Pediatric Referrals to Psychiatry: III. Is the Psychiatrist's Opinion Heard?

1978 ◽  
Vol 8 (3) ◽  
pp. 295-301 ◽  
Author(s):  
Arthur P. Froese
Keyword(s):  
Psychiatric Diagnosis ◽  
Medical Service ◽  
Psychiatric Evaluation ◽  
Psychiatric Diagnoses ◽  
Discharge Diagnosis ◽  
Psychophysiological Disorders

At least one psychiatric diagnosis was made for 205 of 220 children whose psychiatric evaluation had been requested by the medical service. Only 78 of 242 psychiatric diagnoses given the 205 patients were reflected correctly in the medical discharge diagnoses. In addition, seven of fifteen patients considered to be “normal” by the consulting psychiatrist had a psychiatric or mixed medical-psychiatric diagnoses included in the discharge diagnoses. Psychophysiological disorders, psychoses and special symptom diagnoses were likely to be correctly reflected in the discharge diagnoses, while depression and adjustment reaction were not. Possible reasons why the psychiatrist's diagnostic opinion is not correctly reflected in the discharge diagnosis in over one-half of the referrals are discussed. Pediatricians may be reluctant to label their patients “neurotic” for life, or may consider the problem transient—that is, only a “passing phase.” But these theories are discounted by the fact that seven patients considered to be emotionally normal when assessed by the psychiatrist were discharged with a psychiatric or mixed medical-psychiatric diagnosis.

Neuropsychiatric Assessment of Liver Transplantation Candidates: Delirium and other Psychiatric Disorders

1987 ◽  
Vol 16 (2) ◽  
pp. 101-111 ◽  
Author(s):  
Paula T. Trzepacz ◽  
Fred R. Maue ◽  
Gerald Coffman ◽  
David H. Van Thiel
Keyword(s):  
Liver Transplantation ◽  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
Hepatic Function ◽  
Psychosocial Stressors ◽  
Psychiatric Evaluation ◽  
Medical Illness ◽  
Psychiatric Diagnoses ◽  
Discriminant Analyses ◽  
Preoperative Examination

Forty consecutive liver transplantation candidates underwent a standard psychiatric evaluation as part of a multidisciplinary preoperative examination. Psychiatric diagnoses were determined using DSM-III criteria and correlations between the psychiatric diagnoses and the results of bedside cognitive examinations, biochemical measures of hepatic function, and EEG's were made. Half of the patients could not be given a specific psychiatric diagnosis despite the fact of their being in terminal stages of a severe medical illness and being stressed by the uncertainty of whether they would be accepted for possible liver transplantation. Of the twenty patients given a psychiatric diagnosis, 60 percent were found to be delirious and 35 percent had an adjustment disorder. Delirium was associated with a serum albumin less than 3.0 g/dl, grades 1 through 3 EEG dysrhythmias, a Mini Mental State score less than 24 or impairment on Trailmaking Tests. In addition, discriminant analyses were performed to determine which batteries of tests best differentiated the delirious patients. A unique pattern of psychosocial stressors was noted in these patients where the severity of overall stress and of occupational dysfunction was high in most, yet family and social relationships were reported as less affected.

Pediatric Referrals to Psychiatry: I. Comparison of Referrals and Nonreferrals

1977 ◽  
Vol 7 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Arthur P. Froese
Keyword(s):  
Hospital Stay ◽  
Psychiatric Diagnosis ◽  
Psychiatric Evaluation ◽  
Discharge Diagnosis ◽  
Sex Distribution ◽  
Duration Of Hospital Stay ◽  
Group I ◽  
Group Ii

Age, sex and duration of hospital stay of 220 patients consecutively referred to psychiatry (Group I) and of their fellow 2065 nonreferred patients (Group II) were compared. Overall, Group I was significantly older, remained in hospital longer, and included more girls than boys, whereas Group II included slightly more boys than girls. Separation of Group II into those whose primary discharge diagnosis was psychiatric or nonpsychiatric revealed that mean age and duration of hospital stay of the former were almost identical, and the sex distribution was similar, to those of Group I. These findings suggest that children referred for psychiatric evaluation differ from their nonreferred fellows discharged with a nonpsychiatric diagnosis but not from nonreferred fellows discharged with a psychiatric diagnosis.

