Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain

OBJECTIVE: The study examined the associations between several sociodemographic and psychosocial variables and unexplained chronic fatigue in the community before and after adjustment for psychiatric morbidity and determined the prevalence of fatigue and rate of disability resulting from fatigue in the general population. METHOD: The study is a secondary analysis of 1993 data from a household survey of psychiatric morbidity conducted by the Office for Population Censuses and Surveys in Great Britain. The survey included 12,730 subjects age 16-64 years. Unexplained chronic fatigue was used as the dependent variable in a logistic regression analysis, with various sociodemographic and psychosocial variables and psychiatric morbidity as the independent variables. Psychiatric morbidity was assessed by using the Revised Clinical Interview Schedule. Fatigue was measured by using the fatigue section of the Revised Clinical Interview Schedule. RESULTS: A total of 10,108 subjects agreed to cooperate (79.4% participation rate). The prevalence of unexplained chronic fatigue was 9%. Subjects with psychiatric morbidity had higher rates of fatigue. Adjustment for psychiatric morbidity had a minor effect on the associations between sociodemographic factors and chronic fatigue. After adjustment, older subjects, women, and couples with children had higher rates of fatigue. Single subjects, widowed subjects, adults living with parents, and economically inactive subjects had lower rates of fatigue. Fatigue was associated with considerable disability, but most of this disability was explained by the association between fatigue and psychiatric morbidity. CONCLUSIONS: Unexplained chronic fatigue is a common condition, strongly associated with psychiatric morbidity. The close relationship between fatigue and psychiatric morbidity should not obscure the possibility of differences as well as similarities in their etiologies.     

Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain

The study examined the associations between several sociodemographic and psychosocial variables and unexplained chronic fatigue in the community before and after adjustment for psychiatric morbidity and determined the prevalence of fatigue and rate of disability resulting from fatigue in the general population. The study is a secondary analysis of 1993 data from a household survey of psychiatric morbidity conducted by the Office for Population Censuses and Surveys in Great Britain. The survey included 12,730 subjects age 16-64 years. Unexplained chronic fatigue was used as the dependent variable in a logistic regression analysis, with various sociodemographic and psychosocial variables and psychiatric morbidity as the independent variables. Psychiatric morbidity was assessed by using the Revised Clinical Interview Schedule. Fatigue was measured by using the fatigue section of the Revised Clinical Interview Schedule. A total of 10,108 subjects agreed to cooperate (79.4% participation rate). The prevalence of unexplained chronic fatigue was 9%. Subjects with psychiatric morbidity had higher rates of fatigue. Adjustment for psychiatric morbidity had a minor effect on the associations between sociodemographic factors and chronic fatigue. After adjustment, older subjects, women, and couples with children had higher rates of fatigue. Single subjects, widowed subjects, adults living with parents, and economically inactive subjects had lower rates of fatigue. Fatigue was associated with considerable disability, but the association between fatigue and psychiatric morbidity explained most of this disability. Unexplained chronic fatigue is a common condition, strongly associated with psychiatric morbidity. The close relationship between fatigue and psychiatric morbidity should not obscure the possibility of differences as well as similarities in their aetiologies.     

Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain

The study examined the associations between several sociodemographic and psychosocial variables and unexplained chronic fatigue in the community before and after adjustment for psychiatric morbidity and determined the prevalence of fatigue and rate of disability resulting from fatigue in the general population. The study is a secondary analysis of 1993 data from a household survey of psychiatric morbidity conducted by the Office for Population Censuses and Surveys in Great Britain. The survey included 12,730 subjects age 16-64 years. Unexplained chronic fatigue was used as the dependent variable in a logistic regression analysis, with various sociodemographic and psychosocial variables and psychiatric morbidity as the independent variables. Psychiatric morbidity was assessed by using the Revised Clinical Interview Schedule. Fatigue was measured by using the fatigue section of the Revised Clinical Interview Schedule. A total of 10,108 subjects agreed to cooperate (79.4% participation rate). The prevalence of unexplained chronic fatigue was 9%. Subjects with psychiatric morbidity had higher rates of fatigue. Adjustment for psychiatric morbidity had a minor effect on the associations between sociodemographic factors and chronic fatigue. After adjustment, older subjects, women, and couples with children had higher rates of fatigue. Single subjects, widowed subjects, adults living with parents, and economically inactive subjects had lower rates of fatigue. Fatigue was associated with considerable disability, but the association between fatigue and psychiatric morbidity explained most of this disability. Unexplained chronic fatigue is a common condition, strongly associated with psychiatric morbidity. The close relationship between fatigue and psychiatric morbidity should not obscure the possibility of differences as well as similarities in their aetiologies.     

