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1.
Tijdschr Psychiatr ; 58(5): 371-9, 2016.
Article in Dutch | MEDLINE | ID: mdl-27213636

ABSTRACT

BACKGROUND: Catatonia in children and adolescents is the same as it is for adults; in other words it is a recognisable psychomotor syndrome that follows a characteristic course and responds favourably to treatment with benzodiazepines and/or ect. Therefore, one would not expect to encumber many obstacles to diagnosis and treatment. In fact, the obstacles are fairly numerous. AIM: To explore the obstacles that can hinder a simple approach to diagnosis and treatment and to provide support for the clinicians involved. METHOD: We studied the literature systematically using Limo and keywords. RESULTS: For several decades, particularly in the literature, catatonia was defined as a subtype of schizophrenia. This exclusive link to schizophrenia led to the under-diagnosis of catatonia in patients with other psychiatric conditions and to delays in the administration of the correct treatment. Not only this historical error but also other important problems are complicating the approach to catatonia even today. Among other factors hindering diagnosis and treatment are the belief that catatonia is a rare illness, often denied by family members and some clinicians, the use of neuroleptics and the stigmatisation of benzodiazepines and/or ect. CONCLUSION: Controversy about catatonia continues. Although diagnosis and treatment are clearly defined, catatonia is still putting professionals to the test. In our essay we offer some practical guidance and advice.


Subject(s)
Catatonia/diagnosis , Catatonia/therapy , Electroconvulsive Therapy , Informed Consent By Minors , Adolescent , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Catatonia/classification , Catatonia/psychology , Child , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Psychiatric Status Rating Scales , Schizophrenia, Catatonic/classification , Schizophrenia, Catatonic/diagnosis , Schizophrenia, Catatonic/psychology , Schizophrenia, Catatonic/therapy , Schizophrenic Psychology , Treatment Outcome
3.
Tijdschr Psychiatr ; 57(2): 89-93, 2015.
Article in Dutch | MEDLINE | ID: mdl-25669944

ABSTRACT

BACKGROUND: Catatonia develops in children, adolescents, and adults with autism spectrum disorders. AIM: To review catatonia in autism spectrum disorders. METHOD: A case-report is presented and discussed. RESULTS: Catatonia is a comorbid syndrome occurring in 12-17% of selected groups of adolescents and young adults with autism spectrum disorders who have been referred for specialised care or admitted to hospital. Clinical experience and case-reports indicate that benzodiazepines and electroconvulsive therapy can be used safely and effectively in both the treatment in acute cases and maintenance treatments for catatonia patients with autism spectrum disorders. CONCLUSION: Catatonia is a recognisable and treatable syndrome in children and adolescents with autism spectrum disorders.


Subject(s)
Anticonvulsants/therapeutic use , Catatonia/epidemiology , Child Development Disorders, Pervasive/epidemiology , Electroconvulsive Therapy , Benzodiazepines/therapeutic use , Catatonia/therapy , Child , Child Development Disorders, Pervasive/therapy , Comorbidity , Humans , Lorazepam/therapeutic use , Male , Treatment Outcome
4.
Tijdschr Psychiatr ; 57(2): 99-103, 2015.
Article in Dutch | MEDLINE | ID: mdl-25669946

ABSTRACT

BACKGROUND: Catatonia is being increasingly viewed as a unique syndrome consisting of specific motor signs that respond characteristically and uniformly to benzodiazepines and electroconvulsive therapy. This interpretation is also reflected in changes in the classification of catatonia in DSM-5. An all-embracing pathogenesis of catatonia remains elusive. AIM: To review the mechanisms of catatonia. METHOD: We reviewed the literature. RESULTS: Certain aspects of catatonia can be explained by a number of different mechanisms. We present a new, more comprehensive model involving the vagal nerve. CONCLUSION: Further research into the underlying mechanisms of catatonia is needed in order to to find new therapies.


