RESUMEN
The authors examined the latent structure of psychiatric symptoms occurring in patients with medical illness. Symptom data were collected from 312 hospitalized medically ill patients using the Monash Interview for Liaison Psychiatry and subjected to latent trait analysis. A model with 5 dimensions provided an acceptable fit to the data. Dimensions were characterized as demoralization, anhedonia, autonomic anxiety, somatic symptoms, and grief. The demoralization dimension was similar to the concept of demoralization described by Frank and to the "giving up-given up complex" described by Engel. The concepts of demoralization, grief, and anhedonia may be useful in increasing understanding of the minor depressions in people with medical illness and in increasing the specificity of psychological and pharmacological treatments for these disorders.
Asunto(s)
Adaptación Psicológica , Síntomas Afectivos/diagnóstico , Rol del Enfermo , Adolescente , Adulto , Síntomas Afectivos/psicología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Inventario de Personalidad , Psicopatología , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicologíaRESUMEN
OBJECTIVE: To examine differences between women family carers of people with chronic illnesses or disabilities and a group of women 'non-carers' in self-reported physical health, psychological well-being, life satisfaction, social support and feelings of overload. METHOD: Using a computer-assisted telephone interviewing system, a random survey of more than 26,000 households was conducted in Victoria to identify and then interview a representative sample of family carers of people with disabilities or chronic illnesses. The women in the sample (n = 857) were then compared with a sample of women with 'usual family responsibilities' (n = 219) in terms of physical and emotional states. RESULTS: We found higher rates of self-reported ill-health and use of medication, more negative effect, and less life satisfaction and perceived social support, among carers than among women in the comparison group. Even though the latter were more likely to be caring for one or more children, compared with the carers they reported less overload. Irrespective of carers status, women without partners expressed less life satisfaction, and more social isolation and negative effect. CONCLUSIONS AND IMPLICATIONS: The poorer health status and emotional well-being of carers compared with non-carers among women, and associations between overload, social isolation, negative effect and health problems within carers, point to a number of practical interventions such as promoting an awareness in GPs and other health professionals of the impact of caregiving on the health of their patients; informing them about relevant community services; and encouraging appropriate referrals.
Asunto(s)
Cuidadores , Enfermedad Crónica/terapia , Estado de Salud , Calidad de Vida , Adaptación Psicológica , Adulto , Personas con Discapacidad/rehabilitación , Relaciones Familiares , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Persona de Mediana Edad , Muestreo , Apoyo Social , Victoria , Salud de la MujerRESUMEN
The Monash Interview for Liaison Psychiatry (MILP) is a structured interview designed for use with patients who have physical and psychiatric comorbidity. Linked to a computerized diagnostic algorithm, the MILP is able to establish diagnoses according to DSM-III-R, International Classification of Diseases--10th Edition (ICD-10), and DSM-IV criteria, as well as a range of other criteria relevant to consultation-liaison psychiatry. Interrater reliability was assessed with 54 joint interviews, in which the mean kappa for agreement of items was 0.83 and of diagnoses was 0.68. Comparative procedural validity was tested against DSM-III-R decision-tree diagnoses, ICD-10 checklist diagnoses, and Structured Clinical Interview for DSM-III-R interview diagnoses on another sample of 54 patients. Mean kappas for these comparisons were 0.61, 0.56, and 0.31, respectively. As predicted, the MILP more fully covered the spectrum of somatizing disorders, compared with the other methods for establishing diagnoses.
