Showing papers in "International Journal of Psychiatry in Medicine in 2005"
TL;DR: This study supports the acceptability of a semi-structured inquiry into spiritual concerns related to coping with cancer; furthermore, the inquiry appears to have a positive impact on perception of care and well-being.
Abstract: Purpose:Individuals with serious illness often desire to discuss spiritual concerns with their physician, yet substantial barriers exist to doing so, including limited evidence of value. This study evaluated acceptability, impact on satisfaction with care and on quality of life (QOL) of a brief (5–7 minute) semi-structured exploration of spiritual/religious concerns.Patients and Methods:118 consecutive patients of four oncologist-hematologists (95% recruitment; 55.1% female, 91.5% Caucasian, 81.3% Christian) with mixed diagnoses, duration (51.7% diagnosed within 2 years) and prognosis (54.2% in active treatment) were alternately assigned to receive the intervention or usual care during an office visit. Assessment occurred just prior to the visit, immediately after, and after 3 weeks. Measures included the FACT-G QOL and FACIT-Sp (Spiritual Well-Being) Scales; BSI Depression Scale; the PCAS Interpersonal and Communication scales; and ratings of acceptability.Results:Oncologists rated themselves as comforta...
119 citations
TL;DR: It is speculated that the social environment of Japanese and Omani society could reinforce behavior akin to hikikomori although this condition may also transcend geography and ethnicity.
Abstract: Hikikomori, a form of acute social withdrawal, is becoming a silent epidemic in Japan. As it has not been reported from other parts of the world, hikikomori fulfills the criteria for "a culture-bound syndrome." We report a case from Oman, in the southern part of Arabia, with all the essential features of hikikomori. We speculate that the social environment of Japanese and Omani society could reinforce behavior akin to hikikomori although this condition may also transcend geography and ethnicity.
93 citations
TL;DR: An etiological model for the development of burnout in psychiatrists is presented which considers three factors: those which may predispose, precipitate, and perpetuate burnout, and an interaction between the predisposing, precipitating, and perpetuating factors.
Abstract: Objective:This article reviews burnout in psychiatrists. A model of burnout is presented which considers three factors: those which may predispose, precipitate, and perpetuate burnout. Lastly, reco...
70 citations
TL;DR: It is concluded that people prone to chronic distress, brain ischemia, brain trauma, and the aged are at increased risk for neurodegenerative diseases such as Alzheimer's.
Abstract: Objectives:To review salient basic research regarding physical exercise as a major protective factor against hippocampal degradation and to emphasize its relevance to humans.Method:Recent mammalian...
66 citations
TL;DR: Evidence suggests that suicide is generally carried-out by patients who have been recently discharged or by those who manage to get away from the hospital, and the need to establish guidelines for the prevention of suicide in hospitalized patients with schizophrenia is emphasized.
Abstract: Objective:To review the literature on suicide of inpatients with schizophrenia, to identify suicide risk factors as well as typical patterns of behavior and to suggest a rationale and strategies fo...
52 citations
TL;DR: A multiple regression analysis adjusting for the possible confounding effects of sex, age, education, and months of stay in Italy showed that South/Central Americans had significantly higher somatic scores than the other three groups.
Abstract: Objectives:Those responsible for interviewing immigrants in primary care settings often underestimate the importance of somatic symptoms arising from psychological distress. This study investigates the current prevalence of somatization in immigrants, and evaluates the comparative rates of somatic complaints in four ethnic groups (Caucasians, Asians, South/Center Americans, and Africans).Methods:We studied the 301 consecutive outpatients (aged between 16 and 70 years) attending the “Caritas” primary care unit for immigrants in Rome (Italy) from January to December 2003, all of whom completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or more on the BSI-21 were considered at risk for somatization.Results:The current prevalence of somatization was 35.2%; 62.3% of the somatizers were women. A multiple regression analysis adjusting for the possible confounding effects of sex, age, education, and months of stay in Italy showed that South/Central Americans had significan...
45 citations
TL;DR: In this article, the five-factor model of personality was used to describe the correlates of smoking abstinence, and the results showed that following treatment in the Mayo Clinic Nicotine Dependence Center, the six month abs...
