Showing papers in "International Journal of Psychiatry in Medicine in 2006"
TL;DR: CBT is related to short-term effects on depression and anxiety and both short and long term effects on QOL and individual interventions were more effective than group.
Abstract: Objective: The purpose of this meta-analysis was to investigate the effects of cognitive behavioral therapy (CBT) and patient education (PE) on commonly reported problems (depression, anxiety, pain, physical functioning, and quality of life (QOL)) in adult cancer survivors. Methods: Meta analyses of randomized controlled trials of CBT and PE were conducted. MEDLINE, PSYCHINFO and the Cochrane Database were searched from 1993-2004. The effects of individual versus group interventions and short ( 8 months) term follow up are also reported. Results: Fifteen studies met quality criteria. The sample size was 1,492 adult cancer survivors with an age range of 18-84. 790 were randomly assigned to intervention groups and 702 to control groups. CBT varied in duration from 4 weekly one-hour sessions to 55 weekly two-hour sessions. PE ranged from a single 20-minute session to 6 weekly one-hour sessions. Follow up ranged from 1 week to 14 months. CBT was effective for depression (ES = 1.2; 95% CI = 0.22-2.19), anxiety (ES = 1.99; 95% CI = 0.69-3.31), and QOL
574 citations
TL;DR: Clinicians can successfully diagnose most EODs with careful cognitive and family histories, mental status and neurological examinations, and neuroimaging.
Abstract: Early-onset dementia (EOD, < 65 years at onset) is a relatively common and frequently misdiagnosed condition. One reason for misdiagnosis is that EOD has a more varied differential diagnosis than late-onset dementia (LOD). For example, Alzheimer's disease (AD), the preponderant LOD, makes up only about one-third of EODs; the rest are due to vascular dementias, frontotemporal lobar degenerations, traumatic head injury, alcohol-related dementia, and a great many other conditions. Another reason for misdiagnosis is that early-onset AD may have predominant cognitive deficits other than memory loss and a potential familial inheritance with spastic paraparesis, seizures, or myoclonus. A third reason is that EOD often presents with neuropsychiatric features out-of-proportion to any cognitive deficits. Despite these obstacles, it is important to accurately diagnose EODs, particularly because they differ in management and course. Clinicians can successfully diagnose most EODs with careful cognitive and family histories, mental status and neurological examinations, and neuroimaging.
161 citations
TL;DR: Findings of a high prevalence of ELS in otherwise healthy “normal” adults around the world and associations between ELS and current emotional distress suggest that these events have functional relevance and deserve further investigation.
Abstract: Early life stress (ELS) has been linked to adult psychopathology, though few studies have examined the universality of specific adverse childhood events (ACEs) in healthy adults. We examined the co-occurrence of specific ACEs and their relationship to current emotional distress in an international sample of adults without psychopathology. Participants were 1659 men and women recruited for an international neurocognitive-neuroimaging database from sites in the United States, Australia, England, and the Netherlands. Participants had no current or prior diagnosis of major depression, anxiety, substance abuse, or neurological brain disorder. The occurrence and age on onset of 19 ACEs was assessed by a self-report questionnaire (ELSQ), and current symptoms of stress, depression, and anxiety by the Depression Anxiety Stress Scale (DASS). The relationship of specific ACEs to DASS symptoms was examined. Participants reported relatively high prevalence of ACEs. Only 27.6% of the sample reported no ACEs, while 39.5...
130 citations
TL;DR: The Swahili version of the PHQ-9 is a reliable scale in Kenyan H&N cancer patients, and is a valuable tool in screening for and monitoring of depression as a function of QOL in this population.
Abstract: Background:Depression is an important predictor of post therapy quality of life (QOL) in head and neck (H&N) cancer patients. In addition, depression rates may vary among cultures.Objective:As part...
121 citations
TL;DR: Higher prevalence of depressive symptoms among male smokers is stable across time and is likely to contribute to higher morbidity and mortality among these smokers, however, presence of depressive Symptoms did not have a significant impact on smoking cessation.
Abstract: Objective:The majority of past findings indicate that smokers are more likely than non-smokers to report depressive symptoms and that depression may act as an impediment to smoking cessation. The aim of the present study is to examine the stability of the relationship between depressive symptoms and smoking status and to determine whether the presence of depressive symptoms predicts continued smoking.Methods:Subjects were initially healthy men (n=2208) from the Veterans Administration Normative Aging Study, an ongoing cohort of older men who have been re-assessed every 3–5 years for a period of 25 years. Depressive symptoms measures employed were the Cornell Medical Index, the MMPI-2 Content Depression Scale, and the Center for Epidemiological Studies Depression Scale.Results:Depression scores were higher among continuing smokers compared to never and former smokers and those who quit after entering the study. None of the three depressive symptoms measures were associated with decreased likelihood of smok...
59 citations
TL;DR: Chronic hepatitis B and C patients presented a high rate of psychiatric disorder and HRQL was significantly decreased in patients with psychiatric morbidity, which correlated with health-related quality of life (HRQL).
Abstract: Objective:The primary aim of our study was to determine the prevalence of psychiatric morbidity in a cohort of consecutive chronic hepatitis patients not receiving antiviral therapy. The secondary aim of our study was to determine if psychiatric morbidity, type of hepatitis, and the level of depression correlated with health-related quality of life (HRQL).Methods:The study was conducted in collaboration with Hepatology and Infectious Disease Clinics at three-major university hospitals. One hundred seven patients who met the criteria for being diagnosed with either chronic hepatitis B or C, had non-cirrhotic compensated liver disease, had not received antiviral treatment in the preceding 6 months, and had no accompanying physical illness were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Short Form — 36 for measuring HRQL, and semi-structured interviews for assessing psychosocial variables were used. Sixty-seven healthy adults formed the control group.Results:43....
57 citations
TL;DR: Patients diagnosed with bipolar disorder reported greater problems with access to health care, while those diagnosed with schizophrenia were less satisfied with the process of care.
Abstract: Objectives:We compared perceived access to and satisfaction with health care between patients diagnosed with serious mental illness (SMI: schizophrenia or bipolar disorder) and among those with no ...
54 citations
TL;DR: The findings add to the current knowledge on factors associated with trust in health care providers and may help to explain religious differences in the use of preventive services and other health behaviors.
Abstract: Objective:Aspects of the patient-physician relationship, such as trust, influence a variety of health behaviors, including adherence to treatment regimens and the use of preventive health services....
52 citations
TL;DR: Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptic patients.
Abstract: Objective:Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment.Method:Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE), and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings.Results:The mean age of the 51 respondents was 27.7years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life inclu...
52 citations
TL;DR: BDD is a severe disorder that is frequently associated with other psychiatric conditions and responds poorly to treatment in the naturalistic setting and no significant trans-cultural variations were identified in the comparison between Brazilian, North American, and European samples.
Abstract: Objective:The main characteristic of body dysmorphic disorder (BDD) is a preoccupation with an imagined defect in appearance in a normal-appearing person or an excessive preoccupation with appearance in a person with a small physical defect. In this non-controlled study, our objective was to describe the socio-demographic, phenomenological, and long-term outcome features of a Brazilian sample of patients with BDD.Methods:We performed a chart-review of the 166 patients who attended the Obsessions, Compulsions, and Impulsions Subprogram of the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil, during the period between 1998 and 2005.Results:Twenty patients (12%) had clinically significant BDD. This sample was characterized by a predominance of female (n = 11; 55%), single or divorced (n = 18; 90%), and economically unproductive patients (n = 17; 85%). We found an average of 2.5 current imagined defects per patient. The most frequently reported body parts of excessive concern were t...
50 citations
TL;DR: A high proportion of Japanese children and adolescents have depressive tendencies, as determined using the Birleson Depression Self-Rating Scale for children.
