Chapter
General Considerations in Treating Psychiatric Disorders During Pregnancy and Following Delivery
08/2008;
DOI:10.1007/978-1-59745-013-3_1
pp.1-12
- Citations (176)
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Cited In (0)
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Article: Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates.
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ABSTRACT: Current US mental disorder prevalence estimates have limited usefulness for service planning and are often discrepant. Data on clinical significance from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) and the National Comorbidity Survey (NCS) were used to produce revised estimates, for more accurate projections of treatment need and further explication of rate discrepancies. To ascertain the prevalence of clinically significant mental disorders in each survey, responses to questions on life interference from, telling a professional about, or using medication for symptoms were applied to cases meeting symptom criteria in the ECA (n = 20,861) and NCS (n = 8098). A revised national prevalence estimate was made by selecting the lower estimate of the 2 surveys for each diagnostic category, accounting for comorbidity, and combining categories. Using data on clinical significance lowered the past-year prevalence rates of "any disorder" among 18- to 54-year-olds by 17% in the ECA and 32% in the NCS. For adults older than 18 years, the revised estimate for any disorder was 18.5%. Using the clinical significance criterion reduced disparities between estimates in the 2 surveys. Validity of the criterion was supported by associations with disabilities and suicidal behavior. Establishing the clinical significance of disorders in the community is crucial for estimating treatment need. More work should be done in defining and operationalizing clinical significance, and characterizing the utility of clinically significant symptoms in determining treatment need even when some criteria of the disorder are not met. Discrepancies in ECA and NCS results are largely due to methodologic differences.Archives of General Psychiatry 03/2002; 59(2):115-23. · 12.02 Impact Factor -
Article: Parenting and adjustment in schizophrenia.
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ABSTRACT: Patients with schizophrenia who became parents and those who remained childless were compared on premorbid characteristics and current clinical and social adjustment. Subjects were 400 men and women with a DSM-III-R diagnosis of chronic schizophrenia based on the Structured Clinical Interview for DSM-III-R (SCID). Assessments measured concurrent substance abuse and antisocial behavior, positive and negative symptoms using the Positive and Negative Syndrome Scale, functional status using the Global Assessment of Functioning scale, family support, and treatment compliance. A total of 158 patients were parents (47 men and 111 women), and 242 were childless (153 men and 89 women). Compared with childless subjects, parents were more likely to have had better premorbid social adjustment, to have ever been married or involved in a conjugal relationship, and to have become ill at a later age. More than two-thirds of parents entered parenthood before the onset of schizophrenia. More women than men were parents, and parents were more likely to be members of ethnic minority groups. No differences were found in current clinical and social adjustment of parents and childless subjects. Parenthood was associated with better premorbid social adjustment, but it conferred no advantage in the long-term course of schizophrenia. Patients who experience a later onset of schizophrenia or have better premorbid social skills may be more likely to undertake marriage and parenthood, but they will then also be more likely to need special support for the parenting role once the illness begins and takes its typical course.Psychiatric Services 03/1999; 50(2):239-43. · 2.38 Impact Factor -
Article: Chronic schizophrenic women's attitudes toward sex, pregnancy, birth control, and childrearing.
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ABSTRACT: Interviews with 23 chronically institutionalized, schizophrenic women living on a chronic care unit indicated that the majority had a continuing interest in sex and engaged in sexual activity. Fourteen of the women wanted to become pregnant. Few seemed to recognize their limited potential to be adequate parents. Respondents often gave bizarre or inaccurate responses to the interview questions, indicating that their ideas about contraception, pregnancy, and childrearing were affected by psychopathology. The authors concede that the task of designing and implementing birth control programs for severely ill schizophrenic patients is formidable but encourage mental health professionals to openly discuss sex, birth control, and having children with their patients.Hospital & community psychiatry 07/1983; 34(6):536-9.
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