Abstract: Objective:The five-factor model of personality was used to describe the correlates of smoking abstinence.Methods:Following treatment in the Mayo Clinic Nicotine Dependence Center, the six month abs...
44 citations
TL;DR: Three years after gastric banding, positive changes in BMI reduction, partnership, eating behavior, anxiety, depressive symptomatology, and health related quality of life could be observed.
Abstract: Objective:Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volu...
43 citations
TL;DR: Perceived total barriers were greater in participants from several vulnerable populations: those receiving treatment for mental health problems, those with disabilities, and those with worse physical and mental function.
Abstract: Objective:Health care access may be a significant contributor to health outcome. However, few data exist on perception of barriers by patients in treatment, and attending a clinic visit does not mean that no barriers exist. Understanding barriers for treated populations is particularly important in optimizing care for high vulnerability populations, such as those with mental illness and the elderly.Method:A structured interview, demographic questionnaire, and SF-12 were administered to 324 veterans presenting for primary care or mental health appointments at a Veterans Affairs medical center. Principle components analysis was performed and relationships to vulnerability characteristics were identified.Results:Most interview items showed modest mean levels but high variance. Responses were stable over three to six weeks. As hypothesized, perceived total barriers were greater in participants from several vulnerable populations: those receiving treatment for mental health problems, those with disabilities, a...
38 citations
TL;DR: Involvement of family members in the process of change for the transgendered individual is important for both the family as well as the individual concerned.
Abstract: Objective: In Turkey, an individual with gender identity disorder is stigmatized and isolated from society. The family largely reflects and reinforces these negative views because gender crossing poses a threat to the normatively sanctioned gender classification. Methods: We examined the acceptance of gender identity differences by the families in 47 relatives of 39 transgendered individuals who applied to a psychiatry clinic for sex reassignment. Results: Half of the relatives who came to the interview were mothers. While 85.1% of the families considered themselves as secular muslims, 14.9% were very religious. They first noticed the gender identity disorder during puberty (70.2%) or prepuberty (17%). In 63.8% it was remarked that it was a shocking experience. One-third of them felt responsible for it. While 65.9% tried to change the situation by coercion, only 27.7% adopted a supportive attitude. The majority of families tried to conceal the situation from their immediate environment and one-third did not even inform their closest relatives. For half of relatives the mass media was their only source of information whereas one-third received information from doctors. Most of the families were satisfied with the treatment. Family members also reported that the conformity of the transgendered relative within the family improved. Of the family members, 40.4% accepted the transgendered identity and approved the sex reassignment surgery as a final step. Conclusion: Involvement of family members in the process of
32 citations
TL;DR: Aripiprazole appears to be effective in reducing the symptoms of delirium in patients with medically compromised patients and is especially common among medically compromised Patients.
Abstract: Objective Delirium is a common condition frequently seen in consultation-liaison psychiatry. It is especially common among medically compromised patients, and is an indicator of the severity of the medical illness. In addition, it is associated with a higher morbidity, mortality, and longer hospitalization. Traditionally, haloperidol has been used to treat agitation as it may occur in delirium. However, atypical antipsychotics are being increasingly used to treat delirium. Method In this article, we will describe two cases of delirium successfully treated with aripiprazole. Results Both patients had significant improvement in their delirium as measured by the delirium rating scale. Conclusion Aripiprazole appears to be effective in reducing the symptoms of delirium.
TL;DR: Clinicians' awareness and early intervention for psychosocial problems (for example, inadequate family support) could improve diabetes control and there are ethnic differences in juvenile diabetic control in this Malaysian sample.
