Showing papers in "International Journal of Psychiatry in Medicine in 2018"

Stigmatizing attitudes of primary care professionals towards people with mental disorders: A systematic review.

Abstract: ObjectiveTo examine stigmatizing attitudes towards people with mental disorders among primary care professionals and to identify potential factors related to stigmatizing attitudes through a system...

State-dependent alterations of lipid profiles in patients with bipolar disorder.

Abstract: Objective Serum lipid levels may be associated with the affective severity of bipolar disorder, but data on lipid profiles in Asian patients with bipolar disorder and the lipid alterations in different states of opposite polarities are scant. We investigated the lipid profiles of patients in the acute affective, partial, and full remission state in bipolar mania and depression. Methods The physically healthy patients aged between 18 and 45 years with bipolar I disorder, as well as age-matched healthy normal controls were enrolled. We compared the fasting blood levels of glucose, cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein of manic or depressed patients in the acute phase and subsequent partial and full remission with those of their normal controls. Results A total of 32 bipolar manic patients (12 women and 20 men), 32 bipolar depressed participants (18 women and 14 men), and 64 healthy control participants took part in this study. The mean cholesterol level in acute mania was significantly lower than that in acute depression (p < 0.025). The lowest rate of dyslipidemia (hypertriglyceridemia or low high-density lipoprotein cholesterol) was observed in acute bipolar mania. Conclusion Circulating lipid profiles may be easily affected by affective states. The acute manic state may be accompanied by state-dependent lower cholesterol and triglyceride levels relative to that in other mood states.

Two cases of high serum clozapine concentrations occurring during inflammation in Chinese patients.

Abstract: ObjectiveSerious infections or inflammations have been associated with serum clozapine concentration increases and sometimes with clozapine toxicity.MethodThese two cases describe Chinese patients ...

The role of Balint group training in the professional and personal development of family medicine residents.

Abstract: This paper presents a study based on the participation of PGY2 and PGY3 family medicine residents in Balint seminars that occurred twice monthly for 24 months. Balint groups were cofacilitated by l...

The concept of chronotypes and its clinical importance for depressive disorders

Abstract: Chronobiology and chronobiological research deal with time-dependent physiological processes and behavioral correlates as well as their adaptation to environmental conditions. Chronobiological research is presently focused on the impact of circadian rhythms on human behavior. In the last three decades, chronobiology has established itself as an independent area of research evolving to an important field of clinical psychology and psychiatry. In this overview, the results of studies on the clinical importance of chronotypes are summarized. The main focus is on the role of chronotype in depressive disorders.

The patient's voice in the emerging era of participatory medicine.

Abstract: Professionalism in any field requires keeping pace with change, and nowhere is it more true than medicine. Knowledge flow has changed dramatically since today's accreditation standards were developed, and change continues more rapidly than ever. It's time for a fresh look at how best to achieve care in this altered environment, where valid knowledge may come from the patient as well as from clinician resources: a sociological change driven by technological change. The power structure of the clinical relationship is inevitably altered as constraints on patient knowledge are loosened by the internet, apps, and devices, undermining a paradigm of patients as uninformed recipients of care based on a one-way flow of wisdom from providers. Case after case is presented showing that patients today have generated undeniable value, violating the expectations and assumed best practices of the old model. To understand this sociological (yet scientific) change, this article reviews the role of paradigms in the history of sciences as described in Thomas Kuhn's landmark book The Structure of Scientific Revolutions and describes how these anomalous patient stories force the conclusion that the traditional paradigm of patients is no longer supportable and a new paradigm is needed. This in turn means our standards of professionalism and appropriate care must be updated, lest we fail to achieve best possible care in our increasingly overburdened system. Our new standard must be to teach clinicians to recognize, welcome, and work with empowered "e-patients" in the new model of participatory medicine.

Balint 2.0: A virtual Balint group for doctors around the world.

Abstract: Objective Balint groups have shown promise in addressing clinician-patient relationships, clinician burnout, referral practices, and psychological mindedness. However, their traditional format of in-person sessions limits their ability to meet the needs of clinicians practicing in locations without trained Balint leaders. We report on a pilot of an international, internet-based Balint group in collaboration between the World Organization of Family Doctors regional Young Doctors Movements and the International Balint Federation. Method Balint 2.0 arose through interest of the Young Doctors Movements leadership, who approached the International Balint Federation for assistance. Initial discussions and some trialing of videoconference platforms led to monthly group meetings over the internet. Surveys evaluated each individual session as well as quarterly progress of the group. Survey items were borrowed from existing surveys in use by the American and German Balint Societies. Results Session surveys demonstrated the effectiveness of the videoconferencing platform for convening a Balint group, with a majority of participants expressing agreement with survey items evaluating each session. Quarterly survey responses were more positive reflecting agreement with outcomes seen from in-person Balint groups. Conclusions The Balint 2.0 pilot has demonstrated the ability of a Balint group to successfully convene over the internet and reach the common outcomes of a Balint group meeting in-person. The Young Doctors Movements and International Balint Federation plan to expand this work based on this successful pilot. We hope that others may also be able to build on this success with the result that Balint groups are available to clinicians in areas where they might not otherwise be accessible.

Associations among comorbid anxiety, psychiatric symptomatology, and diabetic control in a population with serious mental illness and diabetes: Findings from an interventional randomized controlled trial.