Subject(s)
Catatonia/etiology , Catatonia/pathology , Benzodiazepines/therapeutic use , Catatonia/therapy , Combined Modality Therapy , Electroconvulsive Therapy , Humans , Syndrome
5.
Tijdschr Psychiatr ; 54(5): 475-9, 2012.
Article in Dutch | MEDLINE | ID: mdl-22588963

ABSTRACT

Childhood disintegrative disorder (CDD), early onset schizophrenia (EOS), and late onset autism (LOA) often follow a similar course: initially, development is normal, then there is a sudden neuropsychiatric deterioration of social interaction and communication skills, which is combined with a decline in intelligence and reduction in daily activities. A 9-year-old boy was admitted to the paediatric ward with acute onset of secondary epileptic seizures. It was not long until the boy's symptoms resembled that of patients with cdd, eos and loa. Intensive tests led to the diagnosis of anti-NMDA-receptor encephalitis. Anti-NMDA-receptor encephalitis should be regarded as a possible organic cause underlying the syndromal presentation of CDD, EOS and LOA.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Autistic Disorder/diagnosis , Child Development Disorders, Pervasive/classification , Child Development Disorders, Pervasive/diagnosis , Schizophrenia, Childhood/diagnosis , Age of Onset , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/classification , Autistic Disorder/classification , Child , Diagnosis, Differential , Humans , Male , Schizophrenia, Childhood/classification
6.
Acta Psychiatr Scand ; 125(1): 33-8, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22040029

ABSTRACT

OBJECTIVE: Identify the frequency of catatonia among at-risk children and adolescents receiving psychiatric treatment. METHOD: Subjects were children and adolescents (<18 years), who had received psychiatric treatment at a University Hospital during 2004-2009, and were diagnosed with disorders with known risk for catatonia or displayed symptoms suggestive of catatonia. Approval was obtained from the Investigational Review Board (IRB). The first 101 (n = 101) subjects were selected among 570 subjects identified by psychiatric diagnoses: any pervasive developmental disorder, psychosis-NOS (Not Otherwise Specified), intermittent explosive disorder, mental retardation, catatonia and neuroleptic malignant syndrome. Subjects met study-defined criteria for catatonia, if they had three or more of the following symptoms: unexplained agitation/excitement, disturbed or unusual movements, reduced movements, repetitive or stereotyped movements, or reduced or loss of speech. RESULTS: Eighteen (17.8%) subjects, among a group suspected to be at a higher risk for catatonia, met the study-defined criteria for this syndrome. However, only two subjects had been diagnosed by their treatment providers. Higher rates of intellectual disability and aggression were found among the group that met study-criteria. CONCLUSION: We concluded that catatonia is under recognized and undertreated among children and adolescents receiving psychiatric treatment.


Subject(s)
Catatonia , Hypokinesia/psychology , Intellectual Disability/etiology , Psychomotor Agitation/psychology , Adolescent , Aggression/psychology , Catatonia/diagnosis , Catatonia/etiology , Catatonia/physiopathology , Catatonia/psychology , Child , Child Development Disorders, Pervasive/complications , Child, Preschool , Female , Humans , Intellectual Disability/complications , Intellectual Disability/psychology , Male , Neuroleptic Malignant Syndrome/complications , Psychotic Disorders/complications , Retrospective Studies , Risk Factors , Speech Disorders/complications , Stereotypic Movement Disorder/complications
7.
Acta Psychiatr Scand ; 125(1): 25-32, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22017207

ABSTRACT

OBJECTIVE: Catatonia is considered a unique syndrome of motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, but eminently treatable with specific medical treatments, if recognized early. Catatonia commonly occurs in children and adolescents with a wide range of associated disorders. The role of deprivation, abuse, or trauma in the development of pediatric catatonia is examined. METHOD: Reports considering deprivation, abuse, or trauma as precipitants of catatonia in pediatric cases are culled from the classic writings on catatonia and from a selective review of modern contributions. RESULTS: Kahlbaum gave trauma a central role in catatonia in many young adult cases. Kanner described children with psychogenic catalepsy. Anaclitic depression, a condition found by Spitz in deprived institutionalized children, strongly resembles stuporous catatonia. Leonhard considered lack of communication with the mother or substitute mother as an important risk factor for childhood catatonia. Children including those with autism who experience emotional and physical trauma sometimes develop catatonia. The clinical descriptions of children with classic catatonic syndromes and those of contemporary refugee children with a syndrome labeled Pervasive Refusal Syndrome are similar. CONCLUSION: The literature supports the view that deprivation, abuse, and trauma can precipitate catatonia in children and adolescents.