Abstract: Objectives: To examine the association between ethnicity, depression, quality of life, and diabetic control in Malaysian adolescents and young adults with type I diabetes mellitus. Methods: Fifty-two outpatients with type I diabetes (mean age 15.5 years) who attended a Diabetes Clinic were included. The level of HbA 1c was the measure of diabetes control used (better control defined as HbA 1c < 10%). Other variables were measured through questionnaires (e.g., depressive symptoms, quality of life), computerized diagnostic interviews (major depression), and medical records (e.g., demographic, family circumstances, compliance with treatment). Results: Ethnic Chinese youth showed better diabetic control than Malays and Indians (mean HbA 1c 9.1%, 10.3%, and 11.0% respectively). Young people with better diabetic control (HbA 1c < 10%) were more likely to have better quality of life and less likely to live in problematic families. When the cut-off for diabetic control was stricter (HbA 1c ≤ 8%), the young person's compliance was the main predictor of poor control. Family problems were also associated with poor control but to a lesser extent The initial association between poorer diabetes control and depression became non-significant when quality of life was taken into account. Conclusions: There are ethnic differences in juvenile diabetic control in this Malaysian sample which need to be understood further. Previous findings of an association between quality of life and glycemic control were verified but different definitions of good control showed different associations with individual and environmental variables. Clinicians' awareness and early intervention for psychosocial problems (for example, inadequate family support) could improve diabetes control.
TL;DR: The findings support the notion that religious commitment may help mitigate the stress of the midlife period and more research is needed to translate these findings into clinical interventions that can decrease the burden of anxiety and depression on midlife women.
Abstract: Objective:Spiritual and religious factors may influence mental health in midlife women. The purpose of this study was to explore whether strength of religious beliefs or attendance at religious services helps to mitigate the stresses of life in mid-life women.Methods:Data are from a sub-sample of 265 women, ages 40–70, who were participants in the REACH study, a longitudinal study investigating health parameters in a representative sample of households from rural communities in eastern North Carolina. Using t-tests and linear regression analyses, we analyzed the relationship between frequency of attendance at religious services and strength of religious beliefs in 1997 and subsequent mental health in 2003 as measured by the mental health component score (MCS) of the SF-12.Results:The mean MCS in 2003 was significantly higher (better mental health) in women who reported attending religious services ≥1/week compared to those who reported attending <1/week (53.9 vs. 51.7; p < 0.05). In the linear regression ...
TL;DR: A case of ingestion of a rolled, metal tuna can lid in a male prison inmate previously diagnosed with depression and paranoid schizophrenia is reported, finding that patient had a proclivity toward this swallowing behavior even prior to his incarceration.
Abstract: The topic of foreign body ingestion has received extensive coverage in the areas of surgery, emergency medicine, and pediatrics. A subset of this topic, the intentional ingestion of foreign bodies, however, is much less common, and requires special evaluation and management. Here, we report a case of ingestion of a rolled, metal tuna can lid in a male prison inmate previously diagnosed with depression and paranoid schizophrenia. Following evaluation by the surgical team, the foreign body was removed by laparotomy and the patient was discharged back to the prison without complication. In many cases, ingestions of this type involve a command hallucination ordering the patient to swallow the foreign body. Interestingly, the patient in the present case reported auditory hallucinations commanding him not to swallow the can lid. On further investigation, we found that patient had a proclivity toward this swallowing behavior even prior to his incarceration. Early identification of inmates with this proclivity has important implications for treatment and prevention.
TL;DR: “Adherence” is a broad concept that is preferably used in diabetes care in place of “compliance,” since patients are more autonomous today in defining and following medical treatments than ever before.
Abstract: “Adherence” is a broad concept that is preferably used in diabetes care in place of “compliance,” since patients are more autonomous today in defining and following medical treatments than ever before [1]. Although important to control blood glucose levels, adherence to diabetes management programs appears to be poor [2-4]. Research has shown some links between poor glycaemic control and personality factors in type 2 diabetes patients. High levels of blood glucose were associated with high levels of altruism and low levels of neuroticism, including
TL;DR: Use of Selective Serotonin Reuptake Inhibitors (SSRIs) may also be an effective treatment for coprophagia, particularly in the setting of depression or anxiety.
Abstract: Objective:Coprophagia or the ingestion of feces has long been associated with psychiatric illness. It is considered to be a variant of pica. This behavior requires an extensive medical and psychiatric differential diagnosis. Medical disorders associated with coprophagia include seizure disorders, cerebral atrophy, and tumors. Psychiatric disorders associated with coprophagia include mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, fetishes, delirium, and dementia. In animals, coprophagia is associated with boredom, thiamine deficiency, and lesions of the amygdala.Methods:A case of coprophagia in an elderly man is reported here. A 77-year-old man with mild mental retardation was referred for urgent psychiatric evaluation due to coprophagia. The case is discussed and the literature reviewed.Results:Psychiatric evaluation revealed cognitive dysfunction and depression. Physical examination and laboratory evaluation were noncontributory. He was started on sertraline 25 ...
