摘要:

Because delays in treatment of psychosis may be associated with poorer outcomes, intervention focus has shifted to the prodromal phase of illness. However, knowledge about this phase has been limited to retrospective reconstructions of symptoms once psychosis is already present. The following article offers a new, prospective view of the development of schizophrenia starting from the late prodromal phase of illness. As we use the term, late prodromal phase of illness means at imminent risk of conversion to schizophrenia. In this article, entry, conversion, and discharge data are presented on a sub-population of eight patients who received treatment for psychosis at onset while participating in a prospective double-blind placebo-controlled treatment study of the prodrome to psychosis. Through disguised case examples, this article then focuses on the course of illness progression in three of eight cases who converted to schizophreniform psychosis while randomized on either active medication or placebo. Discussion focuses on the dimensional quality of the transition both from the prodrome to psychosis and from psychosis to recovery.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Research has linked impaired insight in schizophrenia to poorer medication compliance and poorer treatment outcome. The current study attempts to replicate previous findings that impaired insight is related to deficits in work function. To examine this question, 121 participants with schizophrenia or schizoaffective disorder enrolled in vocational rehabilitation were classified as having unimpaired (N= 65), or impaired (N= 56) insight. Next, participants were assigned a work placement and their work performance assessed on the third, fifth, and seventh weeks of work by using the Work Behavior Inventory. Among the 85 participants who completed these weeks of work, a multivariate analysis of variance and subsequent analysis of variance showed participants with impaired insight had significantly poorer ratings of work quality, work habits, cooperativeness, and personal presentation. When measures of global intelligence and executive function were entered as covariates in individual analysis of covariance, groups differed on measures of cooperativeness and personal presentation. Implications for rehabilitation are discussed.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The present study sought to examine subtype differences in comorbidity and in antisocial, educational, and treatment histories among young adults (ages 17–27) with attention deficit hyperactivity disorder (ADHD). Comparisons were made between ADHD Combined Type (ADHD-C;N= 60) and Predominantly Inattentive Type (ADHD-I;N= 36) relative to each other and to a community control group of 64 adults. Both ADHD groups had significantly less education, were less likely to have graduated from college, and were more likely to have received special educational placement in high school. Both groups also presented with a greater likelihood of dysthymia, alcohol dependence/abuse, cannabis dependence/abuse, and learning disorders, as well as greater psychological distress on all scales of the SCL-90-R than the control group. Both ADHD groups were more likely to have received psychiatric medication and other mental health services than control adults. In comparison with ADHD-I, adults with ADHD-C differed in only a few respects. The C-type adults were more likely to have oppositional defiant disorder, to experience interpersonal hostility and paranoia, to have attempted suicide, and to have been arrested than the ADHD-I adults. These results are generally consistent with previous studies of ADHD in children, extend these findings to adults with ADHD, and suggest that the greater impulsivity associated with the ADHD-C subtype may predispose toward greater antisocial behavior and its consequences than does ADHD-I type in adults.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

No longer are the high rates of psychiatric morbidity associated with mass violence in refugee populations invisible to the humanitarian assistance community. However, identification of mental health risk and protective factors that can be utilized by policy planners is still lacking. The objective of this report is to provide an analytic approach to determining these factors. A description is provided from the first large-scale epidemiological study of Cambodian refugees confined to the Thailand-Cambodian border in the 1980s and 1990s. The original data from this study are reanalyzed to evaluate the mental health impact of psychosocial factors subject to the influence of camp authorities, such as opportunities in the refugee camp environment and personal behaviors, in addition to trauma. The results suggest the extraordinary capacity of refugees to protect themselves against mental illness despite horrific life experiences. The recommendation emerges for refugee policy makers to create programs that support work, indigenous religious practices, and culture-based altruistic behavior among refugees. As refugee mental health policy receives increasing attention from the international community, it must consist of recommendations and practices based on scientific analysis and empirical evidence.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A recent study found that female rape victims with acute posttraumatic stress disorder (PTSD) who received a high score on the Peritraumatic Dissociative Experiences Questionnaire exhibited suppression of physiological responses during exposure to trauma-related stimuli. The goal of our present study was to test whether the same relationship holds true for male Vietnam combat veterans with chronic PTSD, using secondary analyses applied to data derived from a Veteran’s Affairs Cooperative Study. Vietnam combat veterans (N= 1238) completed measures to establish combat-related PTSD diagnostic status, extent of PTSD-related symptomatic distress, and presence of dissociative symptoms during their most stressful combat-related experiences. Extreme subgroups of veterans with current PTSD were classified as either low dissociators (N= 118) or high dissociators (N= 256) based on an abbreviated version of the Peritraumatic Dissociative Experiences Questionnaire. Dependent variables reflected subjective distress along with heart rate, skin conductance, electromyographic, and blood pressure data when responding to neutral and trauma-related audiovisual and imagery presentations. Veterans in the current PTSD group had significantly higher dissociation scores than did veterans in the lifetime and never PTSD groups. Among veterans with current PTSD, high dissociators reported greater PTSD-related symptomatic distress than did low dissociators, but the groups did not differ with respect to physiological reactivity to the trauma-related laboratory presentations. Our results replicate the previously reported relationship between peritraumatic dissociation and PTSD status in Vietnam combat veterans. However, we found no association between peritraumatic dissociation and the extent of physiological responding to trauma-relevant cues in male veterans with chronic combat-related PTSD.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors developed the Japanese-language version of the Impact of Event Scale-Revised (IES-R-J) and investigated its reliability and validity in four different groups: workers with lifetime mixed traumatic events, survivors of an arsenic poisoning case, survivors of the Hanshin-Awaji earthquake, and survivors of the Tokyo Metro sarin attack. Evidence includes retest reliability and internal consistency of the IES-R-J. Posttraumatic stress disorder (PTSD) and partial PTSD cases indicated significantly higher scores than non-PTSD cases. The IES-R-J can be a useful self-rating diagnostic instrument particularly for survivors with PTSD symptoms as a clinical concern (PTSD + partial PTSD) by using a 24/25 cutoff in total score. In analysis of scale structure, the majority of intrusion and hyperarousal items were subsumed under the same cluster, whereas avoidance items made up a separate cluster. Female patients indicated higher scores than male patients. A negative weak correlation between age and the score was found only among female earthquake survivors. The IES-R-J can be used as a validated instrument in future international comparative research.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This study adopted a quasi-experimental design to compare the treatment outcomes of inpatient-outpatient programs and day hospital programs for chronic, combat-related posttraumatic stress disorder. Data were drawn from 202 Vietnam veterans who had completed treatment at four programs across Australia. The veterans were assessed on a range of psychological and social variables at intake to the programs and followed up at 3 and 9 months after discharge. A significant main effect was found for time, with veterans from both program models demonstrating improvements that were maintained over the 9-month follow-up period. Group by time effects were not significant, which suggests that inpatient-outpatient programs are not more efficacious than the less expensive day hospital alternatives. In line with current mental health policy directions, the current study lends broad support to the recommendation that treatment services for veterans with posttraumatic stress disorder be delivered in the least restrictive environment.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This study investigated the relationship between panic symptoms during remission and subsequent relapse of panic disorder. Research subjects were 169 individuals, enrolled in the Harvard/Brown Anxiety Research Project, who were in episodes of panic disorder at intake and remitted during the 8-year follow-up period. Panic symptoms during remission were examined as predictors of panic disorder relapse. For the relapses that did occur, we report the level of symptomatology during the previous 4 weeks. Depending on symptom severity and whether or not the relapse included agoraphobia, panic symptoms during remission were associated with an approximate two- to threefold increased risk of relapse. However, on examination of symptoms during the 4 weeks before relapse, we found that the majority of relapses were preceded by no panic symptoms. Thus, although panic symptoms during remission may indicate an increased risk of subsequent relapse, the absence of symptoms during remission does not indicate that relapse is unlikely.

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2002

数据来源: OVID