Reliable quantitative ratings of chronic medical illness burden have proved to be difficult in geropsychiatric practice and research. Thus, the purpose of the study was to demonstrate the feasibility and reliability of a modified version of the Cumulative Illness Rating Scale (CIRS; Linn et al., 1968) in providing quantitative ratings of chronic illness burden. The modified CIRS was operationalized with a manual of guidelines geared toward the geriatric patient and for clarity was designated the CIRS(G). A total of 141 elderly outpatient subjects (two medical clinic groups of 20 each, 45 recurrent depressed subjects, 21 spousally bereaved subjects, and 35 healthy controls) received comprehensive physical examinations, reviews of symptoms, and laboratory testing. These data were then used by nurse practitioners, physician's assistants, and geriatric psychiatrists to compute CIRS(G) ratings of chronic illness burden. As hypothesized, analysis of variance demonstrated significant differences among groups with respect to total medical illness burden, which was highest among medical clinic patients and lowest in control subjects. Good interrater reliability (i.e., intraclass correlations of 0.78 and 0.88 in a subsample of 10 outpatients and a separate group of 10 inpatients, respectively) was achieved for CIRS(G) total scores. Among medical clinic patients, a significant correlation was found, as expected, between CIRS(G) chronic illness burden and capability as quantified by the Older Americans Activities of Daily Living Scale; and between CIRS(G) scores and physicians' global estimates of medical burden. Finally, with repeated measures of illness burden approximately 1 year from symptom baseline, significant rises were detected, as expected. The current data suggest that the CIRS(G) can be successfully applied in medically and psychiatrically impaired elderly subjects, with good interrater reliability and face validity (credibility).

Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale

Objectives The authors test the reliability and validity of the Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) as a written, self-administered survey in outpatients with chronic schizophrenia. Methods Thirty-six schizophrenic outpatients completed a written and oral form of the SF-36. A psychiatrist rated the patients using the Brief Psychiatric Rating Scale to determine severity of psychopathology. Cognitive functioning and academic achievement were also assessed. Internal consistency, test-retest reliability, concurrent and discriminative validity of the oral and written versions were determined. Results The SF-36 in both forms was shown to have good internal consistency, stability, and concurrent validity. The mental health SF-36 subscales had poor discriminant validity, compared with the physical functioning scale that demonstrated good discriminant validity. Conclusions The validity of using the written form of the SF-36 on a sample of patients with chronic mental illness was demonstrated. The SF-36 appears to be an appropriate outcome measure for changes in physical and role functioning in consumers of outpatient mental health programs.

The MOS 36-Item Short Form Health Survey: reliability, validity, and preliminary findings in schizophrenic outpatients.

Objectives.This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical regimens.Methods.The compliance interventions were classified by theoretical focus into educational, behaviora

Effectiveness of Interventions to Improve Patient Compliance a Meta-Analysis

Magnesium (Mg(2+)) is an essential ion to the human body, playing an instrumental role in supporting and sustaining health and life. As the second most abundant intracellular cation after potassium, it is involved in over 600 enzymatic reactions including energy metabolism and protein synthesis. Although Mg(2+) availability has been proven to be disturbed during several clinical situations, serum Mg(2+) values are not generally determined in patients. This review aims to provide an overview of the function of Mg(2+) in human health and disease. In short, Mg(2+) plays an important physiological role particularly in the brain, heart, and skeletal muscles. Moreover, Mg(2+) supplementation has been shown to be beneficial in treatment of, among others, preeclampsia, migraine, depression, coronary artery disease, and asthma. Over the last decade, several hereditary forms of hypomagnesemia have been deciphered, including mutations in transient receptor potential melastatin type 6 (TRPM6), claudin 16, and cyclin M2 (CNNM2). Recently, mutations in Mg(2+) transporter 1 (MagT1) were linked to T-cell deficiency underlining the important role of Mg(2+) in cell viability. Moreover, hypomagnesemia can be the consequence of the use of certain types of drugs, such as diuretics, epidermal growth factor receptor inhibitors, calcineurin inhibitors, and proton pump inhibitors. This review provides an extensive and comprehensive overview of Mg(2+) research over the last few decades, focusing on the regulation of Mg(2+) homeostasis in the intestine, kidney, and bone and disturbances which may result in hypomagnesemia.

Magnesium in Man: Implications for Health and Disease

Rosen's Emergency Medicine - Concepts and Clinical Practice, 2-Volume Set, 8th Edition - Libros de Medicina - Medicina de urgencias y emergencias - 286,00

Rosen's Emergency Medicine - Concepts and Clinical Practice, 2-Volume Set, 8th Edition

The authors studied 100 state hospital psychiatric patients consecutively admitted to a research ward who were screened to eliminate physical illness before admission They found an unusually high incidence of medical illness: 46% of these patients had an unrecognized medical illness that either caused or exacerbated their psychiatric illness, 80% had physical illnesses requiring treatment, and 4% had precancerous conditions or illnesses A workup consisting of psychiatric and physical examination, SMA-34, urinalysis, ECG, and EEG after sleep deprivation identified over 90% of medical illnesses present in this population The authors suggest that such a battery be part of the routine workup for all hospitalized psychiatric patients

Unrecognized physical illness prompting psychiatric admission: a prospective study.

• One hundred patients of lower socioeconomic class were intensively evaluated medically on a research ward for the presence of unrecognized medical illnesses that might have affected their hospitalization. Forty-six percent were thought to have medical illnesses that directly caused or greatly exacerbated their symptoms and were consequently responsible for their admission, while an additional 34% of patients were found to be suffering from a medical illness requiring treatment. A diagnostic battery of physical, psychiatric, and neurologic examinations, coupled with a 34-panel automated blood analysis, complete blood cell count, urinanalysis, ECG, and sleepdeprived EEG established the presence and nature of more than 90% of the illnesses detected, and is therefore recommended as an initial evaluation battery, particularly for patients facing involuntary commitment to a mental hospital.

Physical Illness Manifesting as Psychiatric Disease: II. Analysis of a State Hospital Inpatient Population

The authors report on six patients with diazepam (Valium) toxicity. All showed symptoms of tremulousness, apprehension, insomnia, depression, and (later) ego-alien suicidal ideation. None had a history of previous psychiatric disorder, and all were taking greater than the maximum recommended dose of diazepam. Because the quality of the suicidal ideation in this syndrome differs from the usual indicators of suicidal intent, physicians should be alert to early symptoms of the syndrome and take measures to protect the patient against suicidal impulses.

Richard C.W. Hall

Papers

Unrecognized physical illness prompting psychiatric admission: a prospective study.

Physical Illness Manifesting as Psychiatric Disease: II. Analysis of a State Hospital Inpatient Population

Aberrant response to diazepam: a new syndrome.

Categorization of types of medical/psychiatry units based on level of acuity.

Psychiatric Presentations of Medical Illness