Showing papers in "International Journal of Psychiatry in Medicine in 2002"
TL;DR: The existing literature suggests that anxiety disorders are associated with hyperglycemia in diabetic patients, and additional studies are required to confirm the magnitude of the relationship, to elucidate moderating and causal factors, and to determine whether successful treatment of anxiety improves glycemic control.
Abstract: Objective:To determine whether anxiety is associated with poor glycemic control in adults with type 1 or type 2 diabetes.Method:MEDLINE, PubMed, and PsycINFO databases were used to locate studies that measured the association of anxiety with glycemic control. Meta-analytic procedures were used to convert the findings to a common metric, compute effect sizes (ES), and statistically analyze the collective data.Results:The search procedures identified 12 studies, 11 (92 percent) of which satisfied the criteria for inclusion in the meta-analysis. In this overall group, anxiety was not associated with glycemic control (p = 0.19), although the ES was marginally statistically significant (ES = .09, 95 percent CI = 0.04 to 0.14). In studies that determined anxiety from diagnostic interviews, anxiety was associated with hyperglycemia (p = 0.003) and the ES was also statistically significant (ES: 0.25, 95 percent CI = 0.10 to 0.38).Conclusions:The existing literature suggests that anxiety disorders are associated w...
296 citations
TL;DR: Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population, and further studies with larger samples are needed to better assess the intervention's impact on psychological well-being and immunocompetence.
Abstract: Objective:This pilot study explored the feasibility and the efficacy of a brief, well-defined psychosocial intervention (expressive disclosure) in improving behavioral, medical, immunological, and emotional health outcomes in men with diagnosed prostate cancer.Method:Thirty prostate cancer patients receiving outpatient oncology care were randomized into experimental (disclosure) and control (non-disclosure) groups. All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels. Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment. Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning: physical and psychological symptoms; health care utilization; and immunocompetence.Results:Compared to controls, patients in...
182 citations
TL;DR: The somatoform and depression modules of thePHQ were found to be valid in a Saudi population using the criterion standard of SCID based psychiatric interviews and it is possible to screen primary care patients for mental disorders in international settings and the PHQ is a valid instrument for that purpose.
Abstract: Objectives:Somatization, the tendency to seek treatment for medically unexplained physical symptoms, is an important issue in primary care practice. This study examines the somatoform, depression, and anxiety modules of the Patient Health Questionnaire (PHQ), a screening instrument for the identification of somatoform and other mental disorders. We also utilized the PHQ to measure the prevalence of somatization and co-morbid depression in Saudi Arabian primary care patients.Methods:This is a cross sectional study of 431 male and female Saudi Arabian primary care patients with a two stage design for purposes of validation of the somatoform, depression and anxiety modules of the PHQ. The self administered Patient Health Questionnaire was given to 431 primary care patients and, of this group, the first, consecutive 173 patients (40 percent) were interviewed by mental health professionals using the Structured Clinical Interview (SCID-R) as the criterion standard for validation of the PHQ in the Saudi populati...
170 citations
TL;DR: The results of this study are consistent with the view that religious involvement, like high socioeconomic status, is a general protective factor that promotes health through a variety of causal pathways.
Abstract: Objective:Frequent attendance at religious services has been reported by several studies to be independently associated with lower all-cause mortality. The present study aimed to clarify relationships between religious attendance and mortality by examining how associations of religious attendance with several specific causes of death may be explained by demographics, socioeconomic status, health status, health behaviors, and social connections.Method:Associations between frequent religious attendance and major types of cause-specific mortality between 1965 and 1996 were examined for 6545 residents of Alameda County, California. Sequential proportional hazards regressions were used to study survival time until mortality from circulatory, cancer, digestive, respiratory, or external causes.Results:After adjusting for age and sex, infrequent (never or less than weekly) attenders had significantly higher rates of circulatory, cancer, digestive, and respiratory mortality (p < 0.05), but not mortality due to ext...
