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Biomedical subjects

D Dhossche

Publications and source records attributed to D Dhossche.

10 recordsLinked to original sources

Diagnostic outcome of self-reported hallucinations in a community sample of adolescents.

OBJECTIVE: We aimed to assess the diagnostic outcome of self-reported hallucinations in adolescents from the general population. METHOD: The sample consisted of 914 adolescents between ages 11-18 participating in an ongoing longitudinal study. The participation rate from the original sample was 70%. Responses on the Youth Self-Report questionnaire were used to ascertain hallucinations in adolescents. Eight years later, Axis 1 DSM-IV diagnoses were assessed using the 12-month version Composite International Diagnostic Interview in 783 (86%) of 914 study subjects. No subjects were diagnosed with schizophreniform disorders or schizophrenia. RESULTS: Hallucinations were reported by 6% of adolescents and 3% of young adults. Self-reported hallucinations were associated with concurrent non-psychotic psychiatric problems in both age groups. Adolescents who reported auditory, but not visual, hallucinations, had higher rates of depressive disorders and substance use disorders, but not psychotic disorders, at follow-up, compared to controls. CONCLUSIONS: Self-reported auditory hallucinations in adolescents are markers of concurrent and future psychiatric impairment due to non-psychotic Axis 1 disorders and possibly Axis 2 disorders. It cannot be excluded that there was selective attrition of children and adolescents who developed Schizophrenic or other psychotic disorders later in life.

Adolescent↗

Outcome of self-reported functional-somatic symptoms in a community sample of adolescents.

It is unclear if functional-somatic symptoms in adolescents increase the risk for future psychiatric disorders. Therefore, the outcome and continuity of adolescent self-reported functional-somatic symptoms in young adulthood were assessed. Self-reported data on functional-somatic symptoms from an ongoing epidemiological study in children started in 1983 were analyzed. Participants were adolescents aged 11-18 who filled out standardized questionnaires in 1989 and 1991 and who were reassessed in 1997 when they were young adults between ages 19 and 26. Outcome measures were research psychiatric diagnoses and self-reported functional-somatic symptoms in 1997. Functional-somatic symptoms were associated with other measures of psychopathology in adolescents. Adolescents with specific functional-somatic symptoms tended to report the same symptom along with other symptoms at follow-up. Adolescent self-reported functional-somatic symptoms did not increase the risk for future psychiatric disorders. Young adults with functional-somatic complaints were diagnosed more often than controls with depressive disorders and anxiety disorders, but not with antisocial personality disorders and substance use disorders. Adolescent self-reported functional-somatic symptoms were common and enduring but were not predictive for psychiatric disorders in young adulthood. Adolescents and young adults who complain of multiple functional-somatic complaints should be assessed for the presence of a psychiatric disorder particularly depression or anxiety.

Adolescent↗

A case-control study of tattoos in young suicide victims as a possible marker of risk.

BACKGROUND: The goal was to examine tattooing in suicides, as tattoos have been associated with several risk factors for suicide. METHOD: A chart review of a three-year sample of 134 consecutive suicides in Mobile County, Alabama, was conducted. The prevalence of tattoos was compared between young (<30) white suicides and accidental deaths matched for age, gender and race, in a case-control study. RESULTS: Tattoos were found in 21% of suicides. Fifty-seven percent of young white suicides were tattooed compared to 29% of matched accidental deaths. LIMITATIONS: Findings are preliminary due to the small sample size. The study methodology precluded obtaining information of psychiatric diagnoses prior to death. CONCLUSIONS: Tattoos may be possible markers for lethality from both suicide and accidental death in young people, presumably because of shared risk factors such as substance abuse and personality disorder. Affective disorders should receive further, more specific studies. The clinical value of inquiring about tattoos in young people at risk of suicide needs further study.

Accidents↗

Drug detection in a suburban psychiatric emergency room.

This study evaluated the yield and utility of urine toxicological screening (UTS) in psychiatric emergency room patients. We also assessed the effect of race, gender, and cocaine and/or alcohol detection on clinical symptoms and diagnoses. The study's null hypothesis is that recent use of cocaine and/or alcohol in psychiatric emergency patients does not change rates of psychiatric symptoms at evaluation. We did a retrospective chart review of 325 consecutive psychiatric emergency room patients and of 112 consecutive patients with benzoylecgonine (BE; major metabolite of cocaine) on UTS. At assessment clinicians were blind to the results of UTS in most cases. UTS was positive in about one-fourth of cases who submitted urine for toxicological testing. Alcohol, cocaine, and cannabis accounted for the majority of positive cases, and simultaneous detection of these drugs was common. Very few patients with BE on UTS were younger than 18 and none was older than 45. In patients with BE on UTS, substance use was missed in about one out of seven cases, and cocaine use in about one out of four cases. Patients with BE on UTS showed decreased rates of aggressive and bizarre behavior. Cocaine use increased rates of suicidality in males and rates of paranoia in black male patients. Black patients had more hallucinatory experiences than white patients, regardless of cocaine use. Principal diagnoses of psychotic disorders were frequently assigned to black patients with cocaine use, and principal diagnoses of affective disorders rarely. Patients with both BE and alcohol on UTS and patients with only BE on UTS had low rates of aggression, but patients with only alcohol on UTS were frequently aggressive. This study's findings show distinct clinical effects of cocaine and/or alcohol use on psychiatric emergency room patients, contrary to the null hypothesis. These effects differed according to race and gender. We conclude that there is little support to advocate routine toxicological testing in the psychiatric emergency room. Instead, selective testing based on empirical evaluation of risk factors might be more profitable to improve detection rates of cocaine and alcohol.

Adjustment Disorders↗

Continuation ECT: relapse prevention in affective disorders.

Relapse rates after the acute treatment of affective disorders with drugs or electroconvulsive therapy (ECT) are high (often 50-95%), despite preventive pharmacotherapy. In practice, some patients receive continuation and maintenance ECT after successful treatment of the index episode with ECT. We reviewed the charts of patients with affective illnesses who received continuation ECT (C-ECT) in our inpatient service from 1985 to 1991. In 33 courses of C-ECT, mean intertreatment interval was 10.1 days and the average duration of treatment was 10 weeks. One-year follow-up was available for 21 patients. Seven (33%) patients relapsed and needed re-admission within 1 year. The relapse rate for the patients with delusional depression was 42%, lower than the 95% reported for patients with delusional depression maintained on continuation pharmacotherapy before the C-ECT program started in our facility. No single factor examined was a significant predictor of relapse except C-ECT, which exhibited a sustained prophylactic effect for the year after the index episode.

Adult↗