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Somatoform disorders: a help or hindrance to good patient care
- Authors:
- SHARPE Michael, MAYOU Richard
- Journal article citation:
- British Journal of Psychiatry, 184(6), June 2004, pp.465-467.
- Publisher:
- Cambridge University Press
Somatoform disorders include a hetero-geneous group of diagnoses united only by their tendency to present with somatic complaints. In DSM–III–R the specific subcategories included somatisation disorder, hypochondriasis, body dysmorphic disorder, conversion disorder and chronic pain disorder, but the classification proved inadequate to the clinical task and the most recent edition of DSM (DSM–IV) added the non-specific category of undifferentiated somatoform disorder. This diagnosis, which amounts to little more than relabelling the patient’s own complaint, has turned out in practice to be the most common of the somatoform diagnoses.
Motiveless malignity: problems in the psychotherapy of psychopathic patients
- Author:
- ALVAREZ Anne
- Journal article citation:
- Journal of Child Psychotherapy, 21(2), August 1995, pp.167-182.
- Publisher:
- Routledge
This article attempts to draw attention to the difference between the states of mind and inner worlds of neurotic, borderline and psychopathic patients, with reference to different types of destructiveness: anger in the neurotic patient; desperate vengeful hatred in the borderline paranoid; and a cold addiction to violence in the psychopath. Although most patients refuse to stay put in the neat schematic categories outlined, they do seem to appreciate and to need the therapist's recognition of the specific quality of these vastly different states of mind.
Cumulative incidence of mental disorders among offspring of mothers with psychotic disorder; results from the Helsinki High-Risk Study
- Authors:
- NIEMI Laura T., et al
- Journal article citation:
- British Journal of Psychiatry, 185(1), July 2004, pp.11-17.
- Publisher:
- Cambridge University Press
The Helsinki High-Risk Study follows up all women born between 1916 and 1948 and treated for schizophrenia-spectrum disorders in psychiatric hospitals in Helsinki, their offspring born between 1960 and 1964, and controls. The aim was to determine the cumulative incidence of adulthood Axis I disorders among offspring. Using all hospital and out-patient treatment records we rediagnosed parents and offspring according to DSM–IV–TR criteria. Offspring were grouped by mother’s diagnosis (schizophrenia n=104, schizoaffective disorder n=20, other schizophrenia-spectrum disorder n=30, and affective disorder n=25) and compared with a control group (n=176). The cumulative incidences of Axis I disorders among offspring were calculated. The cumulative incidences of any psychotic disorder were 13.5%, 10.0%, 10.0%, 4.0% and 1.1% among offspring of mothers with schizophrenia, schizo-affective disorder, other schizophrenia-spectrum disorders, affective disorders and controls, respectively. The corresponding figures for schizophrenia were 6.7%, 5.0%, 6.7%, 0% and 0.6%, and for any mental disorder 23.1%, 20.0%, 20.0%, 12.0% and 6.9%. Offspring of mothers with a psychotic disorder have heightened risk of developing a wide range of severe mental disorders.
Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders
- Authors:
- DE WAAL Margot W. M., et al
- Journal article citation:
- British Journal of Psychiatry, 184(6), June 2004, pp.470-476.
- Publisher:
- Cambridge University Press
General practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment. The aim was to quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders. Two-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25–80 years), followed by a standardised diagnostic interview (SCAN 2.1). The prevalence of somatoform disorders was 16.1% (95% CI12.8–19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive. The findings underline the importance of a comprehensive diagnostic approach to psychiatric disorders in general practice.
Assessing the prevalence and exploring the aetiology of intellectual disability in the early twentieth century: the experience of policy and practice in New South Wales
- Author:
- WILLIAMS Ann Katherine
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 28(1), March 2003, pp.40-50.