146 citations
TL;DR: Although fluoxetine had beneficial effects on some measures of cognition, more work is needed to connect these improvements with neuronal remodeling.
Abstract: Objective:There are preclinical data showing that fluoxetine stimulated expression of Brain Derived Neurotrophic Factor (BDNF) and its specific tyrosine kinase receptor, and caused neuritic elongat...
91 citations
TL;DR: More efforts are needed to increase the use of referral to psychotherapy as a treatment option for older medical patients, and specific education, including information about the efficacy of psychotherapy for older adults, as well as direct training in psychosocial techniques, may be helpful in promoting referral toPsychotherapy.
Abstract: Objective:Psychotherapy for late-life depression is an efficacious treatment option for older primary care patients who do not wish to take or do not respond to antidepressant medication. However, rates of physician referral to psychotherapy to treat late-life depression tend to be low. The purpose of this study was to assess attitudes toward psychotherapy for late-life depression and to identify predictors of physician willingness to refer older patients to psychotherapy.Methods:Two hundred and five physicians identified from PPO directories of general internists in California and North Carolina completed a brief mailed survey about how they would treat a hypothetical older depressed patient and specific attitudes and practices regarding their own treatment of late-life depression.Results:Only 27 percent of physicians said they would refer a depressed older patient to psychotherapy. In a regression analysis, female gender, the belief that psychotherapy is effective for older adults, and physician use of ...
50 citations
TL;DR: In this sample of primary care patients with persistent unexplained physical symptoms, little evidence of discrete somatic syndromes is found, which is equally consistent with depression or anxiety being secondary to disability and its consequences as with them being primary.
Abstract: Objective:To re-examine the widespread assumption that medically unexplained physical symptoms represent discrete syndromes resulting from somatization of mental illness.Method:Primary care patients (N = 223) with medically unexplained symptoms of at least one year's duration were recruited to a study of exercise therapy. Data gathered from patients, from their general practitioners, and from medical records were used to examine relationships between self-defined disability, symptoms, mental state, and use of health care.Results:Levels of disability and health care use were both raised, but were only weakly correlated. While most patients were depressed and/or anxious, a minority (14 percent) were neither. Although mental state correlated with disability, health care use was unrelated to either. Among a wide range of recorded symptoms, few correlations were found to support the existence of discrete syndromes. Analysis of agreement between patients and their doctors in assigning symptoms to broadly define...
50 citations
TL;DR: Individuals with changes in day-to-day routines or activities secondary to urinary incontinence were more likely to meet criteria for an anxiety disorder than were other older adults.
Abstract: Objective:No previous research has investigated whether there is an association between anxiety disorders and urinary incontinence. We hypothesized that anxiety disorders would be associated with increased urinary incontinence related disability.Method:Continuing participants who were aged 50 years and older in a longitudinal study of community-dwelling adults who were initially living in East Baltimore in 1981 (n = 787). Participants were classified as incontinent if any uncontrolled urine loss within the 12 months prior to the interview was reported. Urinary incontinence related functional loss was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their urinary incontinence. Anxiety disorders were assessed with standardized interviews.Results:Persons meeting criteria for an anxiety disorder were no more likely to have urinary incontinence than were persons without anxiety disorders (unadjusted odds ratio (OR) = 1.36, 95 pe...
43 citations
TL;DR: Strategies to improve mental health care should account for the orientation of primary care physicians to mental health issues.
Abstract: Objectives:The purpose of this investigation was to assess the relationship of primary care specialty training with self-assessed skill, knowledge, attitudes, and behavior toward depression recogni...
39 citations
TL;DR: A subset of individuals with HIV/AIDS experience high levels of acute stress reactivity to life events considered non-traumatic, and HIV-infected individuals who react strongly to ongoing life stressors are more likely to have developed PTSD symptoms in response to previous traumatic life events.
Abstract: Objective:This study examined the prevalence of acute stress reactions to recent life events among persons living with HIV/AIDS. A second aim was to investigate the relationship of acute stress rea...