TL;DR: People over the age of 80 years of age or those with less than a high school education may require tailored strategies for recruitment even when approached by a trained interviewer in a primary care doctor's office.
Abstract: Objective:An important component of generalizing study results to patients is the extent to which study participants adequately represent individuals targeted for the study. The Spectrum study of d...
TL;DR: Maltreatment in childhood appears to have a relationship to employment disability in adulthood, and the percent of one's lifetime on disability was significantly related to physical and emotional abuse as well as witnessing violence.
Abstract: Introduction:While the relationship between childhood trauma and employment disability has undergone very limited study, existing data suggest a possible correlationMethod:In this study of 91 outpatients in an internal medicine setting, we surveyed participants and inquired about their childhood histories of sexual, physical, and emotional abuse, of physical neglect, and of witnessing violence We also asked whether participants had ever been on employment disability, either psychiatric or non-psychiatric, and the length of that disabilityResults:Being or having been on disability was significantly related to childhood histories of emotional abuse, physical neglect, and witnessing violence Being or having been on psychiatric disability was significantly related to childhood emotional abuse and physical neglect while being on non-psychiatric medical disability was significantly related to witnessing violence The percent of one's lifetime on disability was significantly related to physical and emotional
TL;DR: This preliminary study indicates that psychiatrists and other physicians should consider the frequency and overlap of menopausal and psychiatric symptoms among women with serious mental illness in this age group.
Abstract: Objective:Menopause is an important life event that has not yet been well characterized among women with severe mental illness. Our goal was to evaluate menopause-related quality of life among severely mentally ill women.Method:We conducted a cross-sectional assessment of perimenopausal and postmenopausal women, ages 45–55, diagnosed with schizophrenia/schizoaffective disorder, bipolar disorder, or major depression, who were receiving inpatient or outpatient psychiatric care. Women were compared regarding menopausal symptoms and quality of life using the Menopause Specific Quality of Life Scale (MENQOL).Results:Women with severe mental illnesses who were peri- and post-menopausal experienced considerable vasomotor, physical, sexual, and psychosocial symptoms related to menopause. On seven of 29 MENQOL items, women with major depression reported problems significantly more often than women with other serious mental illnesses.Conclusions:This preliminary study indicates that psychiatrists and other physicia...
TL;DR: Preoperative psychological disturbances during the waiting weeks before cardiac surgery may influence the plasma levels of IL-6 immediately prior to the procedure, according to patients immediately before their operation.
Abstract: Objective:The purpose of this study was to examine the potential effect of mood states and psychosocial functioning during the waiting weeks prior to major cardiac surgery on the plasma Interleukin-6 (IL-6) levels in 236 patients immediately before their operation.Method:The sample was recruited from patients at the cardiac clinic of the University of Michigan Medical Center (Ann Arbor). Two weeks before cardiac surgery, trained research assistants conducted a face-to-face interview with these middle-aged and older patients on their preoperative physical examination date at the clinic. Standardized instruments were used to assess mood states and psychosocial functioning. The blood samples of 236 patients, obtained on the morning of the operation, were analyzed for plasma IL-6.Results:In bivariate analysis, poor psychological functioning and anxiety, as well as bodily pain and body mass index (BMI), were correlated with plasma IL-6 (p < .05), but sociodemographics, chronic illness and use of psychotropic m...
TL;DR: The authors' analyses yielded a point estimate of 20% (+ 10%), depending on a number of factors, that is, the proportion of hospitalized patients who are visited by chaplains.
Abstract: Although a substantial number of studies have documented the spiritual needs of hospitalized patients, few have examined the prevalence of these needs and even fewer have attempted to measure the extent to which they are being met. Since chaplains are the primary providers of spiritual care, chaplains' visits to patients would appear to provide a reasonable proxy for the latter. Based on the limited data available, we estimated the proportion of hospitalized patients who are visited by chaplains. Our analyses yielded a point estimate of 20% (+/- 10%), depending on a number of factors.
