Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network.
Office of Research, American Psychiatric Association, Washington, DC 20005, USA. Archives of General Psychiatry
(Impact Factor: 14.48).
Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.
Available from: preparedpatientforum.com
- "By 1996/1997, however, diagnoses of mood disorders were more than three times as common as anxiety diagnoses in office-based psychiatry (Mojtabai and Olfson 2008). A large study of psychiatric practice that the American Psychiatric Association (APA) conducted in 1997 is illustrative, finding that more than half of patients had mood disorders and about a third had a principal diagnosis of MDD, whereas just 10 percent had received a diagnosis of an anxiety disorder (Pincus et al. 1999). "
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ABSTRACT: During the 1950s and 1960s, anxiety was the emblematic mental health problem in the United States, and depression was considered to be a rare condition. One of the most puzzling phenomena regarding mental health treatment, research, and policy is why depression has become the central component of the stress tradition since then.
This article reviews statistical trends in diagnosis, treatment, drug prescriptions, and textual readings of diagnostic criteria and secondary literature.
The association of anxiety with diffuse and amorphous conceptions of "stress" and "neuroses" became incompatible with professional norms demanding diagnostic specificity. At the same time, the contrasting nosologies of anxiety and depression in the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) extended major depressive disorder to encompass far more patients than any particular anxiety disorder. In addition, antidepressant drugs were not associated with the stigma and alleged side effects of the anxiolytic drugs.
Various factors combined between the 1970s and the 1990s to transform conditions that had been viewed as "anxiety" into "depression." New interests in the twenty-first century, however, might lead to the reemergence of anxiety as the signature mental health problem of American society.
Available from: PubMed Central
- "Despite an increasing amount of studies on the epidemiology of acute mental disorders and the availability of recently introduced pharmacological interventions in the management of such conditions, only few reports provide detailed information on the characteristics of psychiatric patients and treatments received both in the hospital setting and as routine clinical practice . "
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ABSTRACT: this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs). Information was focused on diagnosis (DSM-IV), reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode.
assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30).
864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs) completed both admission and discharge visits. A severe psychotic episode with (19.1%) or without (47.7%) aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge) and depression (12.9% at admission and 14.7% at discharge) were the predominant diagnoses. The mean hospital stay was 12 days. The mean (+/- SD) total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 +/- 5.1, 0.38 +/- 2.2, and 0.21 +/- 1.5. Forty-four (6.0%) patients had episodes of aggressiveness at admission and 8 (1.7%) at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%), 686 (94.2%) and 676 (92.9%). The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%), typical anti-psychotics (48.3%, 57.0%, 49.6%), atypical anti-psychotics (35.6%, 41.8%, 39.8%) and antidepressants (40.9%, 48.8%, 43.2%). Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20.6% and 26.6% with two drugs, and 53.2%, 57.8% and 59.0% with > two drugs. Benzodiazepines were the most common drugs both at admission (60.0%) and during hospitalisation (85.7%), and 69.5% were prescribed at discharge.
patients with psychiatric diseases in acute phase experienced a satisfactory outcome following intensified therapeutic interventions during hospitalisation.
Available from: Nadine Kaslow
- "Each participating psychiatrist completed general information on 12 consecutive patients and more detailed data on a subsample of three patients, according to a randomly assigned start-time. Data were weighted with a three-stage propensity score weighting scheme to generate nationally representative estimates based on a random sample of APA members (Pincus et al., 1999). Among the 1843 patients for whom detailed diagnostic and treatment information was provided, 288 (15.6%) had a diagnosis of schizophrenia or other psychotic disorders , including schizophreniform disorder, schizoaffective disorder, and the other psychotic disorders defined by the "
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ABSTRACT: This study utilized a large clinical dataset of patients representative of those in routine U.S. psychiatric practice to assess the influence of sociodemographic variables and diagnostic class on health plan membership (public or private). Data on patients with schizophrenia or other psychotic disorders (n=288) and patients with mood or anxiety disorders (n=1304) were obtained from a cross-sectional practice-based survey conducted by the American Psychiatric Institute for Research and Education. The likelihood of health plan membership was lower among males and among those from a minority race/ethnicity. Health plan membership was also affected by educational attainment and employment status. Even after controlling for these sociodemographic determinants of health plan membership, individuals with schizophrenia/other psychotic disorders were significantly less likely to belong to a health plan than those with mood/anxiety disorders.
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