34 citations
TL;DR: These findings raise the possibility that a loving relationship with God may exert a protective effect on psychological distress, and may represent an important personal resource for mitigating the emotional consequences of poor health and other deleterious life circumstances.
Abstract: Objective:This study examines the association between a self-reported loving relationship with God and the presence of depressed affect. Building on prior clinical and epidemiologic research on religious factors in mental health, it seeks to extend consideration to internal religious resources.Method:Data are from 205 primary care outpatients who completed a self-administered survey inquiring about their relationship with God, their mental and physical health, and various religious and psychosocial issues. The principal dependent construct is the depressed affect subscale of the General Well-Being Scale. The principal independent construct is a validated eight-item self-report measure of loving and being loved by God based on a theoretical taxonomy developed by Sorokin.Results:Hierarchical ordinary least squares regression was used to investigate the association between this construct, which Sorokin termed “religious love,” and the measure of depressed affect. After controlling for sets of hypothesized me...
TL;DR: A 39-year-old patient who presented with long-term decline and acute onset of psychosis and delirium, and who was found to have neurosarcoidosis is reported on.
Abstract: Neurosarcoidosis is a rare disorder in which psychosis and dementia may occur. They usually appear subsequently to the diagnosis of pulmonary sarcoidosis. We report on a 39-year-old patient who presented with long-term decline and acute onset of psychosis and delirium, and who was found to have neurosarcoidosis.
TL;DR: The results suggest that vitamin B6 may alleviate lithium-induced tremor, but double-blind controlled trials are needed to establish this effect.
Abstract: Objective:The occurrence of tremor in patients receiving lithium is well known, but the management of this side effect is a significant problem both for patients and physicians. Although some reports have suggested that beta-blockers may be useful in treating lithium-induced tremor (LT), these agents have different side effects which limit the possibility of their use. Vitamin B6 has been reported to be effective in treatment of patients suffering from different kinds of neuroleptic-induced movement disorders including parkinsonism and tardive dyskinesia.Methods:This report presents the results of a preliminary four-week open-label clinical trial of five patients who suffered from LT and who were treated with vitamin B6 (900–1200mg/d). The severity of tremor was assessed using the tremor subscale from the Simpson-Angus Scale (SAS) and Subjective Clinical Improvement Impression scale (SCII).Results:After the addition of vitamin B6 to their treatment, according to the SAS scores four patients showed an impr...
TL;DR: Hopelessness is associated with SPMS, and may increase over time in this group, while depression was strongly associated with hopelessness in both RRMS and SPMS.
Abstract: Objective:Two recent randomized double-blind placebo controlled clinical trials of interferon beta-1a in multiple sclerosis have obtained hopelessness ratings using the Beck Hopelessness Scale (BHS...
TL;DR: Psychogenic or nervous cough has generally been viewed as a clinical oddity and largely ignored, but further studies are warranted to study the treatment and outcome of this important psychiatric disorder.
Abstract: Objective:Psychogenic or nervous cough has generally been viewed as a clinical oddity and largely ignored. Though it is not rare, its clinical profile is not yet well known.Method:In the present study, a series of 32 cases of psychogenic cough is reported.Results:Of 32 cases, there were 19 females (59.4 percent) and 13 males (40.6 percent). A majority of patients had cough for more than one month. School phobia (in children) and fear of rejection and need for attention were the most common precipitating or perpetuating factors. Twenty patients (62.5 percent) had a psychiatric disorder, the most common being conversion disorder (21.9 percent) followed by mixed anxiety and depressive disorder (12.5 percent). Drug therapy and/or psychotherapy were used as treatment with 12 cases (37.5 percent) showing remission, 16 cases (50.0 percent) having improvement, and 4 cases (12.5 percent) continuing with the complaint.Conclusion:Further studies are warranted to study the treatment and outcome of this important psyc...
TL;DR: Greater use of religious coping is associated with more functional disabilities and fewer outpatient physical health care visits at baseline, but a lack of decline in health at 4-month follow-up among the bereaved, a sub-group at risk for numerous health impairments.
