Showing papers in "International Journal of Psychiatry in Medicine in 2001"

Religion and medicine II: religion, mental health, and related behaviors.

Abstract: In this second in a series of articles on religion and medicine, I focus on the relationship between religion and mental health. This discussion is based on a comprehensive and systematic review of a century of research examining religion's relationship to mental health, social support, substance abuse, and other behaviors affecting mental or social functioning. This review includes over 630 separate data-based reports that focus on religion and well-being, hope and optimism, meaning and purpose, depression, suicide, anxiety, psychosis, social support and marital stability, alcohol and drug abuse, cigarette smoking, extra-marital sexual behaviors, and delinquency. Reasons for the associations found are discussed and conclusions drawn in light of the findings.

The Utility of the Ces-D as a Depression Screening Measure among Low-Income Women Attending Primary Care Clinics

Abstract: Objective:Depressive disorders are among the most common medical disorders seen in primary care practice. The Center for Epidemiologic Studies-Depression (CES-D) scale is one of the measures commonly suggested for detecting depression in these clinics. However, to our knowledge, there have been no previous studies examining the validity of the CES-D among low-income women attending primary care clinics.Method:Low-income women attending public primary care clinics (n = 179, ages 20–77) completed the CES-D and the Diagnostic Interview Schedule for the DSM-IV (DIS-IV).Results:The results supported the validity of the CES-D. The standard cut-score of 16 and above yielded a sensitivity of .95 and specificity of .70 in predicting Major Depressive Disorder (MDD). However, over two-thirds of those who screened positive did not meet criteria for MDD (positive predictive value = .28). The standard cut-score appears valid, but inefficient for depression screening in this population. An elevated cut-score of 34 yield...

Restricted emotional processing and somatic attribution in fibromyalgia.

Abstract: Objective:Medically unexplained symptoms or syndromes, such as fibromyalgia (FM), might be partly caused or sustained by a mechanism involving restricted emotional processing (REP) and the subsequent attribution of emotional arousal to somatic or syndrome-consistent causes. In this study, it was hypothesized that FM patients, compared to healthy individuals, would be higher on trait measures of REP (defensiveness and alexithymia), and would show affective-autonomic response dissociation, that is, higher standardized scores of heart rate responses than affective responses, during negative emotional stimulation. Additionally, FM patients were expected to attribute their bodily symptoms more to somatic than to psychological causes.Method:Emotional movie excerpts were shown to 16 female FM patients and 17 healthy women. Affective response and heart rate were monitored continuously, while symptoms and their causal attributions were measured before and after the excerpts. Repressor coping style and alexithymia ...

Religion and Medicine IV: Religion, Physical Health, and Clinical Implications

Abstract: In the fourth and final article of this religion and medicine series, I summarize the results of a comprehensive and systematic review of research examining religion's relationship to physical health and mortality. This review focuses on pain and disability, cardiovascular disease, immune and neuroendocrine function, susceptibility to infection, cancer, and overall mortality. I also explore what these research findings mean for medical practice and suggest patient-centered applications that are sensitive to ethical concerns.

Religion and medicine III: developing a theoretical model.

Abstract: In this third of a four-article series on religion and medicine, I describe a theoretical model to illustrate the complex pathways by which religion may influence physical health. Genetic factors, childhood training, psychological and social influences, health behaviors, and healthcare practices are discussed as part of this model. Considerable space is given to recent advances in psychoneuroimmunology and to stress-induced cardiovascular changes that demonstrate physiological pathways by which cognitive, emotional, and behavioral processes may influence susceptibility to disease and disease course. I also discuss research illustrating the important role that social support plays in moderating the physiological effects of stress and improving health outcomes. If religious beliefs and practices improve coping, reduce stress, prevent or facilitate the resolution of depression, improve social support, promote healthy behaviors, and prevent alcohol and drug abuse, then a plausible mechanism exists by which physical health may be affected.

Persons with depressive symptoms and the treatments they receive: a comparison of primary care physicians and psychiatrists.

