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.

scholarly journals Substance use and psychiatric disorders in patients referred to consultation-liaison psychiatry within a regional general hospital

2021 ◽  
Author(s):  
Murray Tucker ◽  
Harry Hill ◽  
Emma Nicholson ◽  
Steven Moylan
Keyword(s):  
Substance Use ◽  
Psychiatric Disorders ◽  
General Hospital ◽  
Psychiatric Diagnosis ◽  
Diagnostic Category ◽  
Adjustment Disorder ◽  
Post Traumatic Stress ◽  
Liaison Psychiatry ◽  
Hospital Patients ◽  
Consultation Liaison Psychiatry

Abstract Little is known about clinically important differences between patients depending on the number of comorbid psychiatric disorders, or the presence or absence of a substance use disorder (SUD) comorbidity. This study investigated for differences in psychosocial disadvantage, psychiatric disorders, and health service amongst 194 general hospital patients referred to consultation-liaison psychiatry (CLP) with no psychiatric diagnosis, single psychiatric diagnosis, multiple (non-SUD) psychiatric diagnoses, or psychiatric diagnosis plus SUD comorbidity. The results showed that SUDs were the commonest diagnostic category (34%). The SUD comorbidity group had more disadvantaged housing, were prescribed most psychoactive medications, and 20% prematurely self-discharged against medical advice. Increased SUDs were associated with reduced length of stay, men, younger age, increased investigations, and reduced private health insurance subscription. Patients with SUD comorbidity versus multiple psychiatric diagnosis had reduced odds of Adjustment Disorder, Somatic Symptom Disorder, and Insomnia Disorder. Post Traumatic Stress Disorder was the strongest predictor of multiple SUDs, followed by Cluster B personality disorders. In conclusion, SUDs have become a leading clinical focus for CLP. The presence or absence of SUDs amongst patients with multiple psychiatric disorders has important clinical implications for engagement, diagnosis, prescribing, and outpatient follow-up.

scholarly journals Adjustment Disorder and Suicidal Behaviours Presenting in the General Medical Setting: A Systematic Review

2019 ◽  
Vol 16 (16) ◽  
pp. 2967 ◽  
Author(s):  
Joanne Fegan ◽  
Anne M. Doherty
Keyword(s):  
Suicidal Ideation ◽  
Strong Association ◽  
Treatment Strategies ◽  
Adjustment Disorder ◽  
Evidence Base ◽  
Medical Setting ◽  
Liaison Psychiatry ◽  
Background Adjustment ◽  
High Prevalence ◽  
Self Harm

Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and behaviours, and AD. In this paper, we aimed to explore this relationship, by establishing the incidence of AD in patients who present with self-harm and suicidal ideation, and the rates of self-harm among patients with a diagnosis of AD. Methods: We conducted a review of the literature of well-established databases using specific key words then synthesised the results into a descriptive narrative as well as representing it in table form. Results: Sample sizes and study methods varied significantly across the review. A majority of studies were retrospective chart-based reviews, and only three used structured diagnostic instruments. A high prevalence of AD (ranging from 9.8 to 100%) was found, with self-poisoning representing the most common form of suicide attempt in the majority of studies. Interpersonal difficulties were the main precipitant in studies which examined this. Conclusions: This study suggests there is a strong association between AD and suicidal behaviours. Given the paucity of research in the area, there is a need to build the evidence base for effective treatment strategies.

A System-wide Retrospective Cohort Analysis of Psychiatric Diagnoses and Persistent Symptoms Following Concussion

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S16.2-S17
Author(s):  
Diab Ali ◽  
Jose H. Posas
Keyword(s):  
Psychiatric Diagnosis ◽  
Retrospective Cohort ◽  
Longitudinal Research ◽  
Neuropsychiatric Symptoms ◽  
Cohort Analysis ◽  
Adjustment Disorder ◽  
Psychiatric Diagnoses ◽  
Psychiatric Comorbidities ◽  
Hospital System ◽  
Persistent Symptoms

ObjectiveTo evaluate the epidemiologic features of psychiatric comorbidities following mild traumatic brain injury (MTBI, or concussion) in a state-wide hospital system cohort over a 10-year period.BackgroundThe epidemiology of neuropsychiatric symptoms and diagnoses following concussion are poorly understood. Despite the rebirth of post-concussion syndrome (PCS) as persistent post-concussion symptoms (PPCS), entailing diverse and complex somatic, cognitive, and emotional components with significant potential overlap or confounding of psychiatric comorbidities, there is scarce characterization of the incidence of such comorbidities following concussion. The study of demographic factors as they relate to psychiatric diagnoses following concussion remains in infancy.Design/MethodsWe conducted an observational retrospective cohort study of all patients who received a diagnosis of concussion within Ochsner Health (OH) over a 10-year period. System-wide electronic medical records were evaluated using ICD-10 codes to collect data on patients with a diagnosis of MTBI or concussion, as compared to patients with no diagnosis of concussion over the same period. Data on subpopulations corresponding to psychiatric diagnostic outcomes following diagnosis of concussion were collected and evaluated to determine timeline-related incidences of outcomes, as well as on demographic and morbid features corresponding to each outcome. These included age, sex, race, ethnicity, household income, neurologic and psychiatric history, cause of concussion, and presence of loss of consciousness.ResultsWe report incidence, demographic, and morbid factor data on patients with a diagnosis of concussion, and as related to outcomes following diagnosis of concussion, including: (1) new diagnosis of PCS, (2) meeting PPCS Berlin Sport Concussion Consensus criteria, (3) new unclassified neuropsychiatric symptoms, (4) any new psychiatric diagnosis, (5) new psychiatric diagnosis excluding PCS, (6) new anxiety, dissociative, stress-related, or somatoform disorder diagnosis, (7) new reaction to severe stress or adjustment disorder diagnosis, and (8) new PTSD diagnosis.ConclusionsWe call for multidisciplinary awareness, screening, and longitudinal research of patients with concussion.

