Showing papers in "International Journal of Psychiatry in Medicine in 2003"
TL;DR: The fact that three quarters of suicide notes contained the theme “apology/shame” suggests that the deceased may have welcomed alternative solutions for their predicaments and that potential major unipolar depressive suicides, in particular, may provide fertile ground for therapeutic intervention.
Abstract: Objective:The aim was to determine if suicide note themes might inform suicide prevention strategies.Method:The themes of 42 suicide notes from the Northern Ireland Suicide Study (major psychological autopsy study) were examined.Results:The commonest themes were “apology/shame” (74%), “love for those left behind” (60%), “life too much to bear” (48%), “instructions regarding practical affairs post-mortem” (36%), “hopelessness/nothing to live for” (21%) and “advice for those left behind” (21%). Notes of suicides with major unipolar depression were more likely than notes of suicides without major unipolar depression to contain the themes “instructions regarding practical affairs post-mortem” (67% versus 19%, p = 0.005) and “hopelessness/nothing to live for” (40% versus 11%, p = 0.049). Notes of suicides with a previous history of deliberate self-harm were less likely than notes of suicides without a history of deliberate self-harm to contain the theme “apology/shame” (58% versus 87%, p = 0.04). Notes of elde...
105 citations
TL;DR: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement, according to this study.
Abstract: Objective:To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes.Method:The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used.Results:Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognit...
95 citations
TL;DR: Efforts to improve care must include practical, validated screening procedures to enhance assessment for mood and anxiety syndromes, particularly among children in whom primary care clinicians identify psychosocial problems.
Abstract: Objective:To seek clues to the enhancement of primary care management by (i) Determining how often and in whom primary care clinicians in the United States, Puerto Rico, and Canada identify pediatric mood or anxiety syndromes; (ii) Determining which clinical and demographic features predict higher rates of identification; (iii) Describing assessment methods used.Methods:This report uses the database of the multi-site Child Behavior Study. This cross-sectional study involved 206 primary care practices in the United States, Puerto Rico, and Canada; 395 clinicians and 20,861 primary care attenders aged 4–15 years. Clinicians completed a visit questionnaire addressing presence and type of psychosocial problems and how assessed. Parents completed a questionnaire addressing family demographics, child symptoms (Pediatric Symptom Checklist) and functioning, and child service use.Results:Clinicians identified psychosocial problems on 17.9% of visits, but mood or anxiety syndromes on only 3.3%, most commonly in chi...
69 citations
TL;DR: Implementing an integrated care model did not occur as intended and experienced CNSs often did not see the need for treatment in many primary care patients identified by the PRIME-MD, suggesting that integrating integrated care models in actual practice may prove challenging.
Abstract: Objective:To examine the effectiveness of integrating generalist and specialist care for veterans with depression.Method:We conducted a randomized trial of patients screening positive for depression at two Veterans Affairs Medical Center general medicine clinic firms. Control firm physicians were notified prior to the encounter when eligible patients had PRIME-MD depression diagnoses. In the intervention firm, a mental health clinical nurse specialist (CNS) was to: design a treatment plan; implement that plan with the primary care physician; and monitor patients via telephone or visits at two weeks, one month and two months. Primary outcomes (depressive symptoms, patient satisfaction with health care) were collected at 3 and 12 months.Results:Of 268 randomized patients, 246 (92%) and 222 (83%) completed 3- and 12-month follow-up interviews. There were no between-group differences in depressive symptoms or satisfaction at 3 or 12 months. The intervention group had greater chart documentation of depression ...
61 citations
TL;DR: A complete, concise review of the interplay between psychological components and erectile function is provided, which reviews the work-up and diagnosis of psychogenic ED, and discusses treatment methods.
Abstract: Objective:To educate healthcare professionals on the historical aspects, clinical diagnosis, and current treatment methods of psychogenic erectile dysfunction.Method:A topic review of current liter...