Abstract: Objective: To determine if demographic differences exist in patients with depressive symptoms as the principal reason for visits to primary care physicians (PCP) versus psychiatrists. To estimate the likelihood of these patients receiving a range of mental health services from each provider group. Methods: Review and analysis of all outpatient visits made by patients with depressive symptoms using the National Ambulatory Medical Care Surveys (NAMCS) conducted in 1995 and 1996. Results: A significantly greater proportion of visits by persons with depressive symptoms as the principal reason for visit were made to psychiatrists than to primary care physicians (T = -3.56, p =.000). However, men, African-Americans, other Non-White persons, and persons aged 65 to 74 and 75 years and over were proportionately more likely to visit a PCP than a psychiatrist. Women, whites, and persons aged 45 to 64 were proportionately more likely to make a visit to a psychiatrist than to a PCP. The overall intensity of care delivered by PCPs for patients with depressive symptoms was significantly lower than that provided by psychiatrists (t = -2.03, p = .02). Analysis of individual services also revealed significant differences in service provision. Conclusions: Demographic differences among the patient caseloads of these physician groups have implications for mental health service delivery because of known distinctions in prevalence rates, symptom presentation, and functionality among depressed patient subgroups.

Lessons Learned: Outcomes and Methodology of a Coping Skills Intervention Trial Comparing Individual and Group Formats for Patients with Cancer:

Abstract: Objective:Nucare, a short-term psychoeducational coping skills training intervention was evaluated in a randomized controlled clinical trial (RCT) of 225 newly diagnosed breast and colon cancer patients.Method:Measures of psychosocial distress, well being and optimism were evaluated every four months during a one-year period. Patients were randomized to one of four arms: Nucare presented in an individual basis; Nucare presented in a group format; a non-directive supportive group; and a no-intervention control. The interventions were provided in five sessions of ninety minutes each.Results:Patients with breast cancer who received Nucare presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms.Conclusions:We were unable to develop functioning groups within the RCT. Partial explanations for the latter finding include the structural limitations of the RCT: the groups were small, difficult to schedule and patients indicated t...

Religion and mental health among women veterans with sexual assault experience.

Abstract: Objective:Religion has been shown to have a positive impact on well-being and to play an important role in coping with stressful life events However, the buffering effect of religiosity on mental health, after a particularly stressful life event such as sexual assault, has not been studied In this study we examined the buffering effect of religion on mental health and depression for women who report experiencing sexual assault while in the militaryMethod:The sample includes a nationally representative sample of 3,543 women veterans who use VA ambulatory care Two dimensions of religiosity were used: organizational (frequency of religious service attendance) and subjective (the extent religious beliefs are a source of strength/comfort) Mental health was measured by the mental component summary (MCS) from the SF36 and depressive symptoms were measured by the Center for Epidemiologic Studies-Depression (CES-D) scaleResults:Women veterans who reported experiencing sexual assault while in the military had

Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients.

Abstract: Objective:To examine psychiatric symptomatology and associated functional impairment among pregnant women; and to examine the obstetrical patient's receptivity to discussion of and intervention reg...

Utilization of medical services and quality of life among low-income patients with generalized anxiety disorder attending primary care clinics.

Abstract: Objective:Anxiety disorders appear to influence morbidity and medical utilization. However, little is known about the relationship between Generalized Anxiety Disorder, quality of life, and medical utilization, especially among low-income patients. The goals of this investigation were to 1) determine if low-income patients with GAD utilize medical services more than patients with other Axis I diagnoses, or no psychopathology, and 2) compare the health-related quality of life of these three groups.Method:Participants were randomly recruited from public primary care clinics and administered intake assessments of demographics, stress, and health-related self-report questionnaires. At the end of the first year a structured psychiatric interview was administered (N = 431). Over the second year, patients (n = 360) were administered a health-related quality of life measure every three months for four assessments. Medical charts were abstracted to collect information about chronic illnesses and visits to outpatie...