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.

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.

Could routine spirometry suggest sensitisation in the military medicine setting?

2017 ◽  
Vol 164 (1) ◽  
pp. 58-60 ◽  
Author(s):  
Ignazio Cirillo ◽  
F Gallo ◽  
G Ciprandi
Keyword(s):  
Military Personnel ◽  
Skin Prick Testing ◽  
Military Medicine ◽  
Medical Setting ◽  
Prick Test ◽  
Formal Requirement ◽  
Forced Expiratory Flow ◽  
Navy Personnel ◽  
The Military ◽  
Pulmonary Volume

IntroductionProviding evidence of sensitisation is the formal requirement for allergy diagnosis. The aim of this study was to evaluate whether spirometry may be able to predict sensitisation in a representative cohort of Italian Navy military personnel.Methods2043 (1875 men, 168 women, mean age 28.35±11.6 years) Italian Navy military personnel were enrolled into this study. Spirometry and skin prick testing were performed to predict sensitisation.ResultsSensitisation, assessed by skin prick test, was documented in 658 (32.2%) subjects. Impaired forced expiratory flow at the 25% and 75% of the pulmonary volume (FEF25–75) as demonstrated on spirometry was detected in 82 subjects, of whom 69 were sensitised (P<0.0001). Impaired FEF25–75 was significantly associated with sensitisation (OR 7.43; 95% CI 4.04 to 14.66; P<0.0001).DiscussionThe findings of this study suggest that impaired FEF25–75 may predict sensitisation in this cohort of Italian Navy personnel. This outcome is relevant in the military medical setting, as it could allow early identification of subjects with subclinical asthma.

scholarly journals Sociocultural Context of Suicidal Behaviour in the Sundarban Region of India

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
A. N. Chowdhury ◽  
S. Banerjee ◽  
A. Brahma ◽  
A. Hazra ◽  
M. G. Weiss
Keyword(s):  
Psychiatric Diagnosis ◽  
Suicidal Behaviour ◽  
Adjustment Disorder ◽  
Community Action ◽  
Easy Access ◽  
Social Stressors ◽  
Young Females ◽  
Detailed Assessment ◽  
Self Harm

The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their “intention to die,” and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.

scholarly journals Adolescent units: a need for change?

2003 ◽  
Vol 27 (8) ◽  
pp. 292-294 ◽  
Author(s):  
Tim Calton ◽  
Jon Arcelus
Keyword(s):  
Mental Health ◽  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
General Purpose ◽  
Clinical Implications ◽  
Violent Behaviour ◽  
Mental Health Act

Aims and MethodTo describe the characteristics and diagnoses of patients admitted to a general adolescent psychiatric in-patient unit. We describe the age, gender and psychiatric diagnosis of the patient, as well as whether the patient exhibited violent behaviour in the ward, whether he/she needed to be transferred to a different service and whether he/she was admitted under a section of the Mental Health Act 1983.ResultsPatients were evenly distributed in terms of gender, with most being 14–16 years old. Diagnoses were varied with adjustment disorder predominating, but could be separated into four main groups. Levels of violence were high, being associated with detention under the Mental Health Act 1983, and often resulted in transfer to another service.Clinical ImplicationsThe needs of certain adolescents admitted to a general-purpose adolescent unit may not be best met in this environment. Current services must change to meet the needs of their patients. There may be a need for greater specialisation.

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 Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Yousaf Iqbal ◽  
Majid Ali Al Abdulla ◽  
Sultan Albrahim ◽  
Javed Latoo ◽  
Rajeev Kumar ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Psychiatric Morbidity ◽  
Physical Symptoms ◽  
Service Planning ◽  
Psychiatric Diagnoses ◽  
Psychiatric History ◽  
Upper Respiratory Tract ◽  
Liaison Psychiatry ◽  
Wide Range ◽  
Consultation Liaison Psychiatry

Background Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients’ clinical status. Representative samples are needed to inform service planning and research. Aims To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar. Method Retrospective review of 50 consecutive referrals. Results Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%). Conclusions A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.

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