58 citations
TL;DR: Selenium therapy may be a beneficial treatment to decrease anxiety in HIV+ drug users who exhibit a high prevalence of psychological burden in HIV/AIDS.
Abstract: Objective: To determine the impact of nutritional (selenium) chemoprevention on levels of psychological burden (anxiety, depression, and mood state) in HIV/AIDS. Method: A randomized, double-blind, ...
50 citations
TL;DR: Verbal fluency increased in all patients, according to their caregivers, and cholinergic stimulation of the CNS serotonergic subsystem with galantamine may enhance expressive language and communication in autistic adults.
Abstract: Objective:To study the usefulness of galantamine, a competitive, reversible acetylcholinesterase inhibitor (AChEI), in adults diagnosed with autism (in accordance with DSM-IV-TR Axis I clinical criteria) before age three years.Methods:To promote verbalization and meaningful speech sound production through biochemical enhancement of the serotonergic subsystem of the central nervous system (CNS), galantamine 4 mg qhs was administered, with indicated dose increases.Results:Verbal fluency increased in all patients, according to their caregivers. One patient developed a macular rash that abated when the medication was discontinued. After one month on donepezil 5 mg qhs, verbal and behavioral regression again led to discontinuation. Doses for the other patients have been escalated by 4 mg daily each month to a maximum of 12 mg, with improvement following each increase.Conclusions:Cholinergic stimulation of the CNS serotonergic subsystem with galantamine may enhance expressive language and communication in autis...
49 citations
TL;DR: Overall, a similar pattern of prevalence and risk factors for mental health problems in children and adolescents in Latin American countries emerged, and rates of disorders in these children are similar to the 15 to 20% found in other countries.
Abstract: Objective:This report reviews population studies of child and adolescent mental health carried out in Latin America over the past 15 years. Also considered is the issue of how to meet the needs of children and adolescents who may present mental health problems in Latin America, given that most of them live in poverty in economies that are underdeveloped, providing limited resources.Method:Ten studies from six different countries were identified that employed some form of randomized sampling method and used standardized instruments for assessment. The authors present a summary of the main characteristics of these studies, highlighting methodological features that may account for differences in the rates obtained.Results:Overall, a similar pattern of prevalence and risk factors for mental health problems in children and adolescents in Latin American countries emerged. Moreover, rates of disorders in these children are similar to the 15 to 20% found in other countries. These findings are similar to those obs...
48 citations
TL;DR: Exploratory models confirmed that lack of religiousness was associated with poor breast cancer survival among African American women and showed a consistent pattern of nonreligiousness being more strongly and negatively related to breast cancer Survival in African Americans than in Whites.
Abstract: Objective:The study investigated whether any of four measures of religiousness predicted longer survival for 145 African-American and 177 White women diagnosed with breast cancer in Connecticut bet...
47 citations
TL;DR: The rising rates of articles on religion and spirituality in biomedical journals suggest a growing recognition of the need to address spiritual and religious issues in health-care.
Abstract: In recent years, several prominent medical journals have published articles addressing the relationship between religion/spirituality and medicine, and recognizing the importance of religion in the lives of most Americans, especially in times of illness. We hypothesized that the publication of these articles reflected a trend in the biomedical literature in which greater attention is being given to the role of religion and spirituality in health-care. A correlational design was used, based on an electronic survey of all articles in MEDLINE for the years 1965 through 2000. The search terms used were: 1) religion or religious; 2) spiritual; and 3) chaplain. The number of articles per 100,000 that mentioned religion (religion or religious), spirituality, or chaplains each year was determined. Statistically significant upward trends across years were found for the rates of articles addressing religion (r = .59, p < .001) and spirituality (r = .89, p < .001) and a non-significant trend was found for chaplains (r = .31). The rising rates of articles on religion and spirituality in biomedical journals suggest a growing recognition of the need to address spiritual and religious issues in health-care.