Abstract: Objective:This report examined associations between religious coping, health, and health service use among a sample of 265 recently bereaved adults.Method:Participants were interviewed an average o...
TL;DR: It is proposed that determination of serum vitamin B12 and folic acid levels should be recommended as routine screening in all new admissions of psychiatric patients regardless of their age or previous state of health.
Abstract: Objective:Vitamin B12 (cobalamin) is a key component in the catabolism of monoamines. B12 deficiency is associated with various neuropsychiatric disorders and may be more frequent in psychiatric inpatients. The authors describe a case report of a newly admitted and relatively young patient (52 years old) with organic psychosis secondary to vitamin B12 deficiency. No other overt clinical features of cobalamin deficit were observed. Symptoms were resolved with B12 and folate replacement. The patient's mental status remained stable over the 3 months after the treatment. The authors note that organic mental changes were reversible with B12 replacement.Conclusions:The authors propose that determination of serum vitamin B12 and folic acid levels should be recommended as routine screening in all new admissions of psychiatric patients regardless of their age or previous state of health.
TL;DR: Examination of behaviors documented by inpatient rehabilitation staff and the association of these behaviors with functional outcome, in elderly persons undergoing rehabilitation after hip fracture found disturbances in cognition and participation were common and were associated with poorer rehabilitation outcome.
Abstract: OBJECTIVE: To examine the range of behaviors documented by inpatient rehabilitation staff and the association of these behaviors with functional outcome, in elderly persons undergoing rehabilitation after hip fracture. METHOD: Subjects were 137 patients, aged 60 and older, admitted to a rehabilitation hospital after a hip fracture, defined as having either a good or poor rehabilitation outcome based on change in Functional Independence Measure motor subscale scores during the course of their admission. Their charts were systematically reviewed for nursing and therapy staff documentation of behaviors. Prevalence of behaviors was compared between good and poor rehabilitation outcome group. RESULTS: Disturbances in cognition and rehabilitation participation were common and were associated with poorer rehabilitation outcome. Behaviors reflective of depression and anxiety were relatively uncommon and not associated with rehabilitation outcome. CONCLUSION: Rehabilitation staff frequently detect and document disturbances in cognition and participation that are associated with poorer rehabilitation outcome. It is recommended that staff observations be routinely added to mental health evaluations. Additionally, routine mental health screening and required staff documentation of behaviors would improve case detection rate. Language: en
TL;DR: Although the clinical features are similar, there appear to be differences between late onset and adolescent cases in psychological mechanisms.
Abstract: Objective Some patients develop an eating disorder at a late age. It is worth investigating why this syndrome develops at such widely different ages. Methods Two Japanese cases of late onset anorexia nervosa are reported. Results In these late onset cases, anorexia developed out of sadness over a loss such as bereavement, divorce, and fear or anxiety for the future. In addition, these two patients didn't demonstrate a fear of aging or of losing their attractiveness and sexuality, nor did they develop a dissociative disturbance based on an early traumatic history of sexual abuse in PTSD. Conclusion Although the clinical features are similar, there appear to be differences between late onset and adolescent cases in psychological mechanisms.
TL;DR: It is argued the necessity of further partnering, within well-defined limits, to maximize the availability of health care education and services throughout this nation.
Abstract: Recent debate over the relationship between government and faith-based organizations has renewed interest in the opportunities and challenges that are associated with change in this area of health care policy. Experience exists already that faith-based organizations can provide effective health education and services in the community. Limited infrastructure and liability are among the important barriers to their expansion. Spurred by the demographics of an aging population and increasing health care costs, we argue the necessity of further partnering, within well-defined limits, to maximize the availability of health care education and services throughout this nation.
TL;DR: PE, a severe and chronic psychiatric and dermatological problem, may be related to affect-regulation, particularly anger and alexithymia, and individuals with PE might benefit from learning how to regulate their affects other than by excoriation.