Asunto(s)
Entrevista Psicológica , Trastornos Mentales/diagnóstico , Grupo de Atención al Paciente , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Trastornos Psicofisiológicos/diagnóstico , Rol del Enfermo , Trastornos Somatomorfos/diagnóstico , Adulto , Anciano , Algoritmos , Comorbilidad , Diagnóstico por Computador/estadística & datos numéricos , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Psicopatología , Trastornos Psicofisiológicos/psicología , Sensibilidad y Especificidad , Programas Informáticos , Trastornos Somatomorfos/psicologíaRESUMEN
BACKGROUND: Past research and instrument development in caregiving have focused on specific aspects of caregiving or specific disability groups. This paper reports the scale characteristics of a new generic instrument developed to assess the experience of caregiving, and the social and emotional well-being of caregivers and a comparison group of 'non-caregivers'. METHODS: Using computer-assisted telephone technology, a random survey of 26000 households was conducted in Victoria, Australia to identify and interview 976 caregivers of people who were aged or had a long-term illness or disability of any kind, and 219 non-caregivers. Both groups were re-interviewed after 15 months. Scales administered on each occasion to caregivers and non-caregivers included life satisfaction, positive and negative affect, social support and overload; and to caregivers, caring role satisfaction, resentment and anger, and, in relation to the care recipient, measures of help provided and needed, severity of disability and behaviour problems. RESULTS: On each occasion and with each sample all scales demonstrated a satisfactory reliability. With a subsample of caregiver-care-recipient dyads (N = 67), caregiver reports of severity of disability, level of helped needed and provided were validated externally by clinician assessments. CONCLUSIONS: A comprehensive instrument to assess the experience of caregiving was developed. It is relevant to a broad range of ages, levels and types of disability and care provided; and, in assessing health and well-being, to both caregivers and non-caregivers. Scales, including both positive and negative dimensions, have demonstrated good internal consistency on two occasions. The instrument is potentially useful in a range of research and practical settings.
Asunto(s)
Cuidadores/psicología , Enfermedad Crónica/psicología , Salud de la Familia , Salud Mental , Psicometría/métodos , Actividades Cotidianas , Afecto , Estudios de Casos y Controles , Análisis Factorial , Estado de Salud , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Satisfacción Personal , Psicometría/normas , Reproducibilidad de los Resultados , Muestreo , Índice de Severidad de la Enfermedad , Trastorno de la Conducta Social , Apoyo Social , Estrés PsicológicoRESUMEN
Research on family caregiving has been based largely on small samples, often drawn from support organisations or services, and has tended to focus on particular disability groups. Our study was population-based and included all ages and disabilities. As the first stage in a longitudinal research and health promotion program for informal caregivers, a statewide random survey of over 26,000 households was conducted by telephone: 78 per cent of self-identified carers (N = 976) agreed to participate in a one-hour interview. This paper presents a sociodemographic profile of Australian caregivers. Four types of relationship between carers and care recipients (adult offspring, spouses, parents and other relatives and friends) provide the framework for results. Group differences were observed on most characteristics: for example, age, living arrangements, work status and duration of care. Care recipient characteristics, including difficult behaviours and need for assistance, are also reported, as well as use of and need for community services. What the findings reflected most was the heterogeneity of both caregivers and care recipients and the diversity of caregiving roles and circumstances.
Asunto(s)
Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Niño , Preescolar , Recolección de Datos , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Distribución Aleatoria , Apoyo Social , Factores de TiempoRESUMEN
OBJECTIVES: To examine psychiatric morbidity, including substance use disorders, and service use in young people with experience of homelessness. DESIGN: A cross-sectional study of 34 new residents in a supported accommodation program in Melbourne. Current and lifetime psychiatric diagnoses were made using the Structured Clinical Interview for the Diagnostic and statistical manual of mental disorders, third edition, revised (DSM-III-R). Use of psychiatric and related services was also assessed. RESULTS: Of the 21 women and 13 men (mean age, 18.1 years; standard deviation, 2.2 years), 50% had a current major DSM-III-R diagnosis, and 82% had a lifetime DSM-III-R diagnosis. The most common diagnoses were alcohol dependence, depressive disorders and cannabis dependence. Co-morbidity was common. Few of the young people had sought or received any treatment for depressive or substance use disorders. CONCLUSIONS: Young people with experience of homelessness have a high prevalence of depressive disorders and substance use disorders, particularly alcohol and cannabis dependence. Despite this they have a low rate of service use. These findings suggest a need for closer interaction between mental health professionals and other agencies in the planning and provision of services to young homeless people.