Subject(s)
Autistic Disorder/diagnosis , Catatonia , Child Abuse/psychology , Child Development , Mother-Child Relations , Adolescent , Catatonia/diagnosis , Catatonia/drug therapy , Catatonia/etiology , Catatonia/psychology , Child , Child, Institutionalized/psychology , Diagnosis, Differential , Early Diagnosis , Early Medical Intervention , Humans , Life Change Events , Precipitating Factors , Psychopathology , Psychosocial Deprivation , Risk Factors
8.
Tijdschr Psychiatr ; 49(4): 257-61, 2007.
Article in Dutch | MEDLINE | ID: mdl-17436212

ABSTRACT

A 24-year-old man who was mentally retarded and had an autistic disorder, developed mutism and motor symptoms. He was diagnosed with catatonia and was treated successfully with lorazepam. Additionally, we review the literature about the diagnosis and treatment of catatonia in patients with autism; in such cases accurate diagnosis is vital but is complicated by overlapping symptoms.


Subject(s)
Autistic Disorder/complications , Catatonia/drug therapy , Hypnotics and Sedatives/therapeutic use , Lorazepam/therapeutic use , Adult , Catatonia/diagnosis , Catatonia/etiology , Humans , Male , Treatment Outcome
9.
Psychol Med ; 32(4): 619-27, 2002 May.
Article in English | MEDLINE | ID: mdl-12102376

ABSTRACT

OBJECTIVE: We aimed to assess the diagnostic outcome of self-reported hallucinations in adolescents from the general population. METHOD: The sample consisted of 914 adolescents between ages 11-18 participating in an ongoing longitudinal study. The participation rate from the original sample was 70%. Responses on the Youth Self-Report questionnaire were used to ascertain hallucinations in adolescents. Eight years later, Axis 1 DSM-IV diagnoses were assessed using the 12-month version Composite International Diagnostic Interview in 783 (86%) of 914 study subjects. No subjects were diagnosed with schizophreniform disorders or schizophrenia. RESULTS: Hallucinations were reported by 6% of adolescents and 3% of young adults. Self-reported hallucinations were associated with concurrent non-psychotic psychiatric problems in both age groups. Adolescents who reported auditory, but not visual, hallucinations, had higher rates of depressive disorders and substance use disorders, but not psychotic disorders, at follow-up, compared to controls. CONCLUSIONS: Self-reported auditory hallucinations in adolescents are markers of concurrent and future psychiatric impairment due to non-psychotic Axis 1 disorders and possibly Axis 2 disorders. It cannot be excluded that there was selective attrition of children and adolescents who developed Schizophrenic or other psychotic disorders later in life.


Subject(s)
Hallucinations/diagnosis , Mental Disorders/diagnosis , Adolescent , Child , Cross-Sectional Studies , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Female , Hallucinations/epidemiology , Hallucinations/psychology , Humans , Longitudinal Studies , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Netherlands/epidemiology , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Sampling Studies
10.
Am J Forensic Med Pathol ; 22(3): 239-43, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11563731

ABSTRACT

The goal in this study was to assess if there is any constancy in detections of psychoactive substances in consecutive suicides. Toxicologic findings in 179 suicides in San Diego County, California, between 1981 and 1982, and 333 suicides in Mobile County, Alabama, between 1990 and 1998, were compared. Alcohol was detected in about 30% of suicides in both samples. Abusable prescription psychoactive substances, i.e., benzodiazepines and opiates, were detected in one fifth of cases in both locations. Nonabusable prescription psychoactive substances, mainly antidepressants, were found in more suicides in Mobile than in San Diego. Detection rates of different classes of psychoactive substances have not changed much in the past decade. Detection of alcohol, cocaine, or cannabis in about 40% of suicides supports the clinical practice of discouraging consumption of these substances in depressed patients. Another challenge is the low rate of detection of antidepressants in suicide, which suggests undertreatment of depression in suicides. Continued reporting of routine, comprehensive, toxicologic findings in suicides is useful to monitor patterns of use of psychoactive substances in this group and to guide suicide prevention in clinical practice and public health policy.


