Showing papers in "International Journal of Psychiatry in Medicine in 1999"

Depressed mood and subjective health symptoms as predictors of mortality in patients with congestive heart failure: a two-years follow-up study.

Abstract: Objective:The present study was undertaken in order to evaluate the relationship between depressed mood (depression, emotional distress) and disease-specific subjective health symptoms upon mortality risk among patients with congestive heart failure (CHF).Methods and Results:Proportional hazard models were used to evaluate the effects of selected biomedical, subjective health and psychological variables on mortality among 119 clinically stable patients (71.4% men; mean age 65.7 years +/− 9.6) with symptomatic heart failure, recruited from an outpatient cardiology practice. Twenty deaths were registered during the twenty-four-month period of data collection, all from cardiac causes. Results indicated that depressed mood was a significant predictor of mortality with a hazard ratio of 1.9, p .002. In contrast, subjective health was not a significant predictor of mortality in a Cox regression model that included depressed mood. The hazard ratio for a 1-point increase in Zung Depression Scale score was equal t...

Patient-centeredness and its correlates among first year medical students.

Abstract: Objective:This research was performed to study the attitudes that medical students hold concerning their relationships with patients, and whether such attitudes are gender-related, affect career plans, and influence their evaluation of psycho-social and biomedical issues.Methods:One hundred fifty-three first year students at the Boston University School of Medicine completed the Patient-Practitioner Orientation Scale (PPOS), a scale that differentiates between a patient-centered vs. doctor-centered orientation toward medical practice, indicated their interest in community and primary care practice, and rank ordered psycho-social and biomedical clinical issues in terms of their perceived relative importance.Results:The data revealed that female medical students were more patient-centered, and that (across sexes) patient centeredness was positively associated with an interest in community and primary care practice and the ranking of psycho-social issues.Conclusions:These findings indicate that differences i...

Editorial: Religion, Spirituality, and Medicine: A Rebuttal to Skeptics:

Abstract: A recent article by Sloan et al. in the Lancet has presented the skeptical side in the scientific debate on the religion-health relationship [1]. The interest in this topic and its relevance to medicine is underscored by the fact over 60 of 126 medical schools in the United States have initiated courses on religion/spirituality, and more are planning to do so. While we agree with Sloan et al. that the

The effects of major depression and phobia on stage at diagnosis of breast cancer.

Abstract: Objective:To examine the longitudinal effects of major depression and phobia on stage at diagnosis of subsequent breast cancer.Method:Data from the New Haven Epidemiologic Catchment Area (ECA) study were linked to the Connecticut Tumor Registry (CTR). The sample comprised of seventy-two women with a first primary breast cancer diagnosed sometime after their baseline ECA study interview. In the ECA study, lifetime psychiatric history was assessed using the Diagnostic Interview Schedule based on DSM-III criteria. Stage at diagnosis of breast cancer was taken from CTR records and dichotomized into early stage (in situ and localized tumors) versus late stage (regional and distant tumors).Results:A positive history of major depression was associated with an increased likelihood of late-stage diagnosis of breast cancer (odds ratio [OR] = 9.81, p = 0.039), whereas a positive history of phobic disorders was associated with a decreased likelihood of late-stage diagnosis (OR = 0.01, p = 0.021), controlling for soci...

Burnout in nursing staff: is there a relationship between depression and burnout?

Abstract: Objective:There is evidence that burnout may be a clinical entity with pathological stress reaction features related to the inability in finding pleasure from work. The purpose of this study was to investigate the relationship between burnout and depression.Methods:The study took place in the general hospital AHEPA of Thessaloniki. All members of the nursing staff (in total 368 subjects) took part. The protocol was self-reported and anonymous, in order to obtain as valid data as possible and included the Maslach Burnout Inventory (MBI) to assess the level of burnout, the Eysenck Personality Questionnaire (EPQ) to assess personality traits, and the Zung Self-Rating Depression Scale to assess depressive symptomatology.Results:The analysis revealed a weak but significant relationship between burnout and depression.Conclusions:Depression is a pervasive disorder that affects almost every aspect of the patient's life. On the contrary, burnout is, by definition, a syndrome restricted to the patient's professiona...

Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPSIS/WHO-EURO).

