Psychiatric morbidity, stressors, impact, and burden in juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is a chronic painful disorder conceivably with adverse psychological sequelae that might influence the outcome of the disease and its treatment. This study was designed to detect the presence of psychiatric disorders and associated abnormal psychosocial situations among children and adolescents with JIA and to evaluate their impact on and burden for their caregivers. Forty subjects with JIA suffering for at least one year were included in the study. Forty age- and sex-matched healthy subjects were included as controls. Clinical psychiatric assessment was carried out blindly, and psychiatric disorders and stressors on abnormal psychosocial situation were assigned on the basis of ICD-10 clinical diagnoses of multiaxial classification of child and adolescent psychiatric disorders. Chronicity, distress, social impairment, and burden for others were rated with the impact supplement of the strengths and difficulties questionnaire (SDQ). Of the 40 cases of JIA, 24 were boys and 16 were girls aged 10-18 years, with a mean age of 13.25 years. The frequency of psychiatric disorders was 35% in the JIA and 12.5% in the control group (p<0.001). The long duration of illness was associated with a higher proportion of cases with psychiatric disorders. In the JIA group, the diagnoses in decreasing order were depressive disorder (15%), somatoform disorder (12.5%), adjustment disorder (5%), and mixed anxiety and depressive disorder (2.5%). Significantly higher stressors, perceived difficulties, distress, social impairment, and burden for caregivers were reported in the JIA group with psychiatric morbidity. The presence of psychiatric disorders was associated with substantial impairment of learning, peer relationship, and leisure activities. Early psychiatric intervention might increase the likelihood of satisfactory outcome of treatment in JIA.     

Psychological comorbidity in elderly patients with cancer

Human life expectancy has increased, nationally and internationally, during recent years and will continue to increase in the future. Old age is commonly associated with health-related impairments, chronic diseases, increasing multimorbidity, as well as with psychosocial burdens, such as social deprivation, reduced social participation, and impairment in activities of daily living. Against this background, studies on mental health addressing psychological?distress and mental disorders of older people have gained increasing attention. The aim of the present overview is to provide insight into psychological comorbidity in elderly with chronic illnesses. The following questions are addressed: (1) what are the prevalence rates of mental disorders in the elderly in general and, specifically, in patients with cancer? (2) How are mental disorders and cancer, respectively, diagnosed in elderly?patients? (3) What are common risk factors associated with the development of mental disorders? (4) Which treatment options are available, and which aspects of health care for elderly patients with chronic diseases need to be considered?     

Decreasing psychological distress in cancer inpatients using FLEX Care®: a pilot study

While the incidence of psychological distress among people receiving treatment for cancer in outpatient treatment settings has received attention by researchers, few studies have investigated the incidence of psychological distress in inpatient settings. Similarly, efficacy or effectiveness studies describing psychosocial interventions with cancer patients in inpatient settings are all but absent from the research literature. The purpose of this study was to screen for psychological distress among persons receiving inpatient treatment for cancer and to then test the efficacy of a communications model known as FLEX Care?, used to enhance routine psychosocial care, in an effort to reduce measurable levels of psychological distress. Following the vetting of more than 400 potential participants, 35 met rigorous screening criteria and also consented to participate in this randomized pre-post control group study. The intervention group received the FLEX Care?-enhanced routine psychosocial intervention, while the control group received the routine psychosocial intervention alone. Mean scores for psychological distress were found to be nearly twice as high in the study sample as those levels reported in outpatient studies. Additionally, participants who received the FLEX Care?-enhanced psychosocial intervention experienced a significant reduction in psychological distress in contrast to participants in the control setting. The findings from this study underscore the need to screen for symptoms of psychological distress in inpatient settings and lend preliminary support to the use of personalized psychosocial intervention strategies that can be used as adjuvant to routine psychosocial care in the inpatient setting to reduce psychological distress.     

Decreasing Psychological Distress in Cancer Inpatients Using FLEX Care®: A Pilot Study

While the incidence of psychological distress among people receiving treatment for cancer in outpatient treatment settings has received attention by researchers, few studies have investigated the incidence of psychological distress in inpatient settings. Similarly, efficacy or effectiveness studies describing psychosocial interventions with cancer patients in inpatient settings are all but absent from the research literature. The purpose of this study was to screen for psychological distress among persons receiving inpatient treatment for cancer and to then test the efficacy of a communications model known as FLEX Care®, used to enhance routine psychosocial care, in an effort to reduce measurable levels of psychological distress. Following the vetting of more than 400 potential participants, 35 met rigorous screening criteria and also consented to participate in this randomized pre–post control group study. The intervention group received the FLEX Care®–enhanced routine psychosocial intervention, while the control group received the routine psychosocial intervention alone. Mean scores for psychological distress were found to be nearly twice as high in the study sample as those levels reported in outpatient studies. Additionally, participants who received the FLEX Care®–enhanced psychosocial intervention experienced a significant reduction in psychological distress in contrast to participants in the control setting. The findings from this study underscore the need to screen for symptoms of psychological distress in inpatient settings and lend preliminary support to the use of personalized psychosocial intervention strategies that can be used as adjuvant to routine psychosocial care in the inpatient setting to reduce psychological distress.     