Subject(s)
Psychotropic Drugs/toxicity , Suicide Prevention , Suicide/statistics & numerical data , Adult , Alabama/epidemiology , California/epidemiology , Female , Humans , Male , Medical Records , Retrospective Studies
11.
J Affect Disord ; 64(2-3): 167-74, 2001 May.
Article in English | MEDLINE | ID: mdl-11313083

ABSTRACT

BACKGROUND: Postmortem toxicology can be useful for reconstructing some clinically important events occurring before a suicide. Its utility may be improved by examining patterns of detected substances in a population over time. METHODS: Toxicology was performed for 333 (96%) of the 346 suicides occurring in Mobile County, Alabama, between October 1990 and September 1998. Detected psychoactive substances were grouped in three categories: alcohol, cocaine, and cannabis; abusable prescription medications; and non-abused psychotropic medications. The overlap between these three categories was assessed. RESULTS: Psychoactive substances were detected in 227 (68%) of 333 suicides. Of the cases positive for any prescription psychoactive medication, 2/3 were positive for an abusable medication. An abusable substance was found in 56% of cases positive for non-abused psychotropic medication. Alcohol, cocaine and/or cannabis were found in 34% of cases with abusable prescription medications and in 33% with non-abused psychotropics. LIMITATIONS: Clinicians must be aware of a number of methodological realities when interpreting routine postmortem toxicology results. CONCLUSIONS: Routine surveillance of psychoactive substances among suicides can provide useful data for directing and monitoring strategies for suicide prevention in clinical practice.


Subject(s)
Psychotropic Drugs/analysis , Substance Abuse Detection/methods , Substance-Related Disorders/epidemiology , Suicide/statistics & numerical data , Toxicology/methods , Adolescent , Adult , Aged , Aged, 80 and over , Alabama/epidemiology , Catchment Area, Health , Female , Humans , Male , Middle Aged , Retrospective Studies , Substance-Related Disorders/diagnosis
12.
Arch Intern Med ; 161(7): 991-4, 2001 Apr 09.
Article in English | MEDLINE | ID: mdl-11295962

ABSTRACT

OBJECTIVE: To assess the scope of diagnostic screening for suicide prevention in general hospital patients. METHODS: Retrospective medical record review of general hospital patients who committed suicide and matched-control subjects who did not commit suicide shortly after being discharged from the hospital. RESULTS: The suicide rate was 32 per 100 000 patient-years. Eight (73%) of 11 patients who committed suicide were diagnosed with depression, substance use disorder, or both at their last hospital admission compared with 11 (33%) of the controls (P<.05). Only 1 of 44 patients (both cases and controls) was referred for psychiatric consultation. CONCLUSIONS: The suicide rate in general hospital patients was almost 3-fold higher than in the general population. Depression and/or substance use disorders were risk factors for suicide. Screening for those disorders may be beneficial for suicide prevention in the general hospital population, but will likely benefit more patients who will not commit suicide.


Subject(s)
Depressive Disorder/diagnosis , Hospitals, General , Hospitals, University , Mass Screening/methods , Mass Screening/standards , Patient Discharge/statistics & numerical data , Substance-Related Disorders/diagnosis , Suicide Prevention , Suicide/statistics & numerical data , Adult , Aged , Alabama/epidemiology , Depressive Disorder/complications , Depressive Disorder/drug therapy , Diagnosis, Dual (Psychiatry) , Feasibility Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Substance-Related Disorders/complications
13.
Ann Clin Psychiatry ; 13(4): 191-9, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11958361

ABSTRACT

It is unclear if functional-somatic symptoms in adolescents increase the risk for future psychiatric disorders. Therefore, the outcome and continuity of adolescent self-reported functional-somatic symptoms in young adulthood were assessed. Self-reported data on functional-somatic symptoms from an ongoing epidemiological study in children started in 1983 were analyzed. Participants were adolescents aged 11-18 who filled out standardized questionnaires in 1989 and 1991 and who were reassessed in 1997 when they were young adults between ages 19 and 26. Outcome measures were research psychiatric diagnoses and self-reported functional-somatic symptoms in 1997. Functional-somatic symptoms were associated with other measures of psychopathology in adolescents. Adolescents with specific functional-somatic symptoms tended to report the same symptom along with other symptoms at follow-up. Adolescent self-reported functional-somatic symptoms did not increase the risk for future psychiatric disorders. Young adults with functional-somatic complaints were diagnosed more often than controls with depressive disorders and anxiety disorders, but not with antisocial personality disorders and substance use disorders. Adolescent self-reported functional-somatic symptoms were common and enduring but were not predictive for psychiatric disorders in young adulthood. Adolescents and young adults who complain of multiple functional-somatic complaints should be assessed for the presence of a psychiatric disorder particularly depression or anxiety.


