Psychological profile of dysfunctional dysphonia.

A high degree of emotional maladjustment can be detected in dysfunctional dysphonia. In these patients, it is not rare to observe an immediate resolution of the phoniatric disorder, but it is equally as common to identify a significant rate of recurrence (> 10%) in the short and long term. This phenomenon may be due to poor adaptive ability in the presence of mood disorders. Aims of this study were: a. selection of a suitable instrument to identify "minor" and "major" symptoms of psychiatric nature in dysphonic subjects; b. evaluation of profile of mood disorders in dysfunctional dysphonic adults. Hopkins Symptom Check List 90 was chosen. This is a scale of self-evaluation, adapted in Italian, complete (9 dimensions) and easy to use. It is employed to evaluate the following dimensions: somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, sleep disorders. Three groups were studied: group 1:40 patients (36 female, 4 male; aged 18-62 years, mean 42) with dysfunctional dysphonia; group 2: 20 patients (18 female, 2 male; aged 19-61 years, mean 43) with ENT disorders; group 3: 20 subjects (18 female, 2 male; aged 18-62 years, mean 42.2) as controls. In the statistical analysis, a one-way variance between the three groups and a post-hoc analysis using Schiffé test (level of significance 0.05) were carried out. Results showed significant differences between group 1 and groups 2 and 3 as far as concerns anxiety, phobia, obsessive-compulsive, interpersonal sensitivity and somatization variables. A significant difference was found only between groups 1 and 3 as far as concerns the variables: sleep disorders, depression and paranoid ideation. No significant difference emerged between the groups regarding psychoticism and anger/hostility dimensions. The present study identified a definite profile of minor personality disorders, of an anxious nature, with evidence of somatization, interpersonal sensitivity and obsessive-compulsive type traits, significantly prevailing in dysfunctional dysphonic subjects. Symptom Check List-90 has, therefore, proven to be an adequate instrument in the more complete definition of subjects affected by dysfunctional dysphonia aiming at referral to an integrated protocol which focuses on phoniatric treatment using an approach which acts upon the behavioural aspects of communication.

The misdiagnosis of delirium.

The authors examined the ability of nonpsychiatric house staff to accurately diagnose delirium at the time of consultation. Of 221 consultations over a 5-year period, 46% were misdiagnosed by the house staff. House staff on the general medicine wards and the nonintensive care unit environment did significantly better than those on the surgical wards and intensive care units. Age, gender, and race of the patient did not overall influence incorrect diagnoses; however, when a misdiagnosis occurred, women were more often given a diagnosis of a depressive disorder, whereas men were more often given a "no diagnosis" label. Finally, the consultees improved over an academic year in accurately identifying women as delirious, whereas no such learning curve existed for men.

Psychiatry in the Army: a brief historical perspective and current developments.

A brief historical review of military psychiatry in the United States Army is presented, focusing on the development of psychiatric treatment of soldiers with acute stress reactions. The authors outline the current roles of the military psychiatrist during peacetime and war, including direct care provider, consultant, and administrator, and discuss the contributions of military psychiatry to the civilian sector in the areas of crisis intervention, community psychiatry, family psychiatry, and substance abuse prevention and treatment.