Abstract: OBJECTIVE: The aim of this study was to investigate the prevalence of depressive symptoms in children and adolescents in the general Japanese population using a depression self-rating scale and determine whether this prevalence varies according to age, gender, or region. METHOD: The Birleson Depression Self-Rating Scale for children (DSRS) was used to examine the extent to which depressive tendencies were present among 2,453 elementary and middle-school children (6 to 15 years old) in two cities in Japan. RESULTS: The mean DSRS score was high at 8.75 +/- 5.66. A significant increase in score was observed with increasing age. There were no significant differences between regions. Using a DSRS cutoff score of 15 points as a risk of depression, the scores of 14.9% of the subjects exceeded the cutoff. CONCLUSIONS: As determined using the DSRS, a high proportion of Japanese children and adolescents have depressive tendencies. Language: en
TL;DR: More studies are warranted to detect and analyze the suicide notes so that they not only help in confirming cause of death as suicide but also help in suicide prevention programs.
Abstract: Objective:Suicide is one of the leading causes of mortality in developing as well as developed countries Psychological autopsy is supplementary to medical autopsy in finding out the correct cause
TL;DR: Investigating whether a personality trait—dispositional social sensitivity—is associated with the adverse social impact of acne found it to be an independent psychological factor associated with poorer social functioning and quality of life.
Abstract: Background:Acne affects a majority of adolescents and a substantial number of adults. The adverse social impact of acne is well documented. Negative social consequences, however, are likely to be determined by personality features as well as acne severity.Purpose:To determine whether a personality trait—dispositional social sensitivity—is associated with the adverse social impact of acne.Methods:A survey of 479 acne sufferers between the ages of 16 and 62 was conducted in the Piedmont region of North Carolina, United States. Respondents were classified as either high or low social sensitivity and compared on demographic, disease characteristics, and quality of life. Main and interaction effects were evaluated for acne severity and social sensitivity in relation to global and intimate social concerns and social interference.Results:Greater acne severity was significantly associated with poorer social outcomes and quality of life (ps < 0.05). For women, higher social sensitivity was independently associated...
TL;DR: Thinking of death and a wish to die are common in older primary care patients and were more likely among persons with chronic medical conditions and Persons with a history of myocardial infarction may be particularly vulnerable to a wishto die.
Abstract: OBJECTIVE: To determine the prevalence of wishes to die and the medical correlates of wishes to die among primary care patients aged 65 years and older. METHOD: Three-hundred and fifty-five adults with and without significant depressive symptoms who were screened in primary care offices and invited to participate completed a baseline in-home assessment. Participants were interviewed using standardized measures of medical conditions, functional status, and psychological status. Thoughts of death and wishes to die were assessed with standard questions from the Composite International Diagnostic Interview (CIDI) Depression Section. RESULTS: The weighted point prevalence of thoughts of death was 9.7% and 6.1% for the wish to die. Several medical conditions were associated with a wish to die, for example myocardial infarction (MI). In multivariate models that adjusted for potentially influential characteristics, the association between a history of MI and the wish to die remained statistically significant (odds ratio (OR) = 3.32, 95% confidence interval (CI) (1.26, 8.75). CONCLUSIONS: Thoughts of death and a wish to die are common in older primary care patients and were more likely among persons with chronic medical conditions. Persons with a history of myocardial infarction may be particularly vulnerable to a wish to die. Language: en
TL;DR: Female gender, the duration of hypertension, and the history of hospitalization are associated with the occurrence and severity of anxiety symptoms in patients with hypertension.
Abstract: Objectives:To investigate incidence and severity of anxiety symptoms in patients with hypertension.Methods:A cross-sectional survey in 891 (432 females) hypertensive patients was conducted in a regional community. All patients were interviewed and detailed physical examination was performed. Zung self-rating anxiety scale (SAS) was used to evaluate the severity of anxiety symptoms.Results:Anxiety was diagnosed on clinical grounds in 103 patients (11.6%) who also had a raw SAS score of more than 40. In all subjects surveyed, the average SAS score in females was higher than males (32.9 ± 7.1 vs 31.2 ± 6.4, p < 0.001). The average SAS score was also higher in patients with hypertension of more than 3 years (32.4 ± 7.0 vs 31.2 ± 6.1, p = 0.01), in patients with severe hypertension (39.8 ± 6.9 vs 29.6 ± 4.5, p < 0.001), and in patients with a history of hospitalization for cardiovascular disorders (35.7 ±7.7 vs 31.7 ±6.6, p < 0.001). Multivariate regression analysis showed that female gender, duration of hyper...