40 citations
TL;DR: It is suggested that PTSD, depression, and health status deterioration in trauma victims may persist over time and resources such as social support can help attenuate the symptoms of those at a higher risk.
Abstract: Objective:This study examined the effect of stressors on PTSD, depression, and health status in a sample of Lebanese civilians exposed to a church explosion and their comparison groups (33 victims,...
TL;DR: Encouraging results of treatment of OSAS in schizophrenia with nCPAP suggest the need for further and more systematic investigation of sleep and its disorders in psychotic patients.
Abstract: A case of a patient with comorbid schizophrenia and obstructive sleep apnea syndrome (OSAS) who was treated with nasal continuous positive airway pressure (nCPAP) is presented. This treatment led to significant improvement of schizophrenic and depressive symptoms, with only a partial, albeit not trivial, effect on his cognitive functioning. These encouraging results of treatment of OSAS in schizophrenia with nCPAP suggest the need for further and more systematic investigation of sleep and its disorders in psychotic patients.
TL;DR: Religion attenuates this association between sexual assault, religion and mental health among male veterans which highlights the important role religion might have in coping with this stressful life event.
Abstract: Objectives:We examine the association between sexual assault, religion and mental health among male veterans.Methods:We used longitudinal data collected from 2,427 male veterans who received VA out...
TL;DR: An aged case that presented with conscious depression, bradycardia, hypotension, miosis and hypothermia was reported and Olanzapine was thought to be the offending agent.
Abstract: Olanzapine, an atypical antipsychotic, is often regarded as a safe choice for psychosis management [1]. We hereby report an aged case that presented with conscious depression, bradycardia, hypotension, miosis and hypothermia. Olanzapine was thought to be the offending agent. His condition improved with supportive therapy.
TL;DR: Clinicians should consider hyperammonemia in all patients who present with coma and other mental status changes while on valproic acid, in such patients, ammonia level should be obtained in addition to liver function tests.
Abstract: Valproic acid is widely used as a mood stabilizer. We report a case of an adult with bipolar disorder taking therapeutic doses of valproic acid, who presented to the emergency department with coma related to hyperammonemia as a complication of valproic acid treatment. Valproic acid was discontinued which resulted in rapid clinical recovery. Valproic acid induced coma was likely related to a urea cycle enzymopathy. Clinicians should consider hyperammonemia in all patients who present with coma and other mental status changes while on valproic acid. In such patients, ammonia level should be obtained in addition to liver function tests.
TL;DR: The possible utility of atypical antipsychotics in the treatment of patients with schizophrenia and comorbid substance abuse needs to be confirmed in clinical trials.
Abstract: Background:Excluding nicotine and caffeine dependence, almost 50% of individuals with schizophrenia also meet the criteria for substance abuse or dependence. Comorbid drug abuse presents complications to the effective treatment of these patients because they have increased psychotic symptoms and poorer treatment compliance.Case Report:This report describes the case of a young man with schizophrenia and comorbid alcohol and cocaine abuse who was successfully treated with quetiapine. The patient was previously treated with olanzapine and developed priapism, which required emergency medical treatment.Conclusions:The possible utility of atypical antipsychotics in the treatment of patients with schizophrenia and comorbid substance abuse needs to be confirmed in clinical trials.
TL;DR: This study shows that primary care patients with co-occurring anxiety and depression can be successfully treated with a brief cognitive-behavioral intervention, and is a test of a flexible treatment approach.
Abstract: Objective:The purpose of this study was to evaluate the effectiveness of a brief cognitive-behavioral intervention for co-occurring anxiety and depression in primary care patients.Method:Participants in this study were 35 veterans seeking care from a VA primary care clinic. Patients were selected for inclusion in this study based on mild to moderate levels of self-reported symptoms of anxiety and depression. Participants received four weekly sessions of cognitive behavioral intervention for their symptoms. The effectiveness of this intervention was compared with the passage of time alone. Measured outcomes included symptoms of anxiety and depression and quality of life.Results:Statistical testing demonstrated that the intervention led to significant reductions in depression and anxiety and improved role functioning. These changes were maintained except for some return of anxiety over a one-month follow-up period following the end of treatment.Conclusions:This study shows that primary care patients with co...