Abstract: OBJECTIVE: The aim of this research was to identify psychosocial characteristics which might predict future suicidal behavior in parasuicidal subjects in Europe. METHOD: The interview utilized for the survey (European Parasuicide Study Interview Schedule--EPSIS) was administered to 1269 parasuicides aged fifteen years and over, within one week of hospital admission after a suicide attempt, and is part of a longitudinal multicenter study. EPSIS included a brief medical questionnaire, scales rating depression, hopelessness, self-esteem, suicide intention, questions on sociodemographic characteristics, an interview on life events and social support, a description of the parasuicidal act, and an evaluation of factors precipitating the index parasuicide. RESULTS: Physical illness proved to be very frequent among suicide attempters. One in two subjects suffered from an acute, chronic, or chronic disorder in relapse at the time of the parasuicide. Subjects with a physical illness were significantly more depressed, particularly subjects from the intermediate age band and ones affected by a chronic physical disease in relapse. Forty-two percent of patients with physical illness rated their somatic problem as a factor precipitating the attempt and 22 percent judged it to be major one. Furthermore, subjects with physical illnesses considered psychiatric symptoms and disorders to be relevant factors in triggering suicidal behavior, to a greater extent than non-sufferers. The importance of physical illness in contributing to suicidal behavior increased with advancing age. CONCLUSIONS: More careful attention to somatic conditions and their subjective implications would probably augment chances of effectively preventing suicide. Language: en

Mental, Physical and Functional Status in Primary Care Attenders:

Abstract: Objective:The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status.Methods:The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life.Results:The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering f...

Mental disorders and help seeking in a rural impoverished population

Abstract: Objective:This study examined the impact of an in-home screening and educational intervention on help seeking among rural impoverished individuals with untreated mental disorders. The effect of including a significant other in the intervention and reasons for not seeking help were explored.Method:The sample was randomly selected from households in nine rural counties in Virginia. The short form of the CIDI was used to screen 646 adult residents. Respondents who screened positive were randomly assigned to one of three groups: 1) no intervention, 2) an educational intervention, or 3) the educational intervention with a significant other. A list of local sources of health and mental health care was distributed. At one-month post interview, respondents were telephoned to inquire about help seeking.Results:Almost one-third (32.4%) of these respondents screened positive for at least one disorder. Five hundred and sixty-six (87.6%) were successfully followed up, and thirty-three of the 566 (5.8%) reported that t...

Parameters of grieving in spontaneous abortion.

Abstract: Objective:The study's objective was to determine the quality and severity of grief after spontaneous abortion and to statistically determine the effect of significant demographics and social variab...

Psychological distress in healthy women with familial breast cancer: like mother, like daughter?

Abstract: Objective:In 1977, the Israel Cancer Association held a one-day conference, on the subject of familial breast cancer, for healthy women with at least one first-degree relative diagnosed with breast cancer. The objective of this study was to assess the psychological distress of a sample of the women who attended.Method:Of the 333 healthy women present at the conference, 230 completed three questionnaires: one on sociodemographic data and the medical history of the first-degree relative(s) (mother and/or sister), and two that measure psychological distress: the Brief Symptom Inventory and the Impact of Events Scale. Sample: The subjects were divided into three categorical groups: those whose mother had breast cancer (group A, N = 176), those whose sister had breast cancer (group B, N = 34), and those whose mother and sister both had the disease (group C, N = 20). In addition, subjects were divided into two groups according to the psychological distress level.Results:Analysis of results (using ANOVA and a Ch...

Psychosocial care by general practitioners--where are the problems? Results of a demonstration project on quality management in psychosocial primary care.

Abstract: OBJECTIVE Since 1987, psychosocial services have been a part of the primary care setting in Germany. In the framework of an eight-center national demonstration program, problems in the diagnosis and therapy of psychosocial problems and psychosomatic disorders were assessed. Methods to improve quality were also implemented. METHOD General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms were documented. Differences between psychosocial strain, treatment, and outcome were determined by analyses of variance. RESULTS Anxiety (62%), depression (51%), and marital/family conflicts (44%) were the most frequent symptoms. Psychosocial treatment was offered more often to those patients who had the highest level of anxiety and depression. Patients with pain and without a psychological attribution to their illnesses were offered less psychosocial treatment and suffered worse results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-oriented case conferences, consultation services, and collaborative groups. CONCLUSIONS These initial results are promising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic symptoms without psychological attribution may need special psychosocial interventions to improve their outcomes.