SCREENING FOR PSYCHIATRIC COMORBIDITY AMONG FEMALE ALCOHOLICS: THE USE OF A QUESTIONNAIRE (SCL-90) AMONG WOMEN EARLY IN THEIR TREATMENT PROGRAMME

The use of a questionnaire, Symptom Check List-90 (SCL-90),as a screening instrument for psychiatric disorders was studiedin 60 women attending their first treatment for alcohol abusein Stockholm, Sweden. A global SCL-90 index, the General SymptomaticIndex (GSI), measuring the total level of recent self-reportedpsychological distress, showed a high efficacy in distinguishing‘psychiatric cases’ from ‘non-cases’in the present sample. Psychiatric cases were defined as subjectssatisfying the criteria for any current DSM-III-R disorder otherthan substance abuse. The psychiatric diagnoses were obtainedindependently by use of the Structured Clinical Interview forDSM-III-R (SCID-I). Psychiatric disorders, especially depressionand anxiety disorders, frequently antecede or develop secondaryto alcohol abuse among women. The use of structured interviewsto diagnose these disorders is, however, time-consuming. Findingsfrom the present study indicate that SCL-90 can be used to detectpsychiatric comorbidity among female alcoholics, thus enablingclinicians to be aware of concomitant psychiatric disordersamong a subgroup of patients.     

Psychosoziale Folgen bei Langzeitüberlebenden einer Krebserkrankung

Although cancer incidence rates are increasing, recent statistical studies suggest that cancer patients are showing higher cure rates as well as improved overall survival rates for most cancer locations. These advances are explained by improved strategies in early diagnoses as well as improved cancer therapies. Therefore, the number of long-term cancer survivors has also increased, but only few studies, especially within the last years, have focused on psychosocial issues of this subgroup. Some studies show that overall quality of life of long-term cancer survivors is quite high and comparable to that of the normal population. Nevertheless, a substantial percentage of former patients shows reduced quality of life and suffers from various sequelae of cancer and its treatment. This review focuses on the most common psychosocial issue of long-term survivors such as reduced psychological wellbeing, neuropsychological deficits and cancer-related fatigue syndrome. Finally, recommendations for problem-oriented interventions as well as improvement of psychosocial care of long-term survivors are given.     

Assessing psychological distress in cancer patients: The use of distress thermometer in an outpatient cancer/hematology treatment center

ABSTRACT

The purpose of this study is to assess the feasibility of the distress thermometer (DT) and the accompanying problem checklist (PC) as a screening tool for psychological distress and the sources of those distress at an outpatient cancer treatment center in Central California. Forty-three patients completed the DT and the PC. Based on a recommended DT cutoff score of 4, patients were classified as “distressed” (>4) and “not-distressed” (<4).

Respondents ranged in age from 34 to 87 years (mean = 60.44, SD = 12.05), the majority of whom were female (55.8%). The most common types of cancer diagnosis were breast cancer, followed by blood abnormality (i.e., blood disorders), lung, and bladder cancer. Based on the recommended DT cutoff score, 51% of patients were identified as significantly distressed. Results showed significant difference on DT score between the distressed and not-distressed groups, t(41) = ?4.25, p < .001. The most commonly reported sources of distress were in the practical, emotional, and physical domains of the PC list.

Routine distress screening can significantly help improve identification of distress and the sources of the distress in cancer patients and enable healthcare professionals to facilitate appropriate psychosocial support and referrals. Implications for practice and research are discussed.     

Diagnoses, requests and timing of 503 psychiatric consultations in two general hospitals

The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists (two full-time and two part-time). This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder (43.5%), adjustment disorder (10.9%) and cognitive disorder (7.6%). In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days (range=1-90, SD=13). Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction.     

Comorbid psychological disorders in patients with chronic somatic diseases

Based on the literature, the assessment of psychological comorbidity in epidemiological studies is reviewed along with prevalence rates of psychological comorbidity and the effect of mental diseases on the development and course of chronic disease as exemplified by coronary heart disease. Psychological comorbidity is associated with reduced quality of life, disease progression, and increased mortality, as numerous studies in coronary heart disease and other chronic diseases have shown. In spite of available valid screening measures which enable large population surveys, diagnostic problems remain, especially with respect to separating mental and somatic symptoms and diagnosing somatic diseases reliably. Psychological comorbidity is frequently overlooked in medical care and poses a high risk for the future somatic and mental course of disease, associated with individual suffering and serious health economic consequences. There is a need for research on suitable interventions for patients with chronic disorders and psychological comorbidity in order to improve their care.     