TL;DR: Two children, with normal intelligence, referred for evaluation of complex cognitive, behavioral, and psychiatric problems, in which Agenesis of Corpus Callosum was an incidental finding underscore the importance of conducting a comprehensive neuropsychiatric evaluation in children with severe behavior problems and other confusing symptoms.
Abstract: Objective:To report two children, with normal intelligence, referred for evaluation of complex cognitive, behavioral, and psychiatric problems, in which Agenesis of Corpus Callosum (ACC) was an inc...
TL;DR: Negative attitudes about loss of autonomy, concerns about being a burden and having few recreational activities are strongly associated with depression in patients with heart failure, and a new measure of Attitudes about Impairment is examined.
Abstract: Objectives: This study examines the relationship between functional impairment and depression in patients with heart failure using a new measure of Attitudes about Impairment Methods: Sixty-nine patients with chronic heart failure completed diagnostic interviews and questionnaires about mood, comorbid illness, functional impairment, and social support Study design was case-control with cases selected because they met criteria for DSM-IV major or minor depression (n = 23) Controls reported no or very few depressive symptoms (n = 46) A preliminary study of the psychometric properties of a new 15-item measure of Attitudes about Impairment was conducted Results: The Attitudes about Impairment measure had a Cronbach's alpha = 081 A factor analysis revealed content domains of negative attitudes about dependency, lack of recreational activities, and concerns about being a burden both currently and in the future This measure correlated highly with the Geriatric Depression Scale (r = 061) and remained high even after controlling for medical burden and social support Patients were diagnosed with either major, minor or no depression using a DSM-IV based structured interview Depressed patients had significantly more negative attitudes about impairment and the association between depression and physical impairment was no longer significant after controlling for scores on the Attitudes about Impairment measure Discussion: Negative attitudes about loss of autonomy, concerns about being a burden and having few recreational activities are strongly associated with depression in patients with heart failure These attitudes account, in part, for the association between impairment and depression in these patients The Attitudes about Impairment measure has adequate intemal consistency and both convergent and discriminant validity with related measures of social support, functional disability and depression
TL;DR: The case of a 40-year-old married white female with isolated complex visual hallucinations compatible with the Charles Bonnet syndrome is described, successfully treated with the atypical antipsychotic olanzapine.
Abstract: Multiple sclerosis (MS) is a fairly common condition that affects approximately 350,000 people in the United States (1). It is associated with various neuropsychiatric symptoms including cognitive and behavioral symptoms. However, visual hallucinations are rare in multiple sclerosis without the presence of cognitive deficits (2). We are describing the case of a 40-year-old married white female with isolated complex visual hallucinations compatible with the Charles Bonnet syndrome (CBS). The patient was successfully treated with the atypical antipsychotic olanzapine.
TL;DR: The prevalence of DSM-IV Major Depressive Disorder and the severity of depressive symptoms were significantly lower among homecare patients who attend religious services, and it is suggested that visitation by clergy may improve depressive symptoms for these patients.
Abstract: Objective:To examine the relationship between religious practice and depression in a sample of geriatric patients receiving homecare nursing services.Methods:Patients were sampled weekly for six months from all those aged 65 to 102, and newly enrolled in a visiting nurse agency (N = 130). Depression was assessed by home interviews using the SCID and HRSD. Patients reported their religious service participation prior to receiving homecare and currently. Health status, disability, pain, social support and history of depression were also assessed.Results:The current prevalence of DSM-IV Major Depressive Disorder (MDD) was significantly greater (p < .05), and depressive symptoms were more severe (p < .02), among those persons who had not attended religious services prior to receiving homecare. Logistic regression demonstrated that the effect of religious attendance remained significant when controlling for health status, disability, pain, social support and history of depression. A subsequent analysis compare...