Subject(s)
Mental Disorders/epidemiology , Psychophysiologic Disorders/epidemiology , Adolescent , Child , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Mental Disorders/diagnosis , Netherlands/epidemiology , Psychology, Adolescent , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Residence Characteristics , Risk Factors , Sampling Studies , Somatoform Disorders/diagnosis , Somatoform Disorders/epidemiology , Somatoform Disorders/psychology , Surveys and Questionnaires
14.
Gen Hosp Psychiatry ; 22(4): 281-8, 2000.
Article in English | MEDLINE | ID: mdl-10936636

ABSTRACT

Substance abuse has been associated with attempted suicide and suicide. Few studies have examined the prevalence and associations of combined depression and substance abuse in suicide attempters. A chart review study of 1136 adult general hospital patients referred for psychiatric consultation between 1995 and 1998 was conducted to assess this further. Among 371 cases with self-harm, 311 (84%) attempted suicide. Suicide attempters were younger and diagnosed more often with comorbid substance abuse than patients without self-harm. Depressive disorders were found in 59% and substance abuse disorders in 46%. Comorbid depression and substance abuse was the most frequent category in suicide attempters, i.e., in 37%. Self-reported suicide intent was associated with increasing age, male gender, and comorbid depression and substance abuse. The suicide rate in suicide attempters was 322 per 100,000 patient-years, and 131 per 100,000 in consultation patients without self-harm. It is concluded that comorbid depression and substance abuse is associated with attempted suicide in psychiatric consultation patients. Suicide attempters should be thoroughly assessed for substance abuse. The increased suicide rate in psychiatric consultation patients with and without suicide attempts warrants further research.


Subject(s)
Depression , Psychiatry , Referral and Consultation , Substance-Related Disorders/complications , Suicide, Attempted/psychology , Adult , Comorbidity , Depression/complications , Depression/epidemiology , Depression/therapy , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Substance-Related Disorders/epidemiology , Suicide, Attempted/prevention & control
15.
J Affect Disord ; 59(2): 165-8, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10837885

ABSTRACT

BACKGROUND: The goal was to examine tattooing in suicides, as tattoos have been associated with several risk factors for suicide. METHOD: A chart review of a three-year sample of 134 consecutive suicides in Mobile County, Alabama, was conducted. The prevalence of tattoos was compared between young (<30) white suicides and accidental deaths matched for age, gender and race, in a case-control study. RESULTS: Tattoos were found in 21% of suicides. Fifty-seven percent of young white suicides were tattooed compared to 29% of matched accidental deaths. LIMITATIONS: Findings are preliminary due to the small sample size. The study methodology precluded obtaining information of psychiatric diagnoses prior to death. CONCLUSIONS: Tattoos may be possible markers for lethality from both suicide and accidental death in young people, presumably because of shared risk factors such as substance abuse and personality disorder. Affective disorders should receive further, more specific studies. The clinical value of inquiring about tattoos in young people at risk of suicide needs further study.


Subject(s)
Suicide/psychology , Tattooing , Accidents/mortality , Adult , Age Factors , Alabama/epidemiology , Case-Control Studies , Educational Status , Female , Humans , Incidence , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Suicide/statistics & numerical data , Tattooing/statistics & numerical data
17.
South Med J ; 93(3): 310-4, 2000 Mar.
Article in English | MEDLINE | ID: mdl-10728520

ABSTRACT

BACKGROUND: Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. METHODS: Charts of 311 consecutive psychiatric ER patients were reviewed. Suicidal behavior was considered present if current suicidal ideation or attempts within 24 hours of or during the emergency evaluation were noted in the chart. RESULTS: Suicidal behavior was present in 38% of the psychiatric ER patients. Younger age, white race, affective disorders in female patients, and substance abuse disorders in male patients were features of the suicidal group. Sex of the patient was not associated with suicidal behavior. CONCLUSIONS: Suicidal behavior is prevalent in the psychiatric ER. Effective suicide prevention in this setting will hinge on finding more specific risk factors.