Asunto(s)
Jóvenes sin Hogar/psicología , Trastornos Mentales/epidemiología , Servicios de Salud Mental/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Australia/epidemiología , Estudios Transversales , Femenino , Jóvenes sin Hogar/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Morbilidad , Escalas de Valoración Psiquiátrica , Trastornos Relacionados con Sustancias/rehabilitaciónRESUMEN
This paper describes the institution of a clinical database in the consultation-liaison psychiatry service of an Australian general hospital psychiatry unit. One of the problems faced was that many researchers and clinicians in Australia use the ICD-9 rather than the DSM-III-R classification system. Nevertheless, it was possible to use the DSM-III-R-based MICRO-CARES clinical database management system in this project. The data obtained during the first 12 months of its use are presented. Despite differences in the patient demographic characteristics, the data obtained are within the ranges described for North American and European sites. The local benefits of such a clinical database are described, and it is argued that such a database is also necessary for interhospital and international collaborative studies and comparisons.
Asunto(s)
Sistemas de Administración de Bases de Datos , Sistemas de Registros Médicos Computarizados , Grupo de Atención al Paciente/organización & administración , Servicio de Psiquiatría en Hospital/organización & administración , Derivación y Consulta/organización & administración , Adulto , Anciano , Recolección de Datos , Femenino , Hospitales con 300 a 499 Camas , Hospitales Generales/organización & administración , Humanos , Masculino , Trastornos Mentales/clasificación , Trastornos Mentales/diagnóstico , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Psiquiatría/organización & administración , Psicotrópicos/uso terapéutico , Diseño de Software , VictoriaRESUMEN
Consultation-liaison (C-L) psychiatry as a service entity has developed slowly and to a variable extent in Australia despite the presence of factors conducive to its development. These include a compulsory national health insurance system and a favorable disposition to the biopsychosocial model and to psychoanalytic ideas. C-L psychiatry, however, does enjoy a high profile in many undergraduate medical and postgraduate psychiatry teaching programs. Research on C-L psychiatry is emerging, complementing a strong history of research in psychosomatic medicine. An Australian and New Zealand C-L psychiatry interest group is being formed. Collaboration with the MICRO-CARES Consortium and the European Consultation-Liaison Workgroup is proving to be a great stimulus.
Asunto(s)
Grupo de Atención al Paciente/tendencias , Psiquiatría/tendencias , Australia , Educación Médica/tendencias , Humanos , Psiquiatría/educación , Especialización/tendenciasRESUMEN
OBJECTIVE: Self-administered questionnaires are frequently used in studies of hospitalized physically ill patients to identify and measure psychiatric morbidity. This study examines the validity of some commonly used questionnaires in this context. METHOD: One hundred and seventy-nine patients in a general hospital completed the GHQ, HAD, BDI and STAI and were interviewed using the SCID-R. The findings were evaluated against DSM-III-R diagnoses using the QROC curve. RESULTS: Thirty-eight percent of patients obtained one or more DSM-III-R diagnoses; 25 percent mood disorder, 12 percent anxiety disorder, 11 percent drug abuse or dependence, 2 percent a somatic syndrome. Eleven percent had more than one diagnosis. As screening instruments for general psychiatric morbidity there were no statistically significant differences between versions of the GHQ and the HAD. With respect to identifying depression, the GHQ tended to perform better than the other instruments. CONCLUSIONS: The questionnaires identified general morbidity and depression satisfactorily but anxiety and drug abuse and dependence syndromes poorly. The results also support the notion that the DSM-III-R classification has a number of deficiencies when used in this population.