Treatment of panic disorder in older adults: a pilot study comparison of alprazolam, imipramine, and placebo.

Abstract: Objective: Several studies have documented that a variety of pharmacological compounds are quite effective in controlling acute symptomatology of panic disorder in the general population. However, there is a paucity of such studies in the management of panic disorder in older adults (ages 55 and above). The purpose of this study was to gather pilot data in older patients with panic disorder to begin to assess the efficacy of two commonly-used antipanic medications, imipramine and alprazolam. Method: Twenty-five (n = 25 (23 females; 2 males); 18 completers, 7 dropouts) older panic disorder (DSM-III-R) patients (age range = 55-73; mean = 61.24) were studied in an eight-week randomized, parallel-groups, double-blind, placebo-controlled, flexible dose design. Outcome was assessed weekly by global change ratings (Hamilton Anxiety and Depression Scales; Physicians' Global Impression ratings) and panic diaries. Because of small sample size, we present data descriptively. Results: Subjects in active medication groups evidenced reductions in panic attacks and in levels of overall anxiety and depression. Therapeutic dosages were approximately half those commonly used in younger panic disorder patients. Conclusion: Our data suggest the comparable efficacy of alprazolam and imipramine in the short-term treatment of older adults with panic disorder. There is clearly the need for a larger scale placebo-controlled study, preferably comparing imipramine andlor alprazolam with one of the SSRIs, to substantiate our findings.

Characteristics and treatment of women with antenatal and postpartum depression.

Abstract: Objective Investigations of the efficacy of treatment for non-psychotic pregnancy-related mood disorders are scarce. Thus, a prospective, longitudinal study of six months duration, involving ninety-six index cases and forty-five healthy women as a reference group, was implemented to determine the response of mood, parenting stress and dyadic adjustment to an eclectic management. Method In this naturalistic study, the index cases were offered treatment consistent with their symptoms, context, and level of compliance. All women received individual psychotherapy combining strategies from Interpersonal and Cognitive Behavioral Psychotherapy and/or Marital Interventions and Pharmacology. Rating scales (Dyadic Adjustment Scale, Hamilton Rating Scale for Depression, Edinburgh Postnatal Depression Scale, Child Stress Inventory) scored monthly, were used to measure the response to treatment over time. Results Depressive symptoms are generally alleviated by the second to third month of treatment. Dyadic discord accentuated by traditional sex role expectations and child care stress exacerbated by low self-esteem persisted throughout the trial at levels significantly different from the untreated reference group. Conclusions Short-term interventions are cost-effective for the relief of mood disorders. However, creative solutions, during an era of economic restraints, are required to extend treatment sufficiently to address couple conflicts and facilitate the transition to parenthood for index cases.

Diagnostic errors of primary care screens for depression and panic disorder.

Abstract: Objective:As the health care reimbursement system has changed, brief screens for detecting mental disorders in primary care have been developed. These efforts have faced the formidable task of identifying patients with mental disorders, while at the same time minimizing the number of misclassified cases. Here we consider the balance between sensitivity and positive predictive value. Primary care patients with false positive and false negative results on screens for depression and panic disorder are compared with regard to comorbidity and functional impairment.Methods:This was a cross- sectional psychometric study. The study sample included 1001 primary care patients from the Department of Internal Medicine at Kaiser Permanente in Oakland, California. The Symptom-Driven Diagnostic System for Primary Care (SDDS-PC) screens and Sheehan Disability Scale were completed by the subjects. The SDDS-PC diagnostic interviews were administered to all subjects.Results:Patients with false positive results on the panic ...

Health-related quality of life in primary care patients with recognized and unrecognized mood and anxiety disorders.

Abstract: Objective: Primary care providers have been criticized for underrecognizing and undertreating mental health disorders. This criticism assumes patients with recognized disorders and those with unrecognized disorders suffer the same burden of illness. This study describes differences in health-related quality of life (HRQOL) in patients with recognized and unrecognized mood and anxiety disorders in a primary care setting. Methods: A probability sample of 500 adult ambulatory patients from a university-based, family practice clinic, completed the PRIME-MD mood and anxiety disorder modules and the SF-36 Health Survey. Computerized patient records were reviewed retrospectively to determine recognition of mood and anxiety disorders. The Mental Health (MCS) and Physical Health (PCS) Component Summary scales of the SF-36 served as the primary outcome measures. Results: Sub-threshold mood and anxiety disorders were less likely to be recognized by physicians than disorders meeting DSM-III-R criteria. Recognized mood disorders were associated with a significant decrement in MCS scores (poorer HRQOL) compared with unrecognized disorders. In contrast, recognized mood disorders demonstrated slightly higher PCS scores. Recognized and unrecognized mood disorders differed significantly in physical functioning, vitality, social functioning, role functioning related to emotional state, and mental health. Recognition of anxiety disorders was not related to HRQOL. Conclusions: Patients with mental health disorders that have been recognized by their health providers appear to suffer from poorer HRQOL than patients whose disorders have not been recognized. This relationship, though, is only apparent for mood disorders. Poorer physical functioning may mask less severe emotional symptoms in mood disorders; profound emotional symptoms make recognition easier.