TL;DR: The primary finding of this study is that during a transfer of an older adult to the home care service sector, essential clinical information is often missing, and there are significant discrepancies between medication regimens.
Abstract: Objective:To assess the completeness and accuracy of clinical information provided by referral sources to visiting nurses for patients admitted to receive home health care.Methods:Clinical referral information for a representative sample of 243 older adults admitted to receive skilled home-health nursing was compared to medical record information from home-health charts and in-home research interviews to determine their concordance. Measures used included referral information, home-care chart documentation, in-home nurse review of medications, medication allergies, caregiver contact information, cognitive status, depression status, and follow-up plan.Results:There were medication discrepancies between in-home nurse review and admission information in 215 cases (88.4%). Clinical information on medication allergies was lacking from referrers in 85 cases (34.9%). No information was provided by the referrers about cognitive status in 38 (73%) cases classified as cognitively impaired and in only 2 of 35 cases ...
TL;DR: Hypotheses generated by analyses are that in African American women stroke is less prevalent and weekly fish intake more prevalent among weekly attenders than others and that there are no significant independent associations of serum lipids, dietary intake, prevalent CHD, or diabetes with frequency of attendance of religious services.
Abstract: Background:Few data have been published on the association of attendance at religious services with cardiovascular morbidity and dietary and metabolic risk factors in representative samples of populations despite a known inverse association with mortality and smoking.Objective:To test the null hypothesis that frequency of attendance at religious services is unrelated to prevalence or levels of cardiovascular disease, dietary and metabolic risk factors.Design:Cross-sectional survey of a large national sample.Participants:American men and women aged 20 years and over with complete data in the Third National Health and Nutrition Examination Survey (n = 14,192).Measurements:Self-reported frequency of attendance at religious services, history of doctor-diagnosed diseases, food intake frequency, 24-hour dietary intake, health status, socio-demographic variables and measured serum lipids and body mass index.Results:Weekly attenders were significantly less likely to report stroke, even after adjusting for multipl...
TL;DR: Sense of humor appeared to mediate better coping and, therefore, protected against detrimental effects of disease-related stressors upon survival in a county cohort of patients diagnosed with end-stage renal failure.
Abstract: Objective:To explore the significance of sense of humor for survival in a county cohort of patients diagnosed with end-stage renal failure. This diagnosis is a life-threatening condition that calls...
TL;DR: The authors found stronger relationships between ethnicity and marital status with patterns of adherence to citalopram than they did other personal characteristics and Identification of a subgroup of patients at particularly high risk of nonadherence is important for the development of adherence interventions.
Abstract: Objective:Our purpose was to determine the personal characteristics associated with different patterns of adherence to the antidepressant citalopram in a primary care trial of depression management.Method:The study sample consisted of 228 adults aged 60 years and older recruited from primary care settings and who participated in a depression intervention. The intervention consisted of services of trained care managers, who offered recommendations to physicians following a clinical algorithm and helped patients with treatment adherence. Adherence to the antidepressant citalopram was measured using pill counts. We employed the latent class model to classify patients according to the pattern of adherence to citalopram over time. We examined the association of sociodemographic characteristics, depression status, cognitive status, and medical comorbidity with the resulting classes of adherence.Results:The latent class model generated three classes of adherence: known to be adherent, unknown adherence, and know...
TL;DR: Depression was not associated with mortality of patients with kidney disease when controlling for gender, age, and treatment modality, but number of depressive symptoms was directly associated with lower quality of life in most of the items of the SF-36.
Abstract: Aims:This study assessed the impact of depression on mortality and quality of life of patients with kidney disease.Material:This study was conducted at Hospital Sao Lucas of Pontificia Universidade...
TL;DR: Not only obesity but also weight problems related to an underweight condition occur more frequently in Japanese schizophrenic inpatients than in normal controls, and the deviation of the BMI distribution may have a relationship with higher mortality and sudden death in schizophrenia.