TL;DR: The combined use of immature and neurotic defenses may be associated with a greater risk to develop a partial ED in adolescent females.
Abstract: Objectives The purpose of this study is to assess whether female adolescents diagnosed with partial eating disorders (EDs) will show less adaptive defense mechanisms compared to female controls with no-ED Methods The following questionnaires were administered to 423 female high-school students: The Eating Attitudes Test (EAT-26), the Defense Style Questionnaire (DSQ), and Life Style Index (LSI) (both tapping defense mechanisms), and a structured questionnaire assessing eating-related issues Weight and height were also recorded Partial anorexia nervosa (AN) and bulimia nervosa (BN) were defined with the combination of a maladaptive EAT score and fulfillment of adapted DSM-IV criteria Results Compared to non-ED controls, participants with partial AN and partial BN used more immature defenses, including the DSQ-immature defense style (only those with partial BN) and LSI-regression, as well as more neurotic defenses, namely the DSQ-neurotic defense style, and LSI-compensation and displacement Conclusions The combined use of immature and neurotic defenses may be associated with a greater risk to develop a partial ED in adolescent females
TL;DR: People who attended religious services were more likely to have continuity with a provider than people who did not attend such services, and this association persisted after controlling for demographic, socioeconomic, and health status variables using regression analysis.
Abstract: Objective:The purpose of this study was to determine whether a relationship exists between religious attendance and continuity of care.Methods:We investigated this relationship in a large national database—the National Health and Nutrition Examination Survey III—which contains information on religious attendance, continuity of care, and potential confounders that might mediate the relationship such as health status and socioeconomic status.Results:A total of 18,162 participants 17 years of age or older were included in the analysis. People who attended religious services were more likely to have continuity with a provider than people who did not attend such services (65% vs. 35%, p < .001). This association persisted after controlling for demographic, socioeconomic, and health status variables using regression analysis.Conclusion:This study documents a significant association between attendance at religious services and continuity with a usual provider. Continuity with a regular medical provider may influ...
TL;DR: A gravid woman in her third trimester merited twin diagnoses of delusional disorder and borderline personality disorder, and was successfully treated with olanzapine and psychotherapy during pregnancy and lactation.
Abstract: This article is a report on a complicated case of delusional disorder in pregnancy and lactation, and effective multidisciplinary treatment. Few reports in the literature concern delusional disorder in pregnancy, or regard olanzapine's safety in pregnancy and lactation. A gravid woman in her third trimester merited twin diagnoses of delusional disorder and borderline personality disorder, and was successfully treated with olanzapine and psychotherapy during pregnancy and lactation. Her infant was large for gestational age (LGA) and had Erb's palsy, which resolved, and remained healthy at six months, with continued breastfeeding. Her delusional beliefs did not recur, nor did she have postpartum depression or psychosis.
TL;DR: This is the first report of successful management of a patient with pseudomalabsorption of levothyroxine, and the approach could be a therapeutic choice for this intractable disorder.
Abstract: Pseudomalabsorption of levothyroxine is a factitious disorder Despite the administration of large doses of levothyroxine, patients with this disorder show hypothyroidism due to noncompliance These patients are different from the patients with simple noncompliance in that they have a psychiatric disorder Because their psychological identities are rooted in their being a "patient," they go to great lengths to become and stay a patient We report a case of pseudomalabsorption of levothyroxine A 28-year-old woman was referred to us because she was believed to have unusual malabsorption of levothyroxine We diagnosed the patient as having this factitious disorder, and as treatment, had her visit a hospital twice a week to take medicine under the observation of nurses so that she would not lose her status as a "patient" Her serum free T4 level normalized during three years with twice weekly dosing of thyroxine after hospital discharge Our approach could be a therapeutic choice for this intractable disorder To our knowledge, this is the first report of successful management of a patient with pseudomal-absorption of levothyroxine
TL;DR: The case of a female, with diet-controlled, type 2 diabetes, whose glucose levels increased with exposure to sertraline is described.