Clonazepam treatment of panic disorder in patients with recurrent chest pain and normal coronary arteries.

Abstract: Objective:To examine the efficacy of clonazepam in chest pain patients with panic disorder and normal coronary arteries.Method:We conducted a placebo controlled, double blind, flexible dose (1–4 mg/d), six-week trial of clonazepam. All subjects (N = 27) had current panic disorder and a negative coronary angiogram or thallium exercise tolerance test within the previous year.Results:Analyses show modest improvements in the clonazepam and placebo groups over the first four weeks in both primary outcome measures. Eight of twelve (67%) clonazepam treated patients responded with reduction of panic attacks by week four to zero per week or half of initial frequency, while seven of fifteen (47%) placebo treated patients responded (not significant). When response was measured by 50 percent reduction in Hamilton Anxiety total score, however, seven of twelve (58%) clonazepam treated patients responded, while two of fifteen (14%) placebo treated patients responded, (p = .038) by Fisher's exact test. Within-subject imp...

Multiple Sclerosis Presenting as Catatonia

Abstract: Objective:Catatonic disorder due to general medical condition must be excluded in psychiatric patients presenting with this movement disorder. This report emphasizes the association of catatonia with multiple sclerosis.Method:A patient with catatonia, psychotic depression, and the subsequent diagnosis of multiple sclerosis is described and the literature reviewed.Results:Mutism, immobility, cataplexy, waxy flexibility, and other aspects of catatonia occur in multiple sclerosis, usually as a consequence of a severe mood disorder and extensive cerebral demyelination. These symptoms may be the presenting manifestations of multiple sclerosis.Conclusions:A high index of suspicion for neurological disease is indicated in patients with new-onset catatonia. Neuroimaging and other studies may reveal underlying demyelination requiring specific therapy.

A review of the differences between somatizing and psychologizing patients in primary care.

Abstract: Objective:This article reviews all published studies on somatizing and psychologizing patients in primary care, according to Bridges and Goldberg's criteria [1].Method:A review of the Medline base from 1985 to 1998 was carried out.Results:Somatization is a concept valid, reliable, and stable over time. There are no differences between somatizers and psychologizers in sociodemographics, social problems or past medical and psychiatric history. The main clinical and diagnostic difference is a predominance of depressive symptoms and disorders in psychologizers. Finally, the most remarkable differences between somatizers and psychologizers are found in personality traits, such as attribution of somatic symptoms. However, some traits considered important in the outcome of somatizers, such as hypochondriasis or locus of control, show no differences between both groups of patients.Conclusion:Contrary to what was expected, the comparison between these two groups of patients give few clues for the etiology and trea...

Personality disorder traits: prevalence and effects on health status in primary care patients.

Abstract: Objective:Previous work in an academic setting has found that scoring in the higher ranges for selected personality disorders on an objective assessment tool was associated with increases in psychi...

The electronic medical record: its role in disseminating depression guidelines in primary care practice.

Abstract: Objective: Using the Agency for Health Care Policy and Research Depression Guideline Panel’s recommendations as its focus, this article describes a step-by-step approach for disseminating a paper-based depression guideline to primary care physicians via a commercially available electronic medical record (EMR) system. Method: Description of the author’s approach to disseminate an evidence-based depression treatment guideline to a group of primary care physicians using a commercially available EMR system and to evaluate the results. Results: We review clinical considerations and practical barriers faced in this process with the expectation that our experiences can guide others attempting to disseminate psychiatric treatment guideline via EMR systems. Conclusions: The EMR offers critical efficiencies in disseminating state-of-the-art clinical practice guidelines and in directing the primary care physicians’ use of them. Still, well-designed, randomized controlled trials are necessary to demonstrate their effectiveness at enhancing patient outcomes for major depression in primary care settings. (Int’l. J. Psychiatry in Medicine 1999;29:267-286)

Psychiatric assessment of candidates for bone marrow transplantation: a psychodynamically-oriented approach.