The Relationship between Attendance at Religious Services and Cardiovascular Inflammatory Markers

Abstract: Objective: Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. Little research has focused on religious attendance and physiological markers of cardiovascular risk. The purpose of this study was to explore the relationship between religious attendance and inflammatory markers of cardiovascular risk. Method: Nationally representative sample of non-institutionalized United States adults aged 40 and over derived from the National Health and Nutrition Examination Survey III 1988-1994 (n = 10,059). The main outcome measures were the inflammatory system markers C-reactive protein, fibrinogen, and white blood cell count. Results: 40. 8 percent of the population attended religious services 40 or more times in the previous year while 22.4 percent attended services less than 40 times and 36.8 percent attended no religious services at all. Non-attenders of religious services were more likely than attenders to have elevated white blood cell counts (p = .001), highly elevated C-reactive protein (p = .02), and elevated fibronogen (p = .05). After adjusting for demographic variables, health status, and BMI, the association between religious attendance and cardiovascular markers remained. Once current smoking was added to the model the independent effect of religious attendance dropped below conventional confidence limits. Conclusions: These findings suggest that people who have attended religious services in the previous year are less likely to have elevated levels of certain inflammatory markers, however, current smoking has significant shared variance with religious attendance.

Narrowing the gap in treatment of depression.

Abstract: Objective:Although effective treatments for depression exist, under or non-treatment of depression is common. Efforts were made in the early 1990s to improve recognition and treatment of depression, with many of those efforts targeted at groups most vulnerable to under-treatment. The purpose of this study is to assess treatment rates in 1993–1994 and 1996–1997.Method:Using nationally representative surveys of office-based practice covering the years 1993, 1994, 1996, and 1997, we obtained estimates of visits by adults in which depression was diagnosed and a prescription for antidepressant medication and/or psychotherapy was provided or ordered.Results:The proportion of physician office visits in which a depression diagnosis was recorded did not change from 1993–1994 (3.48 percent) to 1996–1997 (3.40 percent). However, the rate of antidepressant prescription or psychotherapy rose from 74.2 percent of visits with a depression diagnosis in 1993–1994 to 82.3 percent of these visits in 1996–1997. Significantly...

Obsessive-compulsive disorder and immunocompetence.

Abstract: Objective:A postinfectious, autoimmune response may be associated with the development of pediatric obsessive-compulsive disorder (OCD). According to this model, antistreptococcal antibodies cross-...

Rectal prolapse: a possibly underrecognized complication of anorexia nervosa amenable to surgical correction.

Abstract: Objective:Rectal prolapse is a complication of AN that may be more common than previously recorded experience would suggest.Method:In this report we document, for the first time, the association of anoxia nervosa (AN) and rectal prolapse in a series of three patients seen in the past three years. An extensive review of the literature using Medline over the period from 1966 to Jan 2000 failed to reveal any previous example of this association.Results and Conclusion:The finding could have significant health care implications if confirmed. It would suggest that patients with either the psychiatric or surgical problem may not be receiving the appropriate complementary referrals: psychiatrist to surgeon and vice versa. The importance of recognition of this association in anorectic patients is the availability of effective surgical therapy.

A Case of Factitious Aplastic Anemia

Abstract: Objective:We report the case of factitiously induced aplastic anemia by the ingestion of busulfan, a bifunctional alkylating chemotherapeutic agent used in the treatment of chronic myelogenous leukemia. The medical consequences and financial costs of this illness are reported. The reader will gain an understanding of the relevant clues to the diagnosis of a factitious hematologic illness, the psychodynamic issues present in this case and the legal, ethical and countertransferential issues raised by the case.Method:A single case review including medical and billing records, patient and staff interviews and literature review.Results:The covert ingestion of busulfan by this patient resulted in life-threatening bone marrow suppression, bilateral aseptic hip necrosis, transfusion-dependent thrombocytopenia and a chronic pain syndrome. Her treatment was complicated by noncompliance with prescribed treatments and polymicrobial sepsis possibly secondary to the self-injection of feces into her central line. To dat...