Psychological functioning and psychiatric morbidity in an elderly urban population in Greece

Summary As part of a systematic epidemiological survey of mental disorders in two Athenian boroughs, a probability sample of 251 elderly community residents was examined by a psychiatrist. For the assessment of their mental health, symptom screening scales were used (Langner and CES-D). Cognitive functioning was also evaluated. An overall psychological functioning profile was composed from previously derived mental health levels. Clinical diagnostic examination was based on a semi-structured schedule (PEF) supplemented by DSM-III criteria.A higher proportion of females than males were characterised as psychologically impaired, reporting nonspecific symtoms of distress. Older respondents of lower socioeconomic status experiencing stressful life events, such as living alone or having been exposed to migration in the past, exhibited a significant degree of psychopathology. Of the sample, 20.3% was diagnosed as suffering from a specific psychiatric illness. The prevalence of organic mental disorders was 5.6% and affective disorders of any type constituted nearly half of the diagnosed psychiatric cases. The implications of this survey are of great importance for the design and the development of preventive strategies and community-based interventions.     

Chronic fatigue and minor psychiatric morbidity after viral meningitis: a controlled study.

OBJECTIVE--To test the hypotheses that patients exposed to viral meningitis would be at an increased risk of developing chronic fatigue syndrome and would have an excess of neurological symptoms and physical impairment. METHODS--Eighty three patients were followed up 6-24 months after viral meningitis and a postal questionnaire was used to compare outcome with 76 controls who had had non-enteroviral, non-CNS viral infections. RESULTS--For the 159 patients and controls the prevalence of chronic fatigue syndrome was 12.6%, a rate higher than previously reported from primary care attenders, suggesting that moderate to severe viral infections may play a part in the aetiology of some fatigue states. Those with a history of meningitis showed a slight, non-significant increase in prevalence of chronic fatigue syndrome (OR 1.4; 95% CI 0.5-3.6) which disappeared when logistic regression and analysis was used to correct for age, sex, and duration of follow up (OR 1.0; 95% CI 0.3-2.8). Controls showed marginally higher psychiatric morbidity measured on the general health questionnaire-12 (adjusted OR 0.6; 95% CI 0.3-1.3) Both groups had similar rates of neurological symptoms and physical impairment. The best predictor of chronic fatigue was a prolonged duration time of off work after the illness (OR 4.93, 95% CI 1.3-18.8). The best predictor of severe chronic fatigue syndrome diagnosed by Center for Disease Control criteria was past psychiatric illness (OR 7.82, 95% CI 1.8-34.3). Duration of viral illness, as defined by days in hospital, did not predict chronic fatigue syndrome. CONCLUSIONS--(1) The prevalence of chronic fatigue syndrome is higher than expected for the range of viral illnesses examined; (2) enteroviral infection is unlikely to be a specific risk factor for its development; (3) onset of chronic fatigue syndrome after a viral infection is predicted by psychiatric morbidity and prolonged convalescence, rather than by the severity of the viral illness itself.     