Frequency of and Determinants for Psychotropic Drug Use in an Institution for the Mentally Retarded

1990 ◽  
Vol 156 (4) ◽  
pp. 525-530 ◽  
Author(s):  
Olav M. Linaker
Keyword(s):  
Drug Use ◽  
General Population ◽  
Psychotropic Drug ◽  
Small Proportion ◽  
Psychiatric Diagnosis ◽  
Anticonvulsant Drug ◽  
Mentally Retarded ◽  
Significant Trend ◽  
Disruptive Behaviour ◽  
Psychiatric Diagnoses

The frequency of psychotropic and anticonvulsant drug use in 168 institutionalised mentally retarded adults was studied. Use of neuroleptics and anticonvulsants was more frequent and use of hypnotics and antidepressants less frequent than in the general population. Neuroleptics were given to 49% of the population. Clients with no psychiatric diagnosis consumed less neuroleptics than those with such a diagnosis, and there was a non-significant trend for those with a more serious diagnosis (e.g. schizophrenia) to take a higher dosage. The degree of disruptive behaviour and the availability of a physician were related to dosage of neuroleptics. The various psychiatric diagnoses given could explain only a small proportion of the variance in dosage.

Pink and blue: the role of gender in psychiatric diagnosis

2018 ◽  
Vol 45 (4) ◽  
pp. 271-274
Author(s):  
George Gillett
Keyword(s):  
Sexual Orientation ◽  
Diagnostic Criteria ◽  
Psychiatric Diagnosis ◽  
Personal Characteristics ◽  
Psychiatric Diagnoses ◽  
Qualitative And Quantitative ◽  
Diagnostic Bias ◽  
Gender Based ◽  
Changing Attitudes

Why are the diagnostic criteria of some psychiatric disorders standardised by gender while others are not? Why standardise symptom questionnaires by gender but not other personal characteristics such as ethnicity, socioeconomic class or sexual orientation? And how might our changing attitudes towards gender, born from scientific research and changing societal narratives, alter our opinion of these questions? This paper approaches these dilemmas by assessing the concept of diagnosis in psychiatry itself, before analysing two common approaches to the study of psychiatric diagnosis; the naturalist and constructivist views. The paper assesses the relative merits and significance of each, before turning its attention to the nature of gender and its relevance to psychiatry. The paper introduces a framework to approach gender-based diagnostic bias and concludes by drawing a distinction between qualitative and quantitative standardisation, arguing that gender standardisation of psychiatric diagnoses is ethically justified in the former but not the latter.

scholarly journals Emergency Medical Service Transport Times for Acute Stroke and Myocardial Infarction

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 373-373
Author(s):  
Kelly R Evenson ◽  
Trent B Legare ◽  
Emily B Schroeder ◽  
Jane H Brice ◽  
Wayne D Rosamond ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Service ◽  
American Heart ◽  
Heart Association ◽  
Discharge Diagnosis ◽  
Diagnosis Code ◽  
Stroke Patients ◽  
Delivery Of Care ◽  
Emergency Medical ◽  
Wilcoxon Rank Sum Test

P188 It is currently recommended by the American Heart Association that both stroke and myocardial infarction (MI) patients be treated with urgency, as time dependent medical therapies are available for both conditions. Since stroke symptoms are often vague, it has been hypothesized that stroke patients may not be treated with the same urgency as MI patients by emergency medical services (EMS). To examine this hypothesis, EMS transport times were examined for both stroke and MI patients who used a paramedic-level, county based EMS system for transportation to a single hospital during 1999. Patients were identified by their hospital discharge diagnosis as stroke (ICD-9 430–438) or MI (ICD-9 410–414). Trip sheets with the corresponding transport times were retrospectively obtained from the 911 center. Thirteen patients with both a stroke and MI discharge diagnosis code were excluded from these analyses, leaving 75 stroke and 127 MI patients. While stroke patients were older than MI patients (median 81.1 vs. 73.3 years, p=0.01), the distribution of gender (56.9% women) and ethnicity (68.3% white) was not significantly different between stroke and MI patients. The use of lights and sirens to the scene (84.4%) and to the hospital (10.6%) also was not significantly different between stroke and MI patients. Mean EMS transport times are presented below in minutes, with the corresponding Wilcoxon rank sum test. In this study, all components of EMS transport times were similar for stroke and MI patients. Multiple linear regression predicting transport times confirmed these results. In this single county, EMS urgency for delivery of care was not different for stroke and MI patients.