Abstract: Objective: To seek possible relationships between psychological factors and survival after an intensive medical therapy, using bone marrow transplantation as a model. Method: Candidates for bone marrow transplantation underwent two to three psychodynamically-oriented psychiatric interviews that explored family functioning (F), individual psychological maturity (I ), and the capacity to form and communicate a mature psychological construct of the transplant (T) process. The results were recorded in a semiquantitative manner, assigning a possible score of 1 to 3 for each parameter, for a possible total of 3 to 9 (the F.I.T. assessment). Survival after the transplant was analyzed retrospectively in relation to the F.I.T. assessment. Results: In a series of 112 candidates interviewed prior to transplant, those with the lowest F.I.T. assessment tended not to survive as long. By one year, 95 percent of individuals assigned the lowest score (F.I.T. = 3) had died, whereas 96 percent of those assigned the highest scores (F.I.T. = 7-9) remained alive. The strongest predictors were the I' and T parameters. Conclusion: This approach to assessment of candidates for bone marrow transplantation may identify individuals who require added supportive association between reported lifetime psychiatric history and stage at diagnosis of subsequent breast cancer. Phobia may motivate women to adhere to breast cancer screening recommendations and to report suspicious symptoms to a physician without delay. Major depression, on the other hand, was identified as an important predictor of late-stage diagnosis ; proper recognition and management of depression in the primary care setting may have important implications for breast cancer detection and survival.

Gender and minor psychiatric morbidity: results of a case-control study in a developing country.

Abstract: Objective Women suffer from minor psychiatric disorders (MPM) more frequently than men. Most of the studies were conducted in England and in the United States and some reported the higher occurrence of MPM among women to be modified by marital status and others by sociodemographic variables. The present study intends to address this question in a developing country. Method A population based case-control study was conducted in three important urban centers in Brazil. Two hundred seventy-six individuals diagnosed as new cases of MPM and 261 controls were selected to investigate the role of a set of sociodemographic variables in the association between gender and MPM using logistic regression models. Results Univariate analysis showed that women were more likely than men to suffer from MPM (OR = 3.34; 2.27-4.91). After controlling for other sociodemographic variables, female gender was still positively associated with MPM, but not in a homogeneous way. A multiplicative interaction of gender with age group was found (LRT = 6.01; 2 df; p = 0.05) suggesting an increment in the magnitude of the association among those older than thirty years. Odds-ratios were 2.33 (1.19-4.55), 6.85 (2.86-16.41), and 7.47 (2.90-19.22) for age groups of fourteen to twenty-nine; thirty to forty-four; forty-five or more, respectively. There was no evidence of interaction of gender with marital status or other sociodemographic variables. Conclusions The findings are consistent with the modification of the association between gender and MPM being mediated by social factors.

The psychiatric profile of patients with chronic diseases who do not receive regular medical care.

Abstract: Objective To assess the relationship between psychiatric disorders and lack of regular medical care in individuals with chronic medical diseases. Methods Nine hundred sixty-three respondents to the household-based Baltimore Epidemiologic Catchment Area (ECA) Follow-Up Study were interviewed in 1981, 1982, and 1993-1996. The main outcome measures were: 1) not receiving regular care from a health professional for an active chronic medical condition in 1981, 2) persistent lack of regular medical care, and 3) leaving regular medical care. Results In cross-sectional analyses, having a psychiatric disorder (OR 1.70, 95% CI 1.17-2.48) was associated with not receiving regular medical care. This was mostly due to individuals with phobic disorder (OR 1.57, 95% CI 1.02-2.43). In prospective analyses, depression (RR 2.4, p Conclusions Psychiatric disorders appear to place an individual at risk for irregular medical care. Studies of the quality and continuity of care for patients with chronic medical conditions should include measures of common psychiatric conditions.

An educational intervention using the Agency for Health Care Policy and Research Depression Guidelines among internal medicine residents.