TL;DR: Evidence for the applicability of the GDS to older Chinese-Canadians is presented, with a four-factor model indicated: 1) negative mood; 2) positive mood; 3) inferiority and disinterested; 4) uncertainty.
Abstract: Objective: This study aimed to examine the factor structure of a Chinese version of the 15-item Geriatric Depression Scale (GDS) with a sample of community dwelling elderly Chinese in Canada. Method: The data for this study were obtained from a larger study examining the health and culture of 2,272 older Chinese aged 55 years and above in seven major Canadian cities. Both exploratory factor analysis using the Principal Component Analysis and confirmatory factor analysis were conducted to examine the factor structure of the GDS. Results: The findings in this study indicated a four-factor model: 1) negative mood; 2) positive mood; 3) inferiority and disinterested; 4) uncertainty. The constructs identified were associated with the unique characteristics of older Chinese who are mainly immigrants from other countries. Conclusions: The findings in this study presented evidence for the applicability of the GDS to older Chinese-Canadians. This instrument would be useful for practitioners to identify potential depression concerns among older adults in this ethnic community.
TL;DR: Atypical antipsychotic-induced diabetes does not always take a “type 2” presentation in which weight gain and insulin resistance are implicated, sometimes the presentation is with diabetic ketoacidosis, requiring insulin treatment, which can nevertheless be reversible.
Abstract: Objective:To draw attention to severe presentations of atypical neuroleptic related diabetes and to document that a marked degree of remission can take place after drug withdrawal.Method:We describe two patients who presented with diabetic ketoacidosis after treatment with quetiapine and risperidone, respectively.Results:Both patients were negative for islet cell antibodies. They both required treatment with insulin, one in very high dosage, but their insulin requirements fell progressively after the atypical antipsychotic was withdrawn. After several months, neither patient required antidiabetic treatment.Conclusions:Atypical antipsychotic-induced diabetes does not always take a “type 2” presentation in which weight gain and insulin resistance are implicated. Sometimes the presentation is with diabetic ketoacidosis, requiring insulin treatment, which can nevertheless be reversible.
TL;DR: Preliminary data provide preliminary data suggesting that HIV-seropositive individuals who receive supportive-expressive group psychotherapy may experience concomitant improvements in CD4 cell count and viral load.
Abstract: Objective:This randomized pilot study evaluates whether seropositive patients who are randomly assigned to receive a supportive-expressive group therapy plus education intervention show greater improvements in increased immune function and decreased viral load compared to those randomly assigned to an education-only intervention.Method:Fifty-nine individuals who had been HIV-seropositive for at least 6 months prior to inclusion in the study and had been receiving standard pharmacologic treatment were entered in a prospective randomized trial of the effects of weekly supportive-expressive group therapy on changes in immune status. Participants were matched for AIDS status and sex and randomized to receive weekly sessions of group psychotherapy plus educational materials on HIV/AIDS, or to receive the educational materials alone. Participants were assessed before treatment and then 12 weeks later.Results:Individuals who were randomized to group therapy showed a statistically significant increase in CD4 coun...
TL;DR: Active management of childhood mood and anxiety syndromes in primary care was uncommon in the United States, Puerto Rico, and Canada in the mid-1990s.
Abstract: Objective:To describe how primary care clinicians manage children in whom they diagnose mood or anxiety syndromes.Method:This study is a secondary analysis of data from the multi-site Child Behavior Study (CBS)—a cross-sectional survey of primary care management of psychosocial problems. The management of children in whom clinicians identified mood or anxiety syndromes is described and compared with the management of children in whom they identified other psychosocial problems. Recruitment for the CBS occurred in 206 primary care practices in the United States, Puerto Rico, and Canada from October 1994 through June 1997. Participants were 20,861 consecutively sampled primary care attendees aged 4–15 years and 395 clinicians. Primary outcome measures for this report are rates of referral to specialized mental health care and rates of active primary care management (i.e., scheduling a follow-up appointment and/or providing ongoing counseling and/or psychotropic prescription).Results:Identification of a mood...
TL;DR: Clear improvements on assessments of mood and hopelessness, along with overall improvements in social and occupational functioning were noted, which were attributed to a combination of CBT and pharmacotherapy, where pharmacotherapy alone failed to alleviate symptoms.