scholarly journals The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology

2019 ◽  
Vol 16 (23) ◽  
pp. 4645 ◽  
Author(s):  
James J. Strain
Keyword(s):  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
Screening Tools ◽  
Medical Setting ◽  
Psychiatric Diagnoses ◽  
Liaison Psychiatry ◽  
Common Features ◽  
Biological Studies ◽  
Depression Scales ◽  
The Military

Adjustment Disorder (AD) is one of the most common psychiatric diagnoses employed. In fact, it is the most frequent diagnosis utilized for psychiatric disorders in the military and in children, and is often utilized in the consultation-liaison medical setting. However, it is acknowledged that the diagnosis is not reliable, it cannot be validated, and it has an important degree of subjective consideration in its use. Commonly used screening tools like the Hamilton and Beck Depression Scales do not give an assessment of AD. Furthermore, its use is accompanied with descriptors of depression, anxiety, mixed affects, etc., so that it crosses over several areas of psychiatric dysfunction. It does allow the placement of a patient within a psychiatric diagnosis when they do not reach criteria for a major psychiatric nomenclature. To date, biological studies have not been reported. It is not known if AD with depression is closer to the biological characteristics of depression, or AD with anxiety would have similar characteristics to that seen with major anxiety. It is also not known if AD has a biological signature that would make them an entity with common features, or if they may be more closely allied biologically with the descriptor that accompanies them. Nevertheless, AD is an important category in any psychiatric lexicon and warrants further study and biological understanding.

Psychiatric diagnoses and cognitive impairment in pediatric multiple sclerosis

2013 ◽  
Vol 20 (5) ◽  
pp. 588-593 ◽  
Author(s):  
Deborah Weisbrot ◽  
Leigh Charvet ◽  
Dana Serafin ◽  
Maria Milazzo ◽  
Thomas Preston ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Psychiatric Disorder ◽  
Global Assessment ◽  
Neuropsychological Test ◽  
Psychiatric Evaluation ◽  
Psychiatric Diagnoses ◽  
Global Assessment Scale ◽  
Psychiatric Interview ◽  
Pediatric Multiple Sclerosis

Background: Pediatric multiple sclerosis (MS) represents approximately 5% of the MS population; information regarding clinical features is slowly accumulating. Cognitive and psychiatric impairments frequently occur, but remain poorly understood. Objectives: To describe psychiatric diagnoses among children with MS referred for psychiatric assessment and their relation to cognitive impairment. Methods: Forty-five pediatric MS patients (aged 8 to 17 years) were referred for outpatient psychiatric evaluation including a psychiatric interview (K-SADS), a clinician-based global assessment of functioning (Children’s Global Assessment Scale, CGAS), a neurologic examination including the Expanded Disability Status Scale (EDSS), and a neuropsychological test battery. Results: The most common categories of psychiatric diagnoses were anxiety disorders ( n=15), attention deficit hyperactivity disorder (ADHD, n=12), and mood disorders ( n=11). Cognitive impairment was classified in 20/25 (80%) of patients meeting criteria for a psychiatric disorder versus 11/20 (55%) of those without psychiatric disorder ( p=0.08). Those diagnosed with anxiety or mood disorder had the highest frequency of cognitive impairment, with a significantly higher rate when compared with those with psychiatric diagnoses in other categories ( p=0.05). Conclusions: A variety of psychiatric diagnoses can occur in children with pediatric MS. Many of these children also had cognitive impairment, particularly those in the mood and anxiety groups.