Abstract: Objective:Psychogenic excoriation (PE), which is characterized by lesions formed by self-picking, has a significant place among the dermatoses related to psychological factors. Emotions, particular...
TL;DR: A historical perspective allows an appreciation of the strengths and limitations of older treatments, and sheds light on current strategies, as well as warning and skepticism are encouraged when innovative treatments are proposed.
Abstract: Many different forms of treatment have been used with patients suffering from depression. It can be difficult to examine current treatments and anticipate problems, mistakes, and limitations. However, a historical perspective allows an appreciation of the strengths and limitations of older treatments, and sheds light on current strategies. A variety of effective treatments have been discarded and forgotten. Important lessons can be learned by reviewing the history of treatments for depression. Many treatment strategies were based on accidental discovery, but nonetheless were found effective in reducing the symptoms of depression. Both case examples and group studies have documented the effectiveness of these older treatments. A review of discarded treatments reveals how a biological model can be limited in its ability to produce a lasting cure. Caution and skepticism are encouraged when innovative treatments are proposed.
TL;DR: It is suggested that atypical antipsychotic prescriptions strongly predict fewer prescriptions for EPS treatment, and, by implication, reduced need for EPStreatment in actual ambulatory care practices throughout the nation.
Abstract: Purpose:Antipsychotics, particularly typical agents, have been shown to cause extrapyramidal symptoms (EPS). We hypothesized a negative association between concomitant (at same visit) prescriptions...
TL;DR: Biologic and psychotherapeutic treatment interventions for women with DP may need to address factors of hostility and treatment resistance, as well as psychotherapies that are cognitive and lead to modification of belief paradigm.
Abstract: Objective:False pregnancy or delusional pregnancy, is the condition of believing one is pregnant despite factual evidence to the contrary. This is the first study to utilize a standardized mental d...
TL;DR: The present investigation found underrecognition of psychiatric illness by physicians, with relatively little misdiagnosis of psychiatric disorder in patients whose chronic fatigue was fully explained by a psychiatric disorder.
Abstract: Objective To examine rates of psychiatric diagnoses given by patients' primary or regular physicians to persons with chronic fatigue syndrome (CFS), persons with psychiatrically explained fatigue, and a control group. Physicians' psychiatric diagnosis and participants' self-reported psychiatric diagnoses were compared to lifetime psychiatric diagnoses as measured by a structured psychiatric interview. Method Participants were recruited as part of a community-based epidemiology study of chronic fatigue syndrome. Medical records of 23 persons with chronic fatigue syndrome, 25 persons with psychiatrically explained chronic fatigue, and 19 persons without chronic fatigue (controls) were examined to determine whether their physician had given a diagnosis of mood, anxiety, somatoform, or psychotic disorder. Lifetime psychiatric status was measured using the Structured Clinical Interview for the DSM-IV (SCID). Participants' self reports of specific psychiatric disorders were assessed as part of a detailed medical questionnaire. Results Physicians' diagnosis of a psychiatric illness when at least one psychiatric disorder was present ranged from 40 percent in the psychiatrically explained group, 50 percent in the control group, and 64.3 percent in the CFS group. Participants in the psychiatrically explained group were more accurate than physicians in reporting the presence of a psychiatric disorder, and in accurately reporting the presence of a mood or anxiety disorder. Conclusions The present investigation found underrecognition of psychiatric illness by physicians, with relatively little misdiagnosis of psychiatric illness. Physicians had particular difficulty assessing psychiatric disorder in those patients whose chronic fatigue was fully explained by a psychiatric disorder. Results emphasized the importance of using participant self report as a screening for psychiatric disorder.
TL;DR: Mental health problems are common in primary care although they rarely constitute a reason for consultation, and primary health care staff have a significant role in identifying hidden psychiatric morbidity.