Abstract: Background:Many studies have emphasized the high frequency of obesity in schizophrenic patients. However, the characteristics of the Body Mass Index (BMI) distribution in Japanese schizophrenic patients remain unknown, and the aim of this study was to clarify these characteristics in a Japanese schizophrenic inpatient population.Methods:The subjects were 273 inpatients (males: 141, females: 132) with schizophrenia. The patient BMI distribution was compared with normal control data obtained from the 2003 Japanese National Health and Nutrition Survey.Results:The mean patient BMI was 23.0 ± 4.3, and the BMI showed a normal distribution. The proportion of patients who were obese, of normal weight and underweight was 30.8%, 53.1%, and 16.1%, respectively. No statistical evidence of a higher frequency of obesity was found in male patients, compared to normal controls, but a higher frequency of underweight patients and a lower frequency of normal-weight patients were apparent in most decades of age. In female sc...
TL;DR: In both groups, women with a low income and less education were more likely to experience decision regret or low satisfaction, and total mastectomy-alone patients had lower self-esteem compared to reconstructive surgery patients and healthy women.
Abstract: Objective:In Turkey, despite the fact that breast cancer accounts for 241% of all cancer in women, a very small number of these patients receive breast reconstruction This low percentage would se
TL;DR: Negative symptom profile schizophrenia has cognitive deficits and lower rCBF in bilateral frontal and temporal lobes, which suggests that negative symptom profile schizophrenic patients have hypofrontality.
Abstract: Objective: Cognitive function and regional cerebral blood flow (rCBF) were studied in negative symptom profile schizophrenic patients by using WCST and SPECT. Methods: Twenty-one schizophrenic patients who matched the criteria of Andreason's negative symptom profile received SPECT and WCST, and then were treated with clozapine for 8 consecutive weeks. There were 28 and 12 normal subjects as the control groups of WCST and SPECT, respectively. Results: Compared with controls, significantly poorer performance on total trials of category (TT), persevering errors (PE), and non-persevering errors (NPE) of WCST were found in schizophrenia (p < 0.05). The total score of the scale for assessment negative symptoms (SANS) was significantly related with poor TT (r = 0.45, p < 0.01) and PE performance (r = 0.45, p < 0.01). The poor TT, PE, and NPE tasks of WCST and SANS scores in the negative schizophrenic patients were significantly improved through clozapine treatment (p < 0.05). The schizophrenic patients had a significantly lower rCBF in bilateral frontal and temporal lobes and lower change rate of rCBF in bilateral'frontal lobes during WCST compared to normal controls (p < 0.05). Conclusions: Negative symptom profile schizophrenia has cognitive deficits and lower rCBF in bilateral frontal and temporal lobes, which suggests that negative symptom profile schizophrenic patients have hypofrontality. Clozapine can improve negative symptoms and improve cognitive dysfunction, although it cannot improve reduced rCBF in the frontal lobes.
TL;DR: The cost of depression in Taiwanese adults for the years 2000–2002 increased continuously over the period from 2000-2002, however, the percentage of patients receiving treatment did not increase steadily over the same time period.
Abstract: Objective:To estimate the direct cost of depression in Taiwanese adults for the years 2000–2002.Methods:The medical claims database of the National Health Bureau was analyzed and the cost of treating adults (>15 years of age) with the diagnosis of depression was calculated.Results:The total direct medical costs of adult depression in the three years 2000, 2001, and 2002 were approximately US$ 93 million, US$ 117 million, and US$140million, respectively.Conclusion:The cost of depression increased continuously over the period from 2000–2002. However, the percentage of patients receiving treatment did not increase steadily over the same time period with treatment rates of 1.5% in 2000, 2.3% in 2001, and 2.0% in 2002. The recent annual prevalence of depression in Taiwan has been estimated at 4–5%. Thus, the Taiwanese health authority spends an annual average of US$ 116.6 million to treat depression (1.2% of total national expenses). In sum, the treatment of depression, while costly, deserves greater attention...
TL;DR: In this urban area, proximity of home to clinic did not correlate with primary immunization completion or blood pressure in either a hospital-based or a community clinic.