Six-month and lifetime prevalences of psychiatric disorders in inpatients with diabetes mellitus

1995 ◽  
Vol 10 (5) ◽  
pp. 245-249 ◽  
Author(s):  
F de Mont-Marin ◽  
P Hardy ◽  
JP Lepine ◽  
P Halfon ◽  
A Feline
Keyword(s):  
Diabetes Mellitus ◽  
Anxiety Disorders ◽  
Psychiatric Disorders ◽  
Depressive Episode ◽  
Psychiatric Diagnosis ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Psychiatric Diagnoses ◽  
French Population

SummaryThe Composite International Diagnostic Interview (CIDI) was used to assess the prevalence of psychiatric disorders in a French population of 46 inpatients with diabetes mellitus. According to DSM-III-R criteria, 52.2% of subjects presented at least one psychiatric diagnosis in their lifetime and 41.3% did so less than six months before the study. Affective and anxiety disorders represented at least 83% of the psychiatric diagnoses. The risk for those disorders seems to be restricted to a predisposed group as only one of the 16 subjects who had suffered from an anxiety or depressive episode within the previous six months had never experienced such an episode before.

scholarly journals A register-based observational study on frequent users of emergency services in a Finnish emergency clinic.

2019 ◽  
Author(s):  
Jonna Levola ◽  
Eila Sailas ◽  
Timo Säämänen ◽  
Leena Turunen ◽  
Annika Thomson
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Psychiatric Diagnosis ◽  
Service Use ◽  
Psychiatric Diagnoses ◽  
Service Users ◽  
Frequent Users ◽  
Treatment Services ◽  
Disorder Treatment ◽  
Multivariable Models

Abstract Background: The focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with frequent ER visits. Methods: A cohort (n=138) of frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including ICPC-2 –codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates. Results: Patients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 –codes were inadequately documented. Conclusions: Patients with psychiatric diagnoses are overrepresented in this cohort of frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.

scholarly journals Perspectives on illness-related stigma and electronically sharing psychiatric health information by people with Multiple Sclerosis.

2020 ◽  
Author(s):  
Eileen Yu ◽  
Alexis Adams-Clark ◽  
Alison Riehm ◽  
Caroline Franke ◽  
Ryoko Susukida ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Information ◽  
Electronic Medical Records ◽  
Psychiatric Diagnosis ◽  
Medical Records ◽  
Psychiatric Diagnoses ◽  
Sexual Anxiety ◽  
Related Stigma ◽  
Societal Stigma ◽  
Patient Willingness

Abstract Background: Electronic medical records (EMRs) have transformed the way healthcare professionals manage and share patient data while providing integrated and comprehensive care. However, the rate of EMR use among psychiatrists is generally lower compared to physicians in other medical disciplines, in part due to concerns over patients’ experience of stigma surrounding mental health. This paper explores the willingness to share medical records among people with multiple sclerosis (MS), who experience higher rates of psychiatric comorbidities compared to the general population. It also examines the role that stigma plays in patients’ preferences regarding the sharing of their electronic medical records. Methods: MS patients were surveyed regarding their co-occurring psychiatric and non-psychiatric diagnoses, willingness to share their health information electronically among their treating doctors, and levels of self and societal stigma associated with their various co-occurring diagnoses. Results: 96.44% and 87.14% of participants were willing to share their non-psychiatric and psychiatric diagnoses, respectively; 97.70% and 92.78% were willing to share non-psychiatric and psychiatric medications, respectively. MS patients with a psychiatric co-occurring diagnosis, compared to those without, were significantly more likely to share their psychiatric diagnosis (AOR = 2.59) and psychiatric medications (AOR = 3.19). Those with both non-psychiatric and psychiatric co-occurring diagnoses were significantly more likely to share their psychiatric diagnosis (AOR = 3.84) and psychiatric medications (AOR = 7.02) than patients with no co-occurring diagnosis other than MS. Five (substance use, personality, eating, psychotic, and neurodevelopmental disorders) of the top six diagnoses for which societal stigma was greater than self stigma, and three (sexual, anxiety, and mood disorders) of the top five diagnoses for which self stigma was greater than societal stigma were psychiatric diagnoses. High levels of societal stigma correlated with decreased likelihood in sharing non-psychiatric medications, while high levels of self stigma were associated with a greater decrease in patient willingness to share psychiatric medications. Conclusions: Despite the presence of stigma decreasing patient willingness to share medical records, people with MS who had psychiatric disorders, compared to those without, endorsed greater willingness to share their health records electronically.

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