The prevalence of psychiatric disorders and subsyndromal mental illness in low-income, medically ill elderly.

Abstract: Objective:This study estimated the past and current prevalence of psychiatric illness and subsyndromal mental illness (both pre-relapse and new onset) in a sample of low-income, medically ill older...

Clinical correlates of depression following myocardial infarction.

Abstract: Objective:Post-MI depression increases mortality, especially in the first 18 months after MI. Identifying patients at risk for post-MI depression is therefore important. In the present study we inv...

An Explanatory Model for Munchausen by Proxy Abuse

Abstract: Objective:In Munchausen by proxy (MBP) abuse, a caretaker fabricates or induces illness in another person to obtain emotional gratification. In representative cases, a mother is the perpetrator and her child is the victim. In view of the limits of current explanatory models, we use personal accounts of MBP perpetrators, physicians, and family members as a window into understanding this counterintuitive behavior.Method:As subspecialty clinicians and consultants, we supplemented our extensive direct experience with MBP with a review of published reports of MBP located via MEDLINE and PsycINFO (1980 onward). We also examined the books devoted to the subject and incorporated personal accounts of MBP perpetrators and of family members and professionals involved with them.Results:Factors contributing to the onset and continuation of MBP are the perpetrator's experiencing a particular drive (e.g., intense anger or frustration); lacking or overcoming internal inhibitions against abusive actions; and overcoming ex...

Anxiety and Depression in an Internal Medicine Resident Continuity Clinic: Difficult Diagnoses

Abstract: Objective:To determine the prevalence of anxiety and depression in a residents' clinic and if these diagnoses are associated with patients being perceived as difficult, as well as how often these diagnoses are documented in the patients' charts.Methods:This was a cross-sectional study conducted in a general internal medicine residents' clinic. A total of 135 patients were given the Primary Care Evaluation of Mental Disorders questionnaire (DSM-IIIR version) and their physicians filled out the Difficult Doctor-Patient Relationship Questionnaire after the visit. Charts were reviewed for documentation of a diagnosis of anxiety or depression.Results:Major depression was present in 26 percent, dysthymia 16 percent, major depression in partial remission 9 percent, generalized anxiety disorder 13 percent, and panic disorder 7 percent. Overall, 38 percent had at least one and 21 percent had more than one diagnosis. Of patients with one psychiatric diagnosis, 9 percent were classified as difficult versus 100 perce...

Psychological reactions among family members of patients with implantable defibrillators.

Abstract: Objective: To describe psychological reactions among family members of patients receiving an implantable cardioverter/defibrillator (ICD) during the first 9 months after implantation. Methods: Eighty-two family members (age 56 ± 12 years, 74 percent female, 79 percent married, 88 percent Caucasian) of ICD patients completed questionnaires regarding their mood (Profile of Mood State), cognitive illness appraisals (Meaning of Illness Questionnaire) and coping strategies (Jalowiec Coping Scale) prior to ICD implantation, and as well as 1 and 9 months postoperatively. Results: Total mood disturbance score (TMD), threat appraisal, and emotion- and problem-focused coping were highest prior to ICD implantation, and decreased during the first postoperative month showing stable values thereafter. There was no change in challenge appraisal. Multiple regression analysis found that the use of psychotropic drugs (anxiolytics, sedatives; Beta = .25), emotion-focused coping (Beta = .37), and challenge appraisal (Beta = -.21) at 1 month accounted for 26 percent of variance in TMD at 9 months. Conclusion: A spouse's ICD implantation is a major stressful event for family members leading to a diminished mood state prior ICD implantation. Reduction in emotion-focused coping and the use of challenge appraisal may improve mood state in family members of ICD patients during early follow-up.

An organic psychosis due to a venlafaxine-propafenone interaction.