Physical morbidity in elderly psychiatric inpatients: prevalence and possible relations between the major mental disorders and physical illness

BACKGROUND: This study examines the prevalence of physical morbidity in elderly psychiatric inpatients and the possible relationships between major psychiatric disorders (organic mental disorders, schizophrenic and mood disorders) and physical illnesses. The clinical implications of such relationships are discussed. METHOD: Data were obtained from two old age psychiatry wards over a six month period. Seventy-nine subjects were studied and information was obtained from their medical files. Demographic characteristics, psychiatric diagnosis, number of physical illnesses and number of body systems affected were collected. Analysis of variance (ANOVA) was used to compare the psychiatric groups on continuous outcome data and chi(2) test to compare psychiatric groups on categorical data. RESULTS: Seventy-five per cent of subjects had at least one physical illness. The number of medical illnesses was independent from the psychiatric disorder. Subjects with mood disorders, and especially depression, were more likely to suffer from hypertension, diabetes and cardiovascular illnesses than subjects with schizophrenic or organic disorders. Subjects with organic disorders had the lowest prevalence of endocrine disease and diabetes. CONCLUSIONS: It was concluded the link between mood disorders (depression), cardiovascular diseases and hypertension could be of a 'cause/effect' type or are the results of a survivor effect. The high prevalence of physical morbidity has implications for training and continuing professional development of those in Old Age Psychiatry Services. It should also be taken into consideration when the location of services is being decided.     

Psychological morbidity of farmers and non-farming population: results from a UK survey

The relatively high rate of suicide among UK farmers suggests that they may suffer greater mental health problems than the general population. This paper provides a comparison of the psychological morbidity of farmers and their partners/spouses with non-farmers. The General Health Questionnaire (GHQ-12) was administered using face-to-face interviews with 784 attendees of agricultural shows in the UK. Results show that GHQ-12 scores for farmers and their partners/spouses were significantly higher (P?相似文献   

Psychomotor activity as a correlate of Depression and sleep in acutely disturbed psychiatric inpatients.

Combining a lightweight telemetric mobility sensing system with nightly EEG-sleep recordings, the authors obtained continuous monitoring of rest-activity cycles among psychiatric patients hospitalized for primary depression or acute schizophreniform thought disorder. The patients with primary depression had a significantly higher percentage of their total 24-hour motor activity distributed during the night. Furthermore, this increased nocturnal motor activity did not correlate significantly with concurrent EEG-sleep measures of wakefulness. Indeed, the best predictors of wakefulness were measures of daytime activity. This desynchronization of sleep and nighttime motor activity in primary depression may explain the need for combined pharmacotherapy in some severely depressed patients. The authors suggest that expressing activity as a percentage distribution function, rather than in terms of absolute amplitude, provides an objective diagnostic index of depression.     

REM sleep and adaptation of psychiatric patients: an application of sleep studies.

The authors used sleep laboratory data to predict responses to psychiatric treatment. The predictions were based on the assumptions that REM latency reflects the need for dreaming and therefore the need for adaptation and that REM time reflects the capacity for the adaptive work associated with REM sleep. Dream recall and dream content were considered indicators of psychological mindedness and the patient's current conflicts. With this material, statistically significant predictions of such outcomes as good response to psychotherapy, elopement, or need for medication were made. The results of this study support the hypothesis that REM sleep is involved in adaptation.     

Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions

BACKGROUND: No information is available on the co-occurrence of DSM-IV nicotine dependence and Axis I and II psychiatric disorders in the US population. OBJECTIVES: To present national data on the co-occurrence of current DSM-IV nicotine dependence and other psychiatric disorders by sex and to estimate the burden of all US tobacco consumption carried by nicotine-dependent and psychiatrically ill individuals. DESIGN: Face-to-face interviews. SETTING: The United States. PARTICIPANTS: Household and group-quarters adults (N = 43 093). MAIN OUTCOME MEASURES: Prevalence and comorbidity of current nicotine dependence and Axis I and II disorders and the percentage of cigarettes consumed in the United States among psychiatrically vulnerable subgroups. RESULTS: Among US adults, 12.8% (95% confidence interval, 12.0-13.6) were nicotine dependent. Associations between nicotine dependence and specific Axis I and II disorders were all strong and statistically significant (P<.05) in the total population and among men and women. Nicotine-dependent individuals made up only 12.8% (95% confidence interval, 12.0-13.6) of the population yet consumed 57.5% of all cigarettes smoked in the United States. Nicotine-dependent individuals with a comorbid psychiatric disorder made up 7.1% (95% confidence interval, 6.6-7.6) of the population yet consumed 34.2% of all cigarettes smoked in the United States. CONCLUSIONS: Nicotine-dependent and psychiatrically ill individuals consume about 70% of all cigarettes smoked in the United States. The results of this study highlight the importance of focusing smoking cessation efforts on individuals who are nicotine dependent, individuals who have psychiatric disorders, and individuals who have comorbid nicotine dependence and other psychiatric disorders. Further, awareness of industry segmentation strategies can improve smoking cessation efforts of clinicians and other health professionals among all smokers and especially among the most vulnerable.     

Cardiac and cerebrovascular morbidity and mortality associated with antipsychotic medications in elderly psychiatric inpatients.

OBJECTIVE: To evaluate the rate of adverse medical outcomes for elderly exposed to antipsychotic treatment. METHODS: This was a retrospective evaluation of psychiatric inpatients records. Age, gender, diagnosis, treatment with antipsychotics, and duration of treatment were analyzed. An acute cardiac or cerebrovascular event necessitating transfer to a general hospital or resulting in death was the outcome measure. RESULTS: During 15 years (1990 to 2005), 3,111 elderly were hospitalized. Their mean age was 73.5 +/- 6.1 years, 1,220 were male (39%), and 1,891 were female (61%). Most patients (2,583 [83%]) were exposed to antipsychotics, of which 1,402 (54%) were exposed to second-generation antipsychotics (SGAs). Antipsychotic-treated patients did not have a higher rate of adverse medical outcomes compared with patients who had not received antipsychotics. No significant differences were noted between patients exposed to typical antipsychotics or SGAs. CONCLUSION: Treatment of elderly psychiatric inpatients with antipsychotics did not increase their risk of adverse medical outcomes. Thus, regulating the use of conventional antipsychotics or SGAs for all elderly patients in all indications may be premature.     

Chronic physical conditions and use of health services among persons with mental disorders: results from the Israel National Health Survey

OBJECTIVE: This study aimed to determine the association between common mental disorders and common chronic physical conditions and the contribution of mental disorders to the likelihood of being a higher user of health services. METHOD: A representative sample extracted from the National Population Register of noninstitutionalized residents of Israel aged 21 or older were interviewed at their homes between May 2003 and April 2004. Mental disorders were assessed using a revised version of the World Mental Health Composite International Diagnostic Interview. Chronic physical conditions were measured via a checklist of chronic physical disorders. RESULTS: Current mood or anxiety disorders were found to be associated with higher likelihood of chronic pain, cardiovascular conditions, diabetes and respiratory conditions beyond the sociodemographic characteristics and the risk factors (BMI or smoking). Current mood or anxiety disorders increased the likelihood of being a higher user of primary care beyond the effects of gender, population group, self-evaluation of general health, chronic pain or chronic conditions. CONCLUSION: The results regarding the prevalence of mental-physical comorbidity emphasize the need for integration in the physical and mental care of people with mental disorders.     

Somatic and psychiatric comorbidity in the general elderly population: results from the ZARADEMP Project