Asunto(s)
Trastornos Mentales/diagnóstico , Admisión del Paciente , Grupo de Atención al Paciente , Inventario de Personalidad/estadística & datos numéricos , Rol del Enfermo , Adulto , Anciano , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Australia/epidemiología , Comorbilidad , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Femenino , Humanos , Incidencia , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Determinación de la Personalidad/estadística & datos numéricos , Psicometría , Reproducibilidad de los Resultados , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/epidemiología , Trastornos Somatomorfos/psicología , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
This article describes three recently established community-based crisis services for people with acute psychiatric illness. Data were obtained from local information systems developed in the early phase of service operation. Patterns of service were found to vary among the teams in terms of the frequency of contact with the client, the period of contact with the client and the overall numbers of contacts. Such diversification of services reflects, at least in part, the differences in the service networks within which the new services were Such diversification of services is inevitable and creative, and the evaluation of these services must consider not only the short-term impact of crisis services, but also the impact of the network of care services on longer term outcomes for the client.
Asunto(s)
Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Trastornos Mentales/epidemiología , Enfermedad Aguda , Australia/epidemiología , Urgencias Médicas , Humanos , Trastornos Mentales/diagnósticoRESUMEN
Trained clinicians interviewed 346 people who were representative of those aged 15 to 60 years staying in crisis accommodation centres for the homeless and cheap single-room accommodations in inner Melbourne. The interviewers used a standardised diagnostic instrument, the structured clinical interview for DSM III-R. (Diagnostic and statistical manual of mental disorders - revised), to diagnose a range of severe mental disorders, including psychotic, affective, and substance-related disorders. Almost half the people interviewed received diagnoses of current disorders and over 70% received diagnoses of lifetime disorders. The prevalences of lifetime and current disorders in all categories were as high in young as in older men. Only small numbers of women were seen. The relatively high prevalence of disorder in younger men may be related to selective factors in the survey, to a cohort effect, or to recovery or death of older men with a history of mental disorder. From a practical point of view the important issue is the effect of varying systems of mental health care, and of welfare and housing policies, on the course and outcome of the various disorders, and on the likelihood of individuals living impoverished and disaffiliated lives.
Asunto(s)
Personas con Mala Vivienda/psicología , Trastornos Mentales/epidemiología , Adolescente , Adulto , Factores de Edad , Efecto de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Victoria/epidemiologíaRESUMEN
This paper documents the initial phase of a new research direction which began in 1984 at Royal Park Hospital. Attention is focussed on the place of the university and the research institute in the psychiatric hospital and on the perceived need for concerted research on the major psychoses in Australia. The focal point of the Royal Park research programme, the Aubrey Lewis Clinical Research Unit, has been open since October 1984. The development of the unit's research activities during the initial few years of its existence required an awareness of specific scientific, administrative and political issues. These are discussed in detail in order to convey something of the process, as well as the content of such development, and in an attempt to provide some assistance to others undertaking similar developments.
Asunto(s)
Unidades Hospitalarias , Hospitales Psiquiátricos/organización & administración , Investigación , Esquizofrenia , Femenino , Humanos , Relaciones Interinstitucionales , Masculino , Admisión y Programación de Personal , Universidades , VictoriaRESUMEN
Six hundred people diagnosed as schizophrenic by the specialist psychiatric services in Oxfordshire, between 1971 and 1973, were identified from the Oxford Psychiatric Case Register (OPCR). The person records of deaths and hospital discharges held by the Oxford Record Linkage Study (ORLS) wee used to examine the following items of information for members of this group: details of discharges from an surgical operations performed in Oxfordshire non-psychiatric hospitals in a 6-year period before and a 4-year period after the date of first inclusion in the OPCR, and details of deaths in a 4-year period after the date of first inclusion in the OPCR. The numbers of deaths, discharges and operations so observed in the study group were compared in age, sex and major diagnostic groups with the expected numbers derived from rates prevailing in the Oxfordshire population over the same periods. Observed deaths were twice as numerous as expected in both sexes, and the numbers of general hospital discharges were also higher than expected. Ischaemic heart disease was the commonest cause of death in both sexes, but did not account for the excessive numbers of hospital discharges. Trauma and poisoning accounted for the excess both of deaths in younger members of the study group and of general hospital discharges overall. Social and environmental difficulties associated with the diagnosis schizophrenia are likely to have contributed more than any inherent biological disadvantage to this excess.