Subject(s)
Emergency Service, Hospital , Psychiatric Department, Hospital , Suicide/psychology , Adult , Age Factors , Black People , Chi-Square Distribution , Confidence Intervals , Employment , Female , Humans , Logistic Models , Male , Middle Aged , Mood Disorders/psychology , Prevalence , Retrospective Studies , Risk Factors , Sex Factors , Substance-Related Disorders/psychology , Suicide, Attempted/psychology , White People , Suicide Prevention
18.
Am J Forensic Med Pathol ; 21(4): 330-4, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11111791

ABSTRACT

To assess the role of toxicologic detection of alcohol to diagnose substance abuse disorders in suicides, the author reviewed suicide studies with both comprehensive toxicologic and diagnostic data. The sensitivity of alcohol detection to diagnose alcohol and substance abuse disorders in suicides was low in all studies (range, 39%-42%), and the specificity was 80%-95%. A higher cutoff level for alcohol did not increase diagnostic performance. The author concludes that toxicologic detection of alcohol is not a reliable indicator of alcohol and substance abuse disorders in suicides because of the high rate of false-negatives. Most of the suicides with positive alcohol detection seem to suffer from chronic substance abuse problems. The role of intoxication is difficult to assess because of methodologic problems.


Subject(s)
Ethanol/analysis , Substance-Related Disorders/diagnosis , Suicide , Alcoholism/complications , Alcoholism/psychology , Autopsy/methods , Humans , Predictive Value of Tests , Sensitivity and Specificity
19.
Compr Psychiatry ; 40(5): 343-6, 1999.
Article in English | MEDLINE | ID: mdl-10509615

ABSTRACT

Substance abuse has been linked to aggression in community and psychiatric samples. A retrospective chart review in 311 consecutive psychiatric emergency room patients was conducted to assess the association of substance abuse and aggression in an acute psychiatric setting. Various indices of substance abuse, including positive urine toxicology for alcohol, cocaine, and/or cannabis, were not associated with aggressive behavior. Patients with positive toxicology for cocaine were less frequently aggressive than cocaine-negative patients. Among aggressive patients, the presence of psychotic symptoms was the most important factor associated with admission. These findings suggest that aggression is not a common acute manifestation of recent substance abuse in psychiatric emergency room patients. Selection factors in this population and the specifics of an acute psychiatric setting may obscure the association, if any. Acute psychosis seems to have a more important role in this setting. Future studies should focus on the prevention and early treatment of aggression in psychotic emergency room patients.


Subject(s)
Aggression/drug effects , Alcoholism/epidemiology , Emergency Services, Psychiatric , Ethanol/adverse effects , Illicit Drugs/adverse effects , Substance-Related Disorders/epidemiology , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Aggression/psychology , Alcoholism/diagnosis , Alcoholism/psychology , Child , Comorbidity , Female , Humans , Male , Middle Aged , New York , Patient Admission/statistics & numerical data , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Risk Factors , Substance Abuse Detection , Substance-Related Disorders/diagnosis , Substance-Related Disorders/psychology , Suburban Population
20.
South Med J ; 92(6): 546-56, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10372846

ABSTRACT

BACKGROUND: Personality disorders in medical patients have received less attention than depression, anxiety, or somatization. METHOD: We conducted a selective literature search to assess the role of personality disorders in medical patients. RESULTS: Review of recent studies suggests a high prevalence and morbidity of personality disorders in medical populations. Important correlates in selected groups are depression, somatization, noncompliance, sexual risk taking, and substance abuse. Difficulties in physician-patient relationships are also frequently reported. Psychiatric interventions are considered beneficial, though no single treatment of choice is available. CONCLUSIONS: We recommend that physicians consider the possibility of personality disorders in medical patients to choose appropriate treatments for selected symptoms. Training in interviewing skills may enhance recognition of personality disorders and management of associated psychiatric conditions.


Subject(s)
Personality Disorders/diagnosis , Humans , Personality Disorders/classification , Personality Disorders/therapy , Physician-Patient Relations , Primary Health Care
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