Abstract: Objective:To determine if a brief educational intervention utilizing the Agency for Health Care Policy and Research (AHCPR) Depression Guidelines would effect improved recognition of depressed patients, as well as improved attitudes and knowledge, among Internal Medicine housestaff.Method:This was a randomized trial of an educational intervention for Internal Medicine residents. All patients attending the resident clinics were screened using the Center for Epidemiologic Studies Depression Scale. Persons scoring greater than 16 constituted the prospective cohort. Three hundred eighty-four patients were screened for entry into the study. Of 160 persons meeting the entry criteria, follow up was available on seventy-two (60%). Residents were randomly assigned to receive the educational intervention which consisted of three sessions where the residents received copies and instructions about the AHCPR depression guidelines and the use of a case-finding instrument for depression.Results:Non-recognized patients h...

Training family practice residents in psychiatry: an ambulatory care training model.

Abstract: Objective:To demonstrate the importance of providing psychiatric training to primary care practitioners in ambulatory care settings. Additionally, to describe the model used for this purpose in the Department of Psychiatry and Behavioral Sciences of the University of Texas Medical School at Houston in order to further stimulate educational opportunities on this topic.Method:A review of the psychiatric curriculum offered to family practice residents during their PGY-2 year one-month rotation in psychiatry at the University of Texas Mental Sciences Institute is provided. Emphasis is given to key areas of the curriculum such as: knowledge, skills, and attitude development. Special focus on the clinical and educational experiences is also offered for the purpose of providing unique perspectives about the curriculum methodology.Results:The careful assessment of the feedback obtained from the family practice residents who were exposed to this ambulatory training model demonstrates that this type of setting was ...

Patient-disease characteristics and coping strategies predict hospitalization in emergency psychiatry.

Abstract: Objective: The goal of this study was to analyze how far patient-disease characteristics (sociodemographic variables, previous psychiatric treatment, way of referral, the patient's current diagnosis), and the patient's coping strategies are connected with the consecutive disposition for inpatient or outpatient treatment. Methods: Data from a one-year intake of the psychiatric emergency service at a University Hospital (N = 1439) were monitored and analyzed with regard to the decision on treatment. Four hundred eighty-one patients were hospitalized and 530 were assigned to outpatient treatment. Two subsamples of twenty-eight patients from each group filled out the Bernese Coping Modes questionnaire before the decision with regard to the treatment disposition was taken. Rcsults: The patient's psychiatric history, the way of referral as well as the current axis I diagnosis made a significant contribution to the treatment decision. Overall, patient-disease characteristics allowed for correct classification of 69.3 percent of cases. However, coping was a comparable predictor of hospitalization. Conclusions: It is argued that the search for patient-disease characteristics in the psychiatric emergency room should be complemented by a more extensive monitoring of the patients' way of coping with their current crisis.

Coping mechanisms in patients presenting for in-vitro-fertilization

Abstract: OBJECTIVES The purpose of this study was to assess the coping mechanisms in patients presenting for in-vitro fertilization (IVF). METHODS We evaluated thirty consecutive couples presenting for in-vitro-fertilization. All couples were interviewed individually at first, and then together, using a semi-structured interview technique. Psychiatric diagnoses were made using the Diagnostic and Statistical Manual-IV (DSM-IV) criteria. Coping mechanisms used by the individuals were assessed using the Mechanisms of Coping Scale (MOCS). Other instruments used were Hamilton Depression Rating Scale (HAM-D-17), Hamilton Anxiety Rating Scale (HAM-A), Brief Psychiatric Rating Scale (BPRS), Self-Rating Symptom Scale (SRSS), and Eysenck Personality Inventory (EPI). RESULTS The mean age of the sixty patients was 32.3 +/- 5.2 years. Fatalism was the commonest factor on the mechanisms of coping scale. Analysis of variance (ANOVA) across all factors of the MOCS for demographic factors showed that men used problem-solving mechanisms significantly more often than women (F = 3.0, df = 1, 58, p < 0.05). ANOVA across coping factors on stressors with post-hoc tests of significance revealed that individuals facing social stress used fatalism significantly more often than other coping mechanisms, while those facing career stress used problem-solving significantly more often than other coping mechanisms (F = 5.6, df = 1, 58, p < 0.05 and F = 3.04, df = 1, 58, p < 0.01 respectively). ANOVA across coping factors on HAM-D-17 scores revealed that individuals who used fatalism had significantly higher HAM-D-17 scores compared to those who did not (F = 4.4, df = 1, 58, p < 0.05). ANOVA across coping factors on HAM-A scores revealed that individuals who used escape-avoidance had significantly lower HAM-A scores than those who did not (F = 4.3, df = 1, 58, p < 0.05). ANOVA across coping factors on SRSS scores revealed that individuals who used passivity or fatalistic coping mechanisms had significantly higher scores on SRSS than who did not (F = 4.6, df = 1, 58, p < 0.05 and F = 3.5, df = 1, 58, p < 0.05). CONCLUSIONS Differential patterns of coping were found among the sixty individuals presenting for IVF and were associated with a variety of factors including gender, education, stressors, and levels of depression, anxiety, and overall psychopathology. Efforts to recognize and recruit the coping mechanisms of infertile individuals are likely to enhance their ability to participate effectively in treatment.