Abstract: Empirical studies with humans suggest that selective serotonin reuptake inhibitors (SSRIs) may, through increases in serotonergic activity [1], increase insulin secretion [2], increase insulin sensitivity [3], and lower serum glucose levels [1]. Indeed, the potentially beneficial effects of SSRI treatment in diabetics are documented. However, we describe the case of a female, with diet-controlled, type 2 diabetes, whose glucose levels increased with exposure to sertraline.
TL;DR: Attitudinal and experiential factors play an important role in the likelihood that a provider will treat an older, depressed patient with an antidepressant, more so than knowledge about how to prescribe an anti-depressant to older patients.
Abstract: Objectives:The purpose of this study was to determine if primary care provider knowledge of late-life depression, attitudes about treatment of depression in late life, and experience treating late-life depression affect the likelihood internists would prescribe antidepressants to older patients.Methods:This study was a primary care provider survey study. From a pool of 456 eligible mailed surveys, 253 providers completed (55% response rate) a survey assessing provider self-reported knowledge about treating late-life depression with antidepressants, their attitudes about older patients' acceptance and response to antidepressant medications, their professional and personal experience with antidepressant medication, and their comfort with prescribing antidepressants to older patients was created for this study.Results:Univariate analyses indicated that 75% of primary care providers were knowledgeable about the use of antidepressant treatment in older people, and 86% said they felt comfortable treating depres...
TL;DR: A case of NP-SLE presenting an acute confusional state (delirium), which was successfully managed by risperidone is reported.
Abstract: Acute confusional state (delirium) appears as one of the common neuropsychiatric manifestations of systemic lupus erythematosus (SLE). It has been suggested that neuropsychiatric SLE (NP-SLE) could promote the occurrence of drug-induced extrapyramidal symptoms (EPS). Atypical antipsychotics have been thought to be useful in management of delirium because of their low incidence of adverse effects including EPS. However, no reports of the use of atypical antipsychotics in delirium due to NP-SLE have been published. Here we report a case of NP-SLE presenting an acute confusional state (delirium), which was successfully managed by risperidone.
TL;DR: While anxiety symptoms were common in this primary care sample, their impact on healthcare utilization was limited, in that only obsessive-compulsive personality features demonstrated a relationship.
Abstract: Objective:In this study, we explored the role of anxiety symptoms (i.e., symptoms that would probably not fulfill DSM criteria) in relationship to healthcare utilization.Method:We surveyed 117 outpatients in an internal medicine clinic regarding four types of anxiety symptoms (i.e., mixed anxiety features, generalized anxiety, obsessive-compulsive personality features, worry), and through a retrospective review of medical records, examined healthcare utilization patterns.Results:Nearly 28% of participants endorsed “positive” results on at least three of the anxiety-symptom measures. When examined for relationships to healthcare utilization, only obsessive-compulsive personality features demonstrated a significant relationship.Conclusions:While anxiety symptoms were common in this primary care sample, their impact on healthcare utilization was limited, in that only obsessive-compulsive personality features demonstrated a relationship.
TL;DR: A 38-year-old African American woman who became addicted to cocaine due to self-medication of her sickle cell pain with cocaine is described.
Abstract: There has been widespread speculation that patients with sickle cell disease (SCD) may become drug dependent if their painful crisis is treated with narcotics. However, there has been no scientific evidence to support this assertion. Paradoxically, individuals suffering from sickle cell disease who are not adequately treated may develop an addiction to narcotics due to self-medication to treat their pain. In this article, we describe a 38-year-old African American woman who became addicted to cocaine due to self-medication of her sickle cell pain with cocaine.