Abstract: Objective An extraordinary case of an organic psychosis during the treatment of a patient with a bipolar affective disorder. Methods Clinical observation and further investigations including monitoring of serum levels (case report). Results A significant interaction between venlafaxine and propafenone causes markedly increased serum levels of venlafaxine correlating with unexpected psychopathological changes. Conclusions There is a potentially dangerous interaction between venlafaxine and propafenone. Serum levels of venlafaxine should be monitored if propafenone is added.

Methodological issues in the recruitment of primary care patients with depression.

Abstract: Objective:To compare two strategies of patient recruitment, waiting room (WR) screening and screening after physician referral (PR), for participation in a treatment-outcome study of minor depression and dysthymia in primary care. The influence of demographic factors on patients' refusal to participate in WR screening was also examined.Method:Of a convenience sample of 3,344 first stage patients, a total of 609 patients were evaluated in a semi-structured manner using a two-stage screening procedure from the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD).Results:Male and older patients were more likely to refuse participation in screening than female and younger patients. Waiting room screens yielded a higher number of qualified patients compared to PR screens, but PR screens yielded a higher percentage of patients who qualified for further participation.Conclusions:The recruitment of male and older primary care patients is complicated by their tendency to refuse participation i...

Depression, Medical Illness, and Interleukin-1β in Older Cardiac Patients

Abstract: Objective:A model has been proposed in which atherosclerosis contributes to depression in later life by the effects of cytokines on central monoamine systems. We collected pilot data to test the hypothesis that interleukin-1 (IL-1) is associated with depression in a cardiac patient group.Method:Thirty-seven subjects completed research evaluations that included depression diagnosis (Structured Clinical Interview for DSM-III-R), depressive symptom severity (Hamilton Rating Scale for Depression), medical illness burden (Cumulative Illness Rating Scale), and serum IL-1 level measured by enzyme linked immunosorbent assay.Results:Serum IL-1 level was not significantly associated with depressive symptom severity or depression diagnosis, whether or not controlled for medical illness burden, age, and gender. IL-1 level was significantly correlated with medical illness burden.Conclusions:We did not confirm our study hypothesis. The correlation of IL-1 level with medical illness burden likely reflects its release as...

Psychiatric complications of hydrocephalus.

Abstract: This article explores the association between normal pressure hydrocephalus and psychiatric symptoms, such as depressed mood, delusions, and hallucinations. We are reporting a case of a 30-year-old female with a history of congenital hydrocephalus, is used to illustrate this association. Such patients may benefit from treatment with ventriculoperitoneal or ventriculoatrial shunt procedures.

Childhood trauma and adult somatic preoccupation by body area among women in an internal medicine setting: a pilot study.

Abstract: Objective:This study was designed to explore the relationship between three types of abuse in childhood and their relationship to somatic preoccupation, in general and by body area, in adulthood.Method:Eighty-five women in an internal medicine clinic completed self-report measures of childhood sexual, physical, and emotional abuse as well as the Bradford Somatic Inventory.Results:Using simple correlations, all three types of abuse were positively related to current somatic preoccupation. Using multiple regression analysis that included demographic variables (education and age) and the three forms of childhood abuse, only the demographic variables and sexual abuse were uniquely predictive of somatic preoccupation. To determine the relationship between childhood abuse and somatic symptoms based on body area (head, chest, stomach, throat) and fatigue, a series of multiple regression analyses were performed. The chest and throat areas were significant, but no abuse variable was uniquely predictive.Conclusions...

The use of an emergency ward by patients with depressive or anxiety disorders: a one year follow-up study.

Abstract: Objective:The present study examined patients during the year after the index hospitalization in an Emergency Ward (ED) to determine whether patients with depressive or anxiety disorders have a higher rate of readmission than patients without these conditions.Method:For this purpose, 165 subjects (85 diagnosed with DSM-IV depressive or anxiety disorders and 80 controls) were evaluated with the Hospital Anxiety and Depression Scale (HADS) and with the Duke Severity of Illness Scale both during the index hospitalization and one year later. Hospitalizations during the follow-up period were determined using the hospital database.Results:During the follow-up period, depressed and anxious patients were more frequently rehospitalized in ED wards than controls (p = 0.006), after controlling for the effect of medical illnesses severity, marital status, living arrangement, and employment status. No difference was found regarding the admissions to wards different from ED.Conclusions:Patients with depressive or anxie...

