Suicide victims intentionally go to the metro to kill themselves, often tell others beforehand, and are generally in treatment for serious psychiatric problems. Possible prevention strategies include modification of the environment and procedures in the metro, changing public conceptions of metro suicides, and modifying practice in psychiatric facilities.     

Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization

The widely-used Kessler K6 non-specific distress scale screens for severe mental illness defined as a K6 score ≥ 13, estimated to afflict about 6% of US adults. The K6, as currently used, fails to capture individuals struggling with more moderate mental distress that nonetheless warrants mental health intervention. The current study determined a cutoff criterion on the K6 scale indicative of moderate mental distress based on mental health treatment need and assessed the validity of this criterion by comparing participants with identified moderate and severe mental distress on relevant clinical, impairment, and risk behavior measures. Data were analyzed from 50,880 adult participants in the 2007 California Health Interview Survey. Receiver operating characteristic curve analysis identified K6 ≥ 5 as the optimal lower threshold cut-point indicative of moderate mental distress. Based on the K6, 8.6% of California adults had serious mental distress and another 27.9% had moderate mental distress. Correlates of moderate and serious mental distress were similar. Respondents with moderate mental distress had rates of mental health care utilization, impairment, substance use and other risks lower than respondents with serious mental distress and greater than respondents with none/low mental distress. The findings support expanded use and analysis of the K6 scale in quantifying and examining correlates of mental distress at a moderate, yet still clinically relevant, level.     

Social skills training for chronic psychiatric patients: Rationale,research findings,and future directions

In 1969 Gordon Paul stated that “the ‘hard core’ refractory group of chronic mental patients is clearly one of the most difficult problems facing the mental health field today.”¹ Although some progress has been achieved in this area since then,^2–7 this same hard-core group of patients (most of whom bear schizophrenic diagnoses) remains a persistent challenge to mental health practitioners. A variety of pharmacologic, socioenvironmental, and behavioral approaches (primarily the token economy) have been applied to this group of chronic psychiatric patients. We will very briefly examine the major contributions and limitations of each approach.     

Are There Racial Differences in the Experience of Harmful or Traumatic Events within Psychiatric Settings?

The current study examined racial differences in the reported frequency and distress associated with potentially harmful or traumatic experiences occurring within psychiatric settings. One hundred and forty-two (109 African-American; 32 Caucasian) randomly selected adult consumers recruited from a community psychosocial day program completed a battery of self-report measures to assess experiences in the psychiatric setting, lifetime trauma exposure, PTSD severity, and were the subject of a chart review. A subset of participants (20%) also completed a qualitative interview exploring their perceptions of events occurring in psychiatric settings. Few racial differences were noted in the reported frequency or distress associated with particular events in the psychiatric setting. However, we found differential patterns of association between adverse psychiatric events and lifetime trauma history, and racial differences in diagnosis and medications prescribed by the mental health center. These racial differences merit further attention to better understand their meaning and to improve mental health services provided to both African-Americans and Caucasian public-sector psychiatric patients.     

Psychiatric disorders in children attending a nigerian primary care unit: functional impairment and risk factors

ABSTRACT: BACKGROUND: There is dearth of data on the level of functional impairment and risk factors for psychiatric morbidity in children attending primary care services in developing countries like Nigeria. The risk factors for psychiatric morbidity and functional impairment in children attending the primary care unit of a teaching hospital in Ilorin, Nigeria was therefore investigated to obtain data that could be used in improving service provision by primary care physicians. METHODS: A cross-sectional two-stage design was employed for the study. The first stage involved administration of the Child Behavior Questionnaire (CBQ) to 350 children while the children's version of the schedule for affective disorders and schizophrenia was used for the second stage involving 157 children, all high scorers on CBQ (score of [greater than or equal to] 7) and 30 % of low scorers (score < 7). Diagnosis of psychiatric disorders was based on DSM-IV criteria. In addition, the Children Global Assessment Scale was used to assess the functional status of the children (score of [less than or equal to] 70 indicates functional impairment) while the mothers' mental health status was assessed with the 12-item version of the General Health Questionnaire, a score of 3 or more on this instrument indicate presence of mental morbidity. RESULTS: It was observed that 11.4 % of the children had diagnosable psychiatric disorders and 7.1 % were functionally impaired; and those with psychiatric disorders were more functionally impaired than those without. Thus, significant negative correlation was noted between CBQ scores and CGAS (r = 0.53; p < 0.001). Following logistic regression, younger age of children, frequent hospital attendance and maternal parenting distress independently predicted psychiatric morbidity while child psychopathology and maternal parenting distress predicted functional impairment. CONCLUSIONS: Child psychiatric disorders are prevalent in the primary care unit studied. Many of the risk factors identified in the study population are modifiable. Collaborative efforts between psychiatrists and primary care physicians could therefore help to reduce level of risk and functional impairment and psychiatric morbidity among children attending the primary care unit studied. It could also help improve referral rates of difficult cases to the child and adolescent psychiatric unit of the hospital.     

Consumer-run service participation, recovery of social functioning, and the mediating role of psychological factors

OBJECTIVE: This study examined the relationship between participation in consumer-run services and recovery of social functioning among persons diagnosed as having serious mental illness. It also assessed the role of psychological factors in mediating this relationship. METHODS: Research questions investigated were whether involvement in consumer-run services is positively associated with recovery when premorbid and demographic factors are controlled for, whether psychological factors are positively associated with recovery irrespective of involvement in consumer-run services, and whether the relationship between involvement in consumer-run services and recovery is mediated by the psychological factors. The factors examined were self-efficacy, hopefulness, and active coping strategies. Sixty participants with a past or present diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder and at least one past psychiatric hospitalization were recruited from a community mental health center and two consumer-run programs. Data were collected on hopefulness, self-efficacy, coping strategies, social functioning, and premorbid and demographic characteristics. RESULTS: Findings indicated that participants involved in consumer-run services had better social functioning than those involved only in traditional mental health services, that psychological variables were significantly associated with social functioning, and that the relationship between involvement in consumer-run services and social functioning was partly mediated by the use of more problem-centered coping strategies. Premorbid and demographic factors did not account for the relationship between psychosocial variables and social functioning, although education was a significant predictor of social functioning. CONCLUSIONS: The findings support the view that psychosocial factors may play a role in facilitating good community adjustment for individuals diagnosed as having serious mental illness.     

Sociodemographic and health-related correlates of psychiatric distress in a general population

BACKGROUND: Measuring factors related to psychiatric distress in public health surveys helps to identify groups at risk for developing psychiatric morbidity. AIMS: The aim of this study was to determine which socio-demographic and health-related factors are associated with psychiatric distress in the general population. METHOD: Data were from the Catalan Health Interview Survey (CHIS), a cross-sectional survey of 15000 members of the general population of Catalonia, Spain. The association between scores on the General Health Questionnaire-12 and socio-demographic and healthrelated variables was analyzed using logistic regression. RESULTS: Several socio-demographic and health-related variables were significantly associated with increased psychiatric distress. The factor most consistently related to psychiatric distress was the presence of one or more chronic physical conditions. The number rather than the type of declared chronic conditions was the most important factor,with the odds ratios (OR) for presence of psychiatric distress ranging from 1.1 [95% confidence interval (CI) = 1.0-1.4] for one declared chronic condition to 5.6 (95% CI = 4.2-7.4) in persons with over five chronic conditions. Other significant related variables varied by age and gender. CONCLUSIONS: The number of declared chronic physical conditions appears to be a relevant correlate of the presence of psychiatric distress, independently of other factors, including the type of chronic condition.