Abstract: Objective Serious mental illness and type II diabetes mellitus have a high comorbidity, and both have a higher prevalence of anxiety disorders compared to the general population. Targeted Training in Illness Management is a group-based self-management training approach which targets serious mental illness and type II diabetes mellitus concurrently. This analysis examines data from a randomized controlled trial of Targeted Training in Illness Management intervention to examine the impact of comorbid anxiety on baseline psychiatric symptomatology and diabetic control, and on longitudinal treatment outcomes. Methods We conducted secondary analyses on data from a prospective, 60-week, randomized controlled trial testing Targeted Training in Illness Management versus treatment as usual in 200 individuals with serious mental illness and diabetes. Primary outcomes included measures related to serious mental illness symptoms, functional status, general health status, and diabetes control. Measures were compared between those participants with anxiety disorders versus those without anxiety at baseline as well as over time using linear mixed effects analyses. Results Forty seven percent of the participants had one or more anxiety disorders. At baseline, those with an anxiety diagnosis had higher illness severity, depressive, and other psychiatric symptomatology and disability. Diabetic control (HbA1c) was not significantly different at baseline. In the longitudinal analyses, no significant mean slope differences over time (group-by-time interaction effect) between those with anxiety diagnoses and those without in treatment as usual group were found for primary outcomes. Within the Targeted Training in Illness Management arm, those with anxiety disorders had significantly greater improvement in mental health functioning. Those with anxiety comorbidity in the Targeted Training in Illness Management group demonstrated significantly lower HbA1c levels compared to no anxiety comorbidity and also demonstrated a greater improvement in HbA1c over the first 30 weeks compared to those without anxiety comorbidity. Conclusion Comorbid anxiety in serious mental illness and type II diabetes mellitus population is associated with increased psychiatric symptomatology and greater disability. Individuals from this population appear to experience greater improvement in functioning from baseline with the Targeted Training in Illness Management intervention. Anxiety comorbidity in the serious mental illness and type II diabetes mellitus population does not appear to have a negative impact on diabetic control. These complex relationships need further study. Clinical Trials Registration ClinicalTrials.gov: Improving outcomes for individuals with serious mental illness and diabetes (NCT01410357).

Orbito-frontal cortex and thalamus volumes in the patients with obsessive-compulsive disorder before and after cognitive behavioral therapy.

Abstract: Background The effect of a variety of treatment modalities including psychopharmacological and cognitive behavioral therapy on the brain volumes and neurochemicals have not been investigated enough in the patients with obsessive-compulsive disorder. Therefore, in the present study, we aimed to investigate the effect of cognitive behavioral therapy on the volumes of the orbito-frontal cortex and thalamus regions which seem to be abnormal in the patients with obsessive-compulsive disorder. We hypothesized that there would be change in the volumes of the orbito-frontal cortex and thalamus. Methods Twelve patients with obsessive-compulsive disorder and same number of healthy controls were included into the study. At the beginning of the study, the volumes of the orbito-frontal cortex and thalamus were compared by using magnetic resonance imaging. In addition, volumes of these regions were measured before and after the cognitive behavioral therapy treatment in the patient group. Results The patients with obsessive-compulsive disorder had greater left and right thalamus volumes and smaller left and right orbito-frontal cortex volumes compared to those of healthy control subjects at the beginning of the study. When we compared baseline volumes of the patients with posttreatment ones, we detected that thalamus volumes significantly decreased throughout the period for both sides and that the orbito-frontal cortex volumes significantly increased throughout the period for only left side. Conclusions In summary, we found that cognitive behavioral therapy might volumetrically affect the key brain regions involved in the neuroanatomy of obsessive-compulsive disorder. However, future studies with larger sample are required.

A review of the benefits and limitations of a primary care-embedded psychiatric consultation service in a medically underserved setting:

Abstract: A significant percentage of patients with psychiatric disorders are exclusively seen for health-care services by primary care physicians. To address the mental health needs of such patients, collaborative models of care were developed including the embedded psychiatry consult model which places a consultant psychiatrist on-site to assist the primary care physician to recognize psychiatric disorders, prescribe psychiatric medication, and develop management strategies. Outcome studies have produced ambiguous and inconsistent findings regarding the impact of this model. This review examines a primary care-embedded psychiatric consultation service in place for nine years in a family medicine residency program. Psychiatric consultants, family physicians, and residents actively involved in the service participated in structured interviews designed to identify the clinical and educational value of the service. The benefits and limitations identified were then categorized into physician, consultant, patient, and systems factors. Among the challenges identified were inconsistent patient appointment-keeping, ambiguity about appropriate referrals, consultant scope-of-practice parameters, and delayed follow-up with consultation recommendations. Improved psychiatric education for primary care physicians also appeared to shift referrals toward more complex patients. The benefits identified included the availability of psychiatric services to underserved and disenfranchised patients, increased primary care physician comfort with medication management, and improved interprofessional communication and education. The integration of the service into the clinic fostered the development of a more psychologically minded practice. While highly valued by respondents, potential benefits of the service were limited by residency-specific factors including consultant availability and the high ratio of primary care physicians to consultants.

Balint work and the creation of medical knowledge

Abstract: Michael Balint's pioneering work in primary care was not simply the application of psychodynamic theory to the complex problems and relationships encountered by clinicians. Rather, Balint's work was part of a wider conversation in Western epistemology that had already begun to break down the enlightenment rationalist agenda