The contribution of information technology to improving clinicians' access to high quality evidence.

Abstract: Objective:Rapid access to the results of high quality research studies for real time use during clinical care is the aim of evidence-based medicine.Methods:The current volume and methods of disseminating research findings are barriers to this goal. Electronic publishing, CD-ROMs for personal computers, and Internet-based databases and searching are tools helping to overcome these barriers.Results:Several examples in the United Kingdom and United States employing these tools are described.Conclusions:Technology is making traditional narrative reviews such as printed textbooks obsolete for the practice of evidence-based medicine.

Commentary: the use of placebos in psychiatric research.

Abstract: This issue of the International Journal of Psychiatry in Medicine features two articles examining pharmacologic treatments for panic disorder in adults [1] and the elderly [2]. An important unifying theme arising from these studies is the placebo response in patients with panic disorder. The placebo response is complex and variable. For example, in the Wulsin et al. study [1], the placebo response rate is positive and not statistically different than active medication. In contrast, Sheikh and Swales [2] found a negative placebo response with an increase in symptomatology and a high dropout rate. This commentary will briefly review these two studies and examine the larger question of the use of placebos in psychiatric research. Wulsin and colleagues report on the use of clonazepam in the treatment of panic disorder in patients with recurrent chest pain and normal coronary arteries. They examined twenty-seven subjects in a double blind, placebo controlled sixweek study. Outcome measures included panic attack frequency and reduction in Hamilton Anxiety scores. Wulsin et al. found a good acute response in both the active drug and placebo groups. In the placebo treated group, 47 percent of patients had a reduction of panic attacks by week four to either zero or 50 percent of the initial frequency. This was not significantly different than the 67 percent of patients in the clonazepam group with the same outcome. This difference was not statistically significant, in part due to the small sample size in the study. The authors point out a variety of practical problems limiting the recruitment of a larger study sample including physician time for approving and recruiting patients with negative coronary angiograms, issues of informed consent and patient refusal to participate in the study, in part based on psychiatric stigma. In addition, there was a higher baseline frequency of panic attacks in the placebo

Massage the medium: global theme issue.

Abstract: The International Journal of Psychiatry in Medicine is pleased to participate in the third global theme issue, The Impact of New Technologies in Medicine. The theme was selected after a multiple stage Delphi process involving 100 medical journal editors around the world. First, participants were asked to suggest subjects to be addressed in 1999. Editors voted on the proposals, and then again on the top themes. The idea of publishing a global theme issue has been coordinated once again by a group of prominent medical science physician-editors including Richard M. Glass and David H. Mark of JAMA, Michael Wiles and Miriam Shuchman of the Western Journal of Medicine, John Hoey of the Canadian Medical Association Journal, Liselotte Hojgaard of Ugeskrift for Laeger (Journal of the Danish Medical Association), Richard Horton of The Lancet, Magne Nylenna of Tidsskrift for Den norske laegeforening (Journal of the Norwegian Medical Association), John A. Overbeke of Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine), and Richard Smith of the British Medical Journal. It is fitting that the transition between millenniums for medicine should be accompanied by a focus on both technology and a global theme. The title of this editorial is a homage to Marshall McLuhan (1911-1980), Professor English at the University of Toronto. McLuhan coined the term “global village” [1] and stressed that this century ushered in the end of the age of print and the beginning of the electronic age. The focus of the International Journal of Psychiatry in Medicine is to address the complex relationships among the biological, psychological, and social systems in the world of primary care. At first thought, this focus might seem antithetical to the use of technology or the electronic age and to result in a negative view of the impact of technology in medicine. In the early years of the