Abstract: Objective: Psychiatric problems are often expressed through, or coexist with, somatic symptoms. Cultural factors may influence this association. This study aims to 1) estimate the prevalence of mental health problems in a sample of primary care attendees in a rural area of Greece, and 2) investigate the differences in psychiatric symptomatology among patients from different religious/cultural backgrounds. Method: Over a three-month period, 300 consecutive adult patients (Christians and Moslems) at the rural Primary Care Health Centre of Iasmos in Thrace, Greece, were assessed with the 28-item General Health Questionnaire. Results: The probable prevalence of mental health problems was estimated at 32 percent. Only for a small minority of the patients (3.3 percent) psychological problems were the presenting complaint. Moslems scored significantly higher than Christians in the somatic complaints subscale (p < 0.001). Conclusions: Mental health problems are common in primary care although they rarely constitute a reason for consultation. Sociocultural background may affect the presentation of psychological distress. Primary health care staff have a significant role in identifying hidden psychiatric morbidity.
TL;DR: This study did not find increased direct medical costs in persons with comorbid major depressive disorder and multiple sclerosis and the lack of an association between costs and major depression may or may not be generalizable to health care systems in other countries.
Abstract: Objective:Multiple Sclerosis (MS) is associated with elevated levels of depressive symptoms and an elevated frequency of depressive disorders Depressive disorders, in general, are associated with substantial direct and indirect economic costs, and have been shown to increase the costs associated with the management of medical conditions in a variety of clinical settings However, the impact of depressive disorders on costs associated with MS have not been evaluated The objective of this study was to evaluate this associationMethods:The Composite International Diagnostic Interview (CIDI) was used to identify subjects with major depressive disorder in a sample who had earlier been selected for a broader economic evaluation of the costs associated with MS Costs were measured in two ways: retrospectively (by questionnaire covering a 2-year period) and prospectively (using a 6-month diary) The proportion of subjects reporting any costs and the proportion exceeding various cost thresholds were calculated i
TL;DR: A patient with multiple myeloma with failure-to-thrive who was successfully treated with modafinil and mirtazapine is described, which was able to achieve immediate results in a gravely ill patient.
Abstract: The failure-to-thrive syndrome in geriatric patients is marked by social withdrawal, apathy, depression, anorexia, and cognitive impairment. For therapy to be effective, the treatment plan must target several of theseareas. This case report describes one such course of treatment for a patient with multiple myeloma with failure-to-thrive who was successfully treated with modafinil and mirtazapine. By using combination pharmacotherapy, we were able to achieve immediate results in a gravely ill patient.
TL;DR: The case of a 12-year-old boy where both he and his parents brought forth false allegations of repeated physical abuse induced by his schoolteacher is presented and it is suggested that this case represents a Munchausen by proxy-like syndrome involving both the legal and medical systems.
Abstract: The diagnosis of factitious disorder by proxy is still under investigation. Few studies have researched the psychological status and potential underlying psychopathology of the perpetrator, as well as the impact on the child's development and the pathological reactions of rearing a child within the context of a distorted reality. In this article, we present the case of a 12-year-old boy where this diagnosis was suspected. Both he and his parents brought forth false allegations of repeated physical abuse induced by his schoolteacher. The parents presented with shared psychosis and the child presented with conduct disorder, factitious disorder, and emotional problems. We suggest that this case represents a Munchausen by proxy-like syndrome involving both the legal and medical systems. Hypotheses regarding the pathogenesis of symptoms in the child are noted, underscoring the differences between Munchausen by proxy syndrome appearing in infancy with that appearing in older children.
TL;DR: This is a report on a male patient with a previous history of psychotic disorder who was arrested for arson and during the following hospitalization in a psychiatric unit, a genetic syndrome, namely Klinefelter syndrome (47,XXY), was diagnosed.
Abstract: This is a report on a male patient with a previous history of psychotic disorder who was arrested for arson. During the following hospitalization in a psychiatric unit, a genetic syndrome, namely Klinefelter syndrome (47,XXY), was diagnosed. The association between fire-setting behavior and Klinefelter syndrome is reviewed, and the underlying explanatory hypothesis is discussed.