Abstract: Objective:Primary care clinics are frequently placed in neighborhoods to improve access. Little is known whether or not this improves outcomes. We sought to determine if childhood immunization rate...
TL;DR: Hierarchical multiple regression analyses showed that pre-operative positive religious coping styles and optimism contributed to reduced physical fatigue, controlling for post-operatively confirmed prayer coping and such covariates as severe injury.
Abstract: Purpose:This analysis investigated the effect of faith-based coping used by cardiac patients undergoing surgery on physical and mental fatigue, symptoms which have significant prognostic implications for mortality. Particularly, we explored whether this faith effect is independent or explained by positive mediators.Methods:Two weeks preoperatively, 481 patients (male, 58%; mean age=62 years) were recruited for three sequential interviews. Among them, 426 completed the second interview, and 335 completed the post-operative follow-up. Cross-clamp and bypass time were obtained from patients' charts. Plasma interlukin-6 (IL-6) was used as a correlate of age-associated diseases and frailty.Results:Hierarchical multiple regression analyses showed that pre-operative positive religious coping styles and optimism contributed to reduced physical fatigue, controlling for post-operatively confirmed prayer coping and such covariates as severe injury. Depression and lower-back problems contributed to mental fatigue. No...
TL;DR: Clinicians should be more flexible when they face the above group of patients, as far as the duration of watchful waiting period is concerned, because a long waiting sets those patients under significant emotional burden.
Abstract: OBJECTIVES Guidelines on many disorders recommend a variable period of watchful waiting between diagnosis and indicated action. In this study, we assessed stress during the watchful waiting period for urinary lithiasis, a benign disorder treated with minimally invasive procedures, without the pitfall of the emotional burden of a terminal or debilitating disease or fear of impending major surgery and to assess the distress caused by waiting per se. Furthermore, we attempt to identify individual patients at risk of prolonged or debilitating psychological distress. METHODS A total of 112 lithiasis patients with stones < or =5 mm completed the study. State and trait anxiety were assessed both at baseline and after the end of watchful waiting using STAI, and then they were informed of the indicated action for their case. RESULTS During the 30 days of watchful waiting, patients experienced a significant increase in state anxiety scores, especially if they were male, had high state or trait anxiety scores at baseline, or if they had experienced more than one episode of colicky pain during the waiting period. CONCLUSION Clinicians should be more flexible when they face the above group of patients, as far as the duration of watchful waiting period is concerned, because a long waiting sets those patients under significant emotional burden.
TL;DR: The results show that the compliance and coping potential of oncological in-patients can be comprehensively described by the Transplant Evaluation Rating Scale.
Abstract: Objective:To investigate the impact of psychiatric illness, aggression, and other covarying variables on the compliance and coping potential of cancer patients treated in liaison-consultation psychiatry.Methods:The study involves 270 cancer patients who were admitted to the oncology ward for diagnosis and treatment. Each patient took part in a psychiatric consultation. We used the Transplant Evaluation Rating Scale (TERS), which provides a system for differentially recording the patient's compliance and coping potential (total score for the TERS items 3–10). Following standardization using the basic psychooncological documentation (PO-BADO), the demographic variables were recorded. We also identified the internal processes which each patient used to deal with the disease using criteria established by Kubler-Ross as well as the phases of cancer experience according to Fawzy.Results:Twenty-three variables were checked for their relationship to the coping and compliance potential. For 13 of these, the Mann-W...
TL;DR: There is an expanding evidence base for the efficacy of interventions at the psychological level and patients' views on their healthcare remain crucial.
Abstract: Interactions between physical and mental illness are complex. Each may lead to the other; both arise from common antecedents; they may be synergistic or associations may be spurious. There is an expanding evidence base for the efficacy of interventions at the psychological level. Patients' views on their healthcare remain crucial.
TL;DR: There are some distinct psychotropic prescription trends among internists, which have implications for future training and quality improvement programs.
Abstract: Introduction:Empirical data indicate that patients seen in internal medicine outpatient settings have substantial rates of depression and other psychiatric disorders. Surprisingly, the training req...