OBJECTIVE: In a representative sample of the elderly population in a southern European city, we tested the hypothesis that there is an association between general somatic and general psychiatric morbidity. METHODS: A stratified random sample of 4803 individuals aged > or =55 years was selected for the baseline study in the ZARADEMP Project. The elderly were assessed with standardized Spanish versions of instruments, including the Geriatric Mental State (GMS)-AGECAT. Psychiatric cases were diagnosed according to GMS-AGECAT criteria, and somatic morbidity was documented with the EURODEM Risk Factors Questionnaire. RESULTS: General comorbidity clustered in 19.9% of the elderly when hypertension was removed from the somatic conditions category, with 33.5% of the sample remaining free from both somatic and psychiatric illnesses. General comorbidity was associated with age, female gender, and limited education, but did not increase systematically with age. The frequency of psychiatric illness was higher among the somatic cases than among noncases, and the frequency of somatic morbidity among the psychiatric cases was higher than among noncases. This association between somatic and psychiatric morbidity remained statistically significant after controlling for age, gender, and education [odds ratio (OR)=1.61; confidence interval (CI)=1.38-1.88]. Most somatic categories were associated with psychiatric illness, but after adjusting for demographic variables and individual somatic illnesses, the association remained statistically significant only for cerebrovascular accidents (CVAs) (OR=1.47; CI=1.09-1.98) and thyroid disease (OR=1.67; CI=1.10-2.54). CONCLUSION: This is the first study to document that there is a positive and statistically significant association between general somatic morbidity and general psychiatric morbidity in the (predominantly) elderly population. CVAs and thyroid disease may have more weight in this association.     

Supported education programming for adults with psychiatric disabilities: results from a national survey

Over the last 10 years, supported education (SEd) programs have been the topic of many journal publications and conference presentations, but little is known about their numbers and types across the U.S. This article reports the results of a national survey of all known SEd programs, numbering over 100. The largest number was associated with clubhouses, where full and partial SEd models could be identified. On-site supported education programs were located in community colleges and universities. A dozen "free-standing" programs were also identified. Analyses documented differences across program types in services provided, budget amounts and sources, and coordination with mental health and higher educational institutions. If supported education is to move beyond a specialty program in mental health, providers need to do more to market these services and to work collaboratively with stakeholder groups to expand supported education programming.     

The guy's/age concern survey: Physical health and psychiatric disorder in an urban elderly community

The associations between physical health problems and cognitive impairment, depression, generalized anxiety and phobic disorders are described in a random community sample of 890 elderly people. 28.4% of the total sample reported one or more serious physical health problems, and increased rates of health problems were associated with cognitive impairment, depression, generalized anxiety and agoraphobia. Particular psychiatric disorders were associated with distinct patterns of specific physical health problems. Self-reports of physical health problems were associated with worry about physical health, but this did not account for the association between physical health problems and depression and agoraphobia.     

Emetophobia: preliminary results of an internet survey.

Through electronic mail, we surveyed members of an internet support group for emetophobia (fear of vomiting). Respondents were 50 women and 6 men with a mean age of 31 years. Results suggest that, for this sample, emetophobia is a disorder of early onset and chronic course, with highly persistent and intrusive symptoms. Emetophobia is implicated in social, home-marital, and occupational impairment and it causes significant constriction of leisure activities. Nearly half of women avoided or delayed becoming pregnant. About three quarters of respondents have eating rituals or significantly limit the foods they eat. Respondents describe other problems such as depression, panic attacks, social anxiety, compulsions, and frequent history of childhood separation anxiety.     

Subtypes of psychopathy in the British household population: findings from the national household survey of psychiatric morbidity

Background

Cleckley asserted in 1941 that psychopathic personalities are found in the community as well as prisons. Subtypes of abnormal personality may be identifiable in the general population using contemporary measures of psychopathy.

Methods

Cluster analysis of PCL:SV scores using the four-facet model with a representative sample of 624 adults aged 16–74?years living in households interviewed in the second of a two-phase survey in Great Britain.

Results

Analysis confirmed an optimum 5-cluster solution and existence in the general population of prototypical or criminal psychopaths, non-psychopathic habitual criminals, and “successful psychopaths”. Two additional clusters were identified, one uniquely characterised by impulsive/irresponsible (Facet 3) items and the other by social failure associated with low scores on each facet.

Conclusions

The study confirmed previously hypothesised and two new subtypes of psychopathy within the general population. This prototypical classification may compliment existing typologies during clinical assessment following further refinement.