Schizophrenic-like symptoms in a patient with thrombo-angiitis obliterans (Winiwarter-Buerger's disease).

Abstract: In this article a case of schizophrenic-like symptoms in a patient with thrombo-angiitis obliterans (TAO) is presented. His CT and MRI findings indicated a diffuse ischemia in the white matter, suggestive of TAO, not of focal lesions. The patient, except for age, did not have other risk factors for other cerebrovascular diseases. Psychotic symptoms may be the result of cerebral TAO, via deep and periventricular white matter lesions.

T3 blood levels and treatment outcome in depression.

Abstract: Objective:We examined the correlation between the basal triiodothyronine resin uptake (T3-RU) levels in depressed subjects and the response to antidepressant treatment.Method:We treated with fluoxetine 235 outpatients meeting DSM-IV criteria for major depression. We measured T3 resin uptake (T3-RU) levels before the onset of treatment. The 17-item Hamilton Rating Scale for Depression (Ham-D-17) was administered before, during and after the eight weeks of treatment to assess changes in depressive symptoms.Results:16 patients (6.8 percent) had low T3-RU levels (range 16.5–21), and 7 patients (3.0 percent) had high T3-RU levels (range 36–38). No relationship was found between T3-RU levels and clinical improvement, defined as either total Ham-D-17 score change or Ham-D-17 score ≤ 7 in the last 3 weeks of treatment, even after adjusting for baseline severity of depression.Conclusion:Abnormal T3-RU levels are rather uncommon in outpatient depression and do not correlate with the response to antidepressant treat...

How well informed are australian general practitioners about adolescent suicide? Implications for primary prevention.

Abstract: OBJECTIVE: To investigate the extent of knowledge of Australian general practitioners (GPs) in terms of critical information about adolescent suicide. METHOD: GPs knowledge about adolescent suicide was assessed using the 39-item Adolescent Suicide Behaviour Questionnaire (ASBQ), distributed to all GPs listed on the Medical Practitioners Board register of the Australian state of Victoria. Forty-three percent of GPs (n = 1694) completed and returned the survey. RESULTS: GPs scored, on average, 71 percent of the questionnaire items correct. The mean level of incorrect and uncertain responses was 14 percent and 15 percent, respectively. However, there were wide differences in the number of correct scores between individual GPs, with some respondents scoring as few as four items correct and others as many as 38 items correct. Analysis of knowledge rates within ABSQ content domains showed that GPs were generally well informed about adolescent suicide in relation to precipitating factors, and less well informed about the remaining content domains. CONCLUSIONS: Australian GPs are, in general, moderately well informed, and are in a unique position to identify those at risk and to provide appropriate intervention (or referral). However, there is considerable variability in the accuracy of beliefs about adolescent suicide, with some GPs demonstrating excellent knowledge levels but others holding little accurate information. The extent of this variability in knowledge is a cause for concern. Findings highlight the need for ongoing education of GPs as an essential component of prevention strategies for youth suicide. Language: en

A case of bilateral ptosis with unsteady gait: suggestibility and culture in conversion disorder.

Abstract: We report a case of a 14-year-old girl who presented, following a sudden onset, with bilateral ptosis, gait disturbance, difficulty swallowing and loss of appetite, right hypochondriacal pain, and frontal headache. Protracted neurological and medical examinations were unremarkable; neither was precipitating psychological stresses evident. The condition, which manifest as typical conversion disorder, lasted for one year. "Treatment" involving electrical stimulation of both eyes muscles and legs with positive reassurance resolved the symptom. This case supports the view that conversion disorder, not only involves a strong element of suggestion, but also incorporates socio-cultural sanctioned prescription.