Abstract: Objective:To demonstrate through the use of a case study, the application of cognitive psychotherapy in the treatment of resistant depression.Method:The case of a woman with an 18-month history of resistant depression associated with low self-esteem, guilt and shame, who failed to respond to three therapeutic trials of antidepressants is described. A detailed description of a CBT intervention over 12 sessions is given.Result:Clear improvements on assessments of mood and hopelessness, along with overall improvements in social and occupational functioning were noted.Conclusion:These improvements were attributed to a combination of CBT and pharmacotherapy, where pharmacotherapy alone failed to alleviate symptoms. A concise literature review revealed relatively few published trials of psychological treatments, and a lack of clear guidelines on pharmacological treatments. More research is needed to explore the efficacy of psychological therapies for treatment resistant depression.
TL;DR: It is recommended to obtain baseline liver function tests before starting risperidone and regular monitoring to screen patients for liver damage during therapy whenever a patient is also receiving fluoxetine.
Abstract: Objective:Risperidone is an atypical neuroleptic drug widely used due to the lower incidence and severity of hepatic adverse effects in comparison to phenothiazines. Although idiosyncratic reversible hepatotoxicity may occur in association with risperidone, the interaction with fluoxetine might increase the risk of toxic liver injury in a vulnerable patient.Methods and Results:We present a case of acute cholestatic hepatitis probably associated with the use of risperidone after only a few days of therapy in a patient also treated with fluoxetine. The patient, a 64-year-old male, developed a rapid increase in liver enzymes after starting treatment with only four doses of risperidone 2 mg/day.Conclusions:We recommend obtaining baseline liver function tests before starting risperidone and regular monitoring to screen patients for liver damage during therapy whenever a patient is also receiving fluoxetine.
TL;DR: It is concluded that recognition alone of MDD among Chinese Americans in the community primary care setting does not lead to adequate initiation of treatment for depression by PCPs.
Abstract: Purpose:This study aims to examine the effect of identifying Chinese American patients as having major depressive disorder (MDD) to their primary care physicians (PCPs) on the latter's attention given to the treatment of depression.Methodology:Forty Chinese American patients from a primary care clinic were identified as having major depressive disorder (MDD), and their primary care physicians (PCPs) were notified of the diagnosis by letter. Three months later, medical records of subjects in the study were reviewed to see if their PCPs had intervened through referral and/or initiated treatment of depression.Results:PCPs documented intervention in 19 patients (47%) regarding their depression. Two of these patients (11%) were started on an antidepressant. Four (21%) accepted and 13 (68%) declined referral to mental health services. No intervention was recorded for 21 (53%) patients.Conclusion:We conclude that recognition alone of MDD among Chinese Americans in the community primary care setting does not lead...
TL;DR: It is suggested that oral ziprasidone may be an effective and safe medication for the treatment of agitation or psychosis in patients with dementia.
Abstract: Objective:These case reports examine the potential efficacy and safety of ziprasidone for the treatment of agitation or psychosis in dementia.Method:The authors performed a retrospective chart review of three patients with DSM-IV diagnoses of dementia, treated with ziprasidone for agitation/psychosis on an academic psychiatric inpatient unit in 2002–2003. In addition, these three case reports are supplemented by a clinical report of the first outpatient with DSM-IV diagnosis of dementia completing a prospective open-label six-week study in 2004 evaluating the use of oral ziprasidone for agitation/psychosis in dementia. Qualitative descriptions of clinical improvement provide outcome data for these case reports.Results:Four patients with dementia with agitation/psychosis experienced marked behavioral improvement after receiving oral doses of ziprasidone (20–160 mg/day), without any evidence of problematic cardiac or other side-effects. Two of the four patients had final EKGs and both of these patients demo...
TL;DR: It appears possible to adapt the conventional written emotional expression procedure in a way that encourages individuals to take a religious perspective, thereby augmenting effects on distress, and support further investigation of integrating religion into trauma interventions, particularly for individuals exposed to highly traumatic events.
Abstract: Objective:Previous research has found an association between writing about traumatic events and well-being. This study examined the effects of taking a religious perspective during a trauma-writing...