Psychological testing in adolescent medicine

Psychological and neuropsychological assessment remains an important aspect of clinical evaluation in adolescents with psychiatric and neurologic disorders. The primary care practitioner can refer for psychological and neuropsychological assessment when cognitive, behavioral, or psychiatric problems appear to be affecting the adolescent's learning, psychosocial development, or overall functioning. The most appropriate assessment depends upon the diagnostic issue at hand. Most referrals will include IQ and achievement testing to assess for learning disabilities; behavioral and personality assessment to aid in psychiatric diagnosis and treatment planning; and neuropsychological testing for more complex issues, such as the impact of neurological disorders and injuries on cognition and behavior. The patient can be referred to the school psychologist for IQ and achievement testing that complements any additional testing that may be required to help determine the best intervention. Psychological assessment can be invaluable in the early identification and intervention of learning, behavioral, and psychiatric difficulties in adolescents.     

Double diagnosis or comorbidity? Definition and clinical observation

There is a high prevalence of a comorbid substance use disorder in subjects with psychotic or mood disorders. Psychiatric patients are reported to abuse alcohol or drugs. This comorbidity raises the question whether one disorder is a consequence of the other. The self-medication hypothesis of substance abuse suggests that drug abuse is driven by an attempt to alleviate specific psychological distress but this unidirectional causality is not supported. The main aims of this review are to describe the difference between dual diagnosis and comorbidity in psychiatric patients and the possible patterns of different clinical conditions.     

Does routine psychological screening of newly diagnosed rural cancer patients lead to better patient outcomes? Results of a pilot study

Background: Few studies have reported on the impact of screening on patient outcomes or clinical practice and research describing the implementation of psychosocial screening in rural services is scarce. Aims: This study investigated the feasibility and utility of a psychological screening program in Australian rural oncology clinics. Subjects & methods: A total of 83 newly diagnosed adult cancer patients, seen at one of three rural outpatient oncology clinics participated in this study. Results: Nineteen of forty‐three (44%) participants in the screening phase scored above cut‐off score on the Distress Thermometer (DT), a validated screening tool for distress in cancer patients. The DT had acceptable sensitivity (86%) and specificity (77%) as a screening tool using another validated self‐report measure of psychological symptoms, the Psychological Symptoms Subscale of the Somatic and Psychological Health Report Short form, as a‘gold standard’. Screening with the DT did not significantly increase the rate of referrals to psychosocial staff of distressed individuals. However, screening with the DT reduced time to referral. The screened group reported significantly greater unmet needs in univariate (P = 0.01) and multivariate analyses (P = 0.01). Conclusions: Psychological screening did not increase rates of referral to psychosocial support staff for patients with psychological morbidity. However, given the methodological limitations of this pilot study, the results should be interpreted with caution. The DT was found to have acceptable sensitivity and specificity to detect likely cases of psychological morbidity. Barriers to implementation of psychological screening in rural clinics and recommendations for future psychological screening programs at outpatient oncology clinics are discussed.     

Development and validation of a psychosocial screening instrument for cancer

Background  

We are reporting on the development of a psychosocial screening tool for cancer patients. The tool was to be brief, at a relatively low reading level, capture psychological variables relevant to distress and health-related quality-of-life in cancer patients, possess good reliability and validity, and be free of copyright protection.     

Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown

The present study aimed at identifying psychological and psychosocial variables that might predict weight gain during the COVID-19 lockdown in patients affected by overweight/obesity with and without a psychiatric diagnosis. An online survey was administered between 25 April and 10 May 2020, to investigate participants’ changes in dietary habits during the lockdown period. 110 participants were recruited and allocated to two groups, 63 patients had no psychiatric diagnosis; there were 47 patients with psychiatric diagnosis. ANOVA analyses compared the groups with respect to psychological distress levels, risk perception, social support, emotion regulation, and eating behaviors. For each group, a binary logistic regression analysis was conducted, including the factors that were found to significantly differ between groups. Weight gain during lockdown was reported by 31 of the participants affected by overweight/obesity without a psychiatric diagnosis and by 31 patients with a psychiatric diagnosis. Weight gain predictors were stress and low depression for patients without a psychiatric diagnosis and binge eating behaviors for patients with a psychiatric diagnosis. Of patients without a psychiatric diagnosis, 60% reported much more frequent night eating episodes. The risk of night eating syndrome in persons affected by overweight/obesity with no psychiatric diagnosis should be further investigated to inform the development of tailored medical, psychological, and psychosocial interventions.     

Assessing Psychological Symptoms in Recent Immigrant Adolescents

Immigrant youth are often exposed to numerous psychosocial stressors, placing them at risk for psychological distress. Little research assesses psychopathology in this population during early stages of acculturation. This study compared student and teacher reports of psychological symptoms in a diverse sample of recently immigrated youth. Students (N = 174) attended public high schools in a northeastern city. Students and teachers independently completed the Achenbach System of Empirically Based Assessment, and four DSM-derived subscales were explored. Psychological symptoms among immigrant students were higher than normative rates. Across all subscales, teacher ratings of student symptoms were significantly lower than student self-reported symptoms, and this difference was larger than that found in a normative sample. Results suggest that many immigrant youth experience psychological problems but may not be perceived as being in distress. Therefore, the most effective assessment approach may be active screening, rather than relying on self initiated help-seeking or teacher observation alone.     

Psychological interventions in patients with chronic physical diseases and psychological comorbidity

The term chronic physical disease summarizes various diseases characterized by a multifactorial genesis, long-term and often progressive course, as well as frequent restricting physical and psychosocial sequelae. Over the last 2?decades, research in medical psychology has demonstrated high prevalence rates of psychological comorbidity among patients with chronic medical conditions, indicating an urgent need for psychosocial treatment. The goal of psychosocial interventions is to reduce adverse disease consequences and improve quality of life. The intervention programs can be differentiated according to target populations, healthcare models, indications, treatment models, and treatment settings. They range from rather general approaches based on broad psychosocial support, health promotion, and patient education programs to problem-specific interventions. Concerning theoretical approaches, cognitive?Cbehavioral interventions currently dominate; however, psychodynamic oriented and mixed approaches are being increasingly implemented. Reviews and meta-analyses of evaluation studies demonstrate the efficacy of these programs. However, there is still a discrepancy between psychotherapeutic options for patients with chronic physical diseases and their practical implementation.     

Inpatient management of children and adolescents with psychiatric diseases in Germany

Employing official statistics from the year 1997 the present article analyses in-patient treatment of children and adolescents with psychological disorders in all 16 German Bundeslaender. Sixty per cent of the children and adolescents who are referred to and treated in a German clinic for psychological disorders on the basis of a psychiatric diagnosis are not given professionally adequate treatment. Furthermore, evidence is presented documenting inpatient treatment of children only 0 to 12 months of age in clinics throughout Germany on the basis of psychiatric diagnoses. A new measure is introduced for future planning of inpatient health care for children and adolescents with psychological disorders in Germany.     

Race,psychiatric comorbidity,and headache characteristics in patients in headache subspecialty treatment clinics

Objective. This research examined how race, psychiatric comorbidity, and headache characteristics are inter-related in patients with severe headache disorders.

Design. This study used a naturalistic cohort design and assessed 114 Black and 173 White patients receiving treatment in headache subspecialty clinics in Cincinnati, Cleveland, Columbus, and Toledo, OH. Face-to-face interviews yielded headache and psychiatric diagnoses; 30-day daily diaries collected data on headache frequency, severity, and disability; and self-administered surveys obtained data on headache management self-efficacy, headache locus of control, and quality of life.

Results. Compared with Whites, Blacks reported more frequent and severe headaches, were more likely to be diagnosed with depressive disorders, and were more likely to be diagnosed with chronic headaches. White and Black patients diagnosed with both depression and anxiety reported the most frequent headache days per month and the lowest levels of life quality and headache management self-efficacy.

Conclusions. Additional research on race, psychiatric comorbidity, and headache characteristics is needed that can inform culturally contextualized interventions for persons with severe headache disorders.     

Diagnosis of psychiatric disorder in clinical evaluation of chronic fatigue syndrome

The overlap of symptoms in chronic fatigue syndrome (CFS) and psychiatric disorders such as depression can complicate diagnosis. Patients often complain that they are wrongly given a psychiatric label. We compared psychiatric diagnoses made by general practitioners and hospital doctors with diagnoses established according to research diagnostic criteria. 68 CFS patients referred to a hospital fatigue clinic were assessed, and psychiatric diagnoses were established by use of a standardized interview schedule designed to provide current and lifetime diagnoses. These were compared with psychiatric diagnoses previously given to patients. Of the 31 patients who had previously received a psychiatric diagnosis 21 (68%) had been misdiagnosed: in most cases there was no evidence of any past or current psychiatric disorder. Of the 37 patients who had not previously received a psychiatric diagnosis 13 (35%) had a treatable psychiatric disorder in addition to CFS. These findings highlight the difficulties of routine clinical evaluation of psychiatric disorder in CFS patients. We advise doctors to focus on subtle features that discriminate between disorders and to use a brief screening instrument such as the Hospital Anxiety and Depression Scale.