- Publisher:
- Taylor and Francis
From the beginning of the twentieth century to the failure of the passage of the New South Wales Mental Defectives Bill in 1930, several investigations were conducted in an attempt to assess the prevalence of intellectual disability in the Australian community. During this period, 7252 people were admitted to state mental hospitals in New South Wales with a diagnosis of congenital or infantile mental deficiency, including the diagnostic subcategories of epileptic insanity and general paralysis of the insane. Using primary source material including annual reports of the New South Wales Lunacy Department, New South Wales Inspector General of the Insane Correspondence Files, and aggregated diagnostic data from patient case notes, this article will discuss attempts to assess the prevalence of intellectual disability in Australia and more specifically in New South Wales during the period and attempts to attribute causation. Epilepsy and syphilis will be discussed in terms of causation and correlation as specific co-morbid conditions associated with intellectual disability.
Essentials of the World Psychiatric Association's international guidelines for diagnostic assessment (IGDA)
- Author:
- ROYAL COLLEGE OF PSYCHIATRISTS
- Publisher:
- The British Journal of Psychiatry, Vol. 182 Supp. 45, 2003
- Publication year:
- 2003
- Pagination:
- 29p.,bibliogs.
This monograph presents the 100 IGDA guidelines, along with explanatory diagrams and tables, and recommended reading lists. This material is organised into ten parts, covering conceptual bases, interviewing and information sources, symptom and supplementary assessments, comprehensive diagnostic formulation, treatment planning and chart organisation. A final part sets out an illustrative clinical case. These guidelines are offered as recommendations for both in-patient and out-patient care, and for both child and adult psychiatry. The manner of their application should be informed by local realities and needs.
The impact of subjective and expressed anger on the functioning of psychiatric outpatients with post-traumatic stress disorder
- Authors:
- FRANKLIN C. Laurel, POSTERNAK Michael A., ZIMMERMAN Mark
- Journal article citation:
- Journal of Interpersonal Violence, 17(12), December 2002, pp.1263-1273.
- Publisher:
- Sage
Research has shown that anger may be related to the development and maintenance of post-traumatic stress disorder (PTSD). This study investigates the impact of anger on patients with PTSD in a general psychiatric population. Participants diagnosed with PTSD were grouped according to current levels of subjective and inappropriately expressed anger: low subjective and expressed anger; elevated subjective anger and low expressed anger; low subjective anger and elevated expressed anger; and elevated subjective and expressed anger. It was hypothesized that participants reporting elevated levels of subjective anger coupled with recent overt expression would be more impaired and distressed than individuals with PTSD in the other anger groups, after comorbid diagnoses were controlled. The elevated subjective and expressed anger group was more impaired/distressed on global measures and their elevated anger affected some measures of behavioral functioning.
The concurrent validity of the Global Assessment of Functioning (GAF)
- Authors:
- STARTUP Mike, JACKSON Mike C., BENDIX Sue
- Journal article citation:
- British Journal of Clinical Psychology, 41(4), November 2002, pp.417-422.
- Publisher:
- Wiley
Few studies of the validity of the Global Assessment of Functioning (GAF) have been published and none has shown how GAF ratings are associated with concurrent ratings of symptoms and social functioning. This article provides such data. The GAF can be rated reliably after minimal training. It provides a valid summary of symptoms and social functioning among schizophrenic patients provided they are not assessed when suffering from acute psychotic episodes.
Pandora's box: the effect of diagnostic disclosure on a depressed patient
- Author:
- LEBOLT Jonathan
- Journal article citation:
- Clinical Social Work Journal, 30(3), Autumn 2002, pp.281-291.
- Publisher:
- Springer
- Place of publication:
- New York
There is little literature on the effect of disclosure of psychiatric diagnosis on treatment. A case is presented in which the therapist suggests a depressed patient may be bipolar. Three concepts are utilized to understand the resultant impasse: empathic failure, intersubjective disjunction, and projective identification, and the subjugating third.
Patient's perceptions of entitlement to time in practice consultations for depression: qualitative study
- Authors:
- POLLOCK Kristian, GRIME Janet
- Journal article citation:
- British Medical Journal, 28.09.02, 2002, pp.687-690.
- Publisher:
- British Medical Association
Patient's self imposed restraint in taking up doctor's time has important consequences for the recognition and treatment of depression Doctor's need to have greater awareness of patient's anxiety about time and should move to allay such anxieties by pre-emptive reassurance.