The interface of psychiatric disorders and diabetes mellitus.

This paper reviews recent developments at the interface between psychiatric disorders and diabetes mellitus. A Medline search for the interval 1994 to 2000 was conducted, and the review addresses selected content from the search involving the following: 1) neuroleptic induced diabetes and the associated issue of diabetes and schizophrenia; 2) developments concerning various facets of the relationship of diabetes mellitus and depressive disorder; and 3) recent findings with regard to specific diabetic complications and their links to psychiatry.

Effects of allergy season on mood and cognitive function.

The study was conducted to evaluate the effects of having allergic reactions (ie, being in allergy seasons without taking medications) on: (1) speed of cognitive processing, (2) psychomotor speed, (3) ability to sustain attention, (4) verbal learning and memory, and (5) mood. Subjects (ten atopic, eight control) were given a neuropsychologic test and mood rating battery in an A-B-A design ie, in, out of, and in allergy seasons. Only atopic subjects exhibited declines in verbal learning, slower decision-making and psychomotor speed on both simple and choice reaction time tests, and lower positive affect during their allergy seasons in comparison to out of allergy seasons. Atopic subjects did not demonstrate declines in ability to sustain attention. Biochemical mechanisms may cause these changes.

Psychiatric diagnosis and the surgical outcome of pancreas transplantation in patients with type I diabetes mellitus.

To examine the role of psychiatric diagnosis in the surgical outcome of pancreas transplantation, we studied candidates with type I diabetes mellitus. Eighty of 140 candidates underwent transplantation. Survival analysis found the extent of human leukocyte antigen-DR (HLA-DR) matching, two diagnoses, and patients' perceived support from first-degree relatives to be related to duration of full-graft function. Lifetime diagnoses of tobacco use disorder (P = 0.029) and alcohol abuse/dependence (P = 0.006) were associated with less favorable outcomes; perceived support was associated with positive outcomes (P = 0.048). Subsequent analysis suggested that the four variables independently and directly affect outcome.

Lifetime prevalence of psychiatric disorders in patients with alopecia areata.

Thirty-one patients with alopecia areata were administered a structured psychiatric interview (the Diagnostic Interview Schedule; DIS). Overall, 74% had one or more lifetime psychiatric diagnoses. Particularly noteworthy were the high lifetime prevalence rates of major depression (39%) and generalized anxiety disorder (39%). In addition, patients reported increased rates of psychiatric disorders in first-degree relatives: anxiety disorders (58%), affective disorders (35%), and substance use disorders (35%). Patients with patchy alopecia areata were more likely to have a diagnosis of generalized anxiety disorder. No relationships were found between major depression and any variable characterizing alopecia areata history. Possible interrelationships between psychiatric disorders and alopecia areata are discussed. The study suggests that patients with alopecia areata are at increased risk for psychiatric disorders, and calls attention to the need for psychiatric assessment in this population.

Depressed mood and other variables related to bone marrow transplantation survival in acute leukemia.

Routine psychiatric evaluations of 100 adult patients undergoing allogeneic bone marrow transplantation for acute leukemia were reviewed to examine the possible relationship of psychiatric and psychosocial factors to duration of survival following the procedure. Three variables were found to independently affect outcome: illness status (first remission vs. other status), presence of depressed mood, and the extent of perceived social support. Patients transplanted while in their first remission had significantly improved survival; patients with depressed mood, regardless of specific psychiatric diagnosis, had poorer outcomes; and patients with a high level of perceived social support had improved survival. The possible mechanisms by which these variables affect outcome are discussed.

Adjustment disorders in medically ill inpatients referred for consultation in a university hospital.

The study examined medical records of 121 medical-surgical inpatients diagnosed with adjustment disorder by psychiatric consultants in a university hospital. Medical illness was the primary stressor, evoking the maladaptive reaction in 83 (68.6%) cases. These patients were largely free of preceding psychiatric problems, suffering protracted hospitalizations for advanced illnesses, particularly malignancy and diabetes; in contrast, the 38 (31.4%) patients whose adjustment disorder was precipitated by a stressor other than medical illness had established psychiatric histories and recurrent problems with relationships or finances. The data suggest that in the medically ill, identifying the primary stressor producing an adjustment disorder is more instructive than focusing upon "predominant" symptomatology and "subtypes."

Non-erotic self-choking in five psychiatric inpatients.

Recurrent self-choking without suicidal intent has received limited attention in the literature; most reports have focused on the sexual nature of the behavior. The authors describe five psychiatric inpatients who engaged in repeated non-erotic self-choking. Similarities in clinical features of the cases include a history of substance abuse (including abuse of volatile substances), aggressive behaviors, a chronic history of psychotic symptoms leading to repeated long-term hospitalizations, and a sense of relief or pleasure, but no overt sexual stimulation, caused by self-choking. The possible role of limbic system dysfunction in this behavior is considered.

Prevalence of major depression, simple phobia, and other psychiatric disorders in patients with long-standing type I diabetes mellitus.

To examine the prevalence of psychiatric disorders in patients with long-standing type I diabetes mellitus, we assessed a series of candidates for pancreas transplantation. Using the Diagnostic Interview Schedule, six-month and lifetime prevalences of psychiatric disorders were established for the candidates and their potential donors (first-degree relatives). Excluding tobacco use disorder and psychosexual dysfunction, 38 diabetic subjects (51%) received one or more psychiatric diagnoses. The lifetime prevalence of major depression was comparable for female (11 of 48 [22.9%]) and male (seven of 27 [25.9%]) diabetics; both rates were significantly higher than rates in first-degree relatives and the general population. Among female diabetics, the six-month and lifetime prevalences of simple phobia were increased vs donors and the general population; among male diabetics, the lifetime prevalence of antisocial personality disorder was greater than that in the general population. None of these disorders was found to be related to the duration of diabetes or the presence of various complications. The data suggest that increased rates of psychiatric disorder in type I diabetics have both gender-independent and gender-related components.