摘要:

In theory, research, and practice, mental health professionals have tended to ignore or pathologize the religious and spiritual dimensions of life. This represents a type of cultural insensitivity toward individuals who have religious and spiritual experiences in both Western and non-Western cultures. After documenting the “religiosity gap” between clinicians and patients, the authors review the role of theory, inadequate training, and biological primacy in fostering psychiatry's insensitivity. A new Z Code (formerly V Code) diagnostic category is proposed for DSM-IV: psychoreligious or psychospiritual problem. Examples of psychoreligious problems include loss or questioning of a firmly held faith, and conversion to a new faith. Examples of psychospiritual problems include near-death experiences and mystical experiences. Both types of problems are defined, and differential diagnostic issues are discussed. This new diagnostic category would: a) improve diagnostic assessments when religious and spiritual issues are involved; b) reduce iatrogenic harm from misdiagnosis of psychoreligious and psychospiritual problems; c) improve treatment of such problems by stimulating clinical research; and d) encourage clinical training centers to address the religious and spiritual dimensions of human existence.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The sequelae of severe closed head injury have received much attention in the literature, but the effects of mild closed head injury (MHI) are less well established. There is a subgroup of patients who complain of persisting postconcussive symptoms (PCS) beyond the first weeks of recovery. Although the symptoms generally develop in the absence of clear neurological abnormalities, the condition of PCS can be chronic and disabling. It has been assumed that PCS result from an interaction between organic and psychological factors. Differentiating between the effect of primary neurological injury and secondary psychosocial problems is often difficult for clinicians and engenders controversy. Neuropsychological, neurophysiological, and neuroimaging measures can be helpful in selecting patients at risk of developing PCS. Assessment of the level of cognitive functioning, individual susceptibility to stress, and environmental demands may be beneficial in treating symptomatic patients.It is true that the vague and aspecific nature of the postconcussion syndrome may have given rise to the controversy over this entity, but the many methodological inconsistencies in the experimental approaches to the syndrome have certainly enhanced the confusion about this issue. The ensuing controversy surrounding research on the outcome of MHI and the postconcussion syndrome reflects ambiguities in definition, inconsistencies in criteria for patient selection, variation in procedures for neurobehavioral assessment, and difficulty in obtaining follow-up data.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We assessed improvement patterns and predictors of outcome over a 1-year period, in a sample of depressed patients receiving treatment from a specialized mood disorders unit. Patients with melancholia had a differential improvement pattern from the nonmelancholics in the first 20 weeks, but case rates and severity levels were comparable at 20 weeks and at 1 year. Only three variables (older age at first episode, less severe depression and extraversion) were predictors of improvement in both groups. Improvement was predicted by less psychomotor disturbance, absence of personality disorder, and higher social functioning in the melancholic patients. A reported absence of timidity and shyness in childhood, a briefer duration of depression, and receipt of individual psychotherapy predicted a better outcome in the nonmelancholic patients. Although significant predictors were few overall, the suggested differential relevance for most of the isolated predictors argues for outcome studies that examine melancholic and nonmelancholic depressive disorders separately.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The prognostic utility of mood-incongruent psychotic features was examined in a sample of 23 hospitalized manic patients. Patients were initially subdivided according to whether they met Research Diagnostic Criteria (RDC) for schizoaffective, mainly affective (mood-incongruent) manic disorder (SAM;N= 11) or RDC primary manic (mood-congruent or nonpsychotdc) manic disorder (PM;N= 12). Patients were then followed over a 9-month posthospitalization period and rated every 3 months for relapse status, symptom severity, social adjustment, and medication noncompliance. Patients with SAM and PM did not differ at follow-up on rates or timing of manic or depressive relapses or on cycling of symptoms of mood disorder. However, at follow-up, SAM patients had more severe positive and negative psychotic symptoms and poorer social adjustment, and were less medically compliant than PM patients. Results are consistent with the view that mania with mood-incongruent psychotic features is a poor-prognosis subtype of bipolar disorder.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The relationship of emotion differentiation to symptom severity in depression was investigated. The subjects were 25 patients diagnosed with unipolar major depression. Subjects were clinically assessed using the Schedule for Affective Disorders and Schizophrenia and the Hamilton rating scales for anxiety and depression. In addition, subjects completed a number of self-report measures of symptoms and attitudes. Twelve basic emotion terms were incorporated into free-response attribute lists which subjects used to rate aspects of themselves and of other significant people in their lives. A clustering algorithm (HICLAS) was used to derive a social perception structure from this data for each subject. The differentiation of negative emotion within an individual's structure (NES) was measured by dividing the number of attribute categories containing negative emotions by the total number of categories in that person's structure. The results indicated that NES is a significant correlate of depressive symptomatology independent of self-esteem and other variables. Relatively undiffer-entiated emotion structure (low NES) was associated with significantly higher levels of depressive symptomatology.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We examined the association between affective disorders and eating disorders in 22 eating disorder inpatients who were interviewed using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. The first series of 11 were interviewed as part of an interrater reliability study; the second series, done as follow-up to the first, consisted of 11 consecutive admissions. Overall, there were 15 bulimics and seven anorexics. Nineteen patients had a major affective disorder, and 13 (59%) had bipolar II affective disorder. Bipolar II affective disorder appears to be a common finding in hospitalized patients with severe persistent eating disorders.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In a psychiatric rehabilitation study, 154 concurrent ratings were performed using the 30-item Positive and Negative Syndrome Scale (PANSS) and the 18-item Brief Psychiatric Rating Scale (BPRS). Although both instruments had excellent interrater reliability, the PANSS was consistently better: on the 18 symptom items the two instruments share, the PANSS had higher intraclassr'son 14; for the syndromes, the PANSS was higher than the BPRS on positive, negative, and total. Weighted Kappas comparing shared items revealed that most were not interchangeable, with only three coefficients in the excellent range. However, syndrome scale scores were very highly correlated and resulted in similar classification for negative schizophrenia. Ten of the 12 items of the PANSS not included in the BPRS had low zero-order correlations with BPRS items, which suggests that they measure symptoms distinct from those measured by the BPRS and should add to clinical predictive power. This proved true in our study of rehabilitation of patients with schizophrenia PANSS symptom ratings explained up to 55% of the variance on seven measures of work performance, whereas the BPRS had lower predictive power on six of the seven measures. We concluded that the PANSS may be superior to the BPRS in clinical research on schizophrenia and that most BPRS items are not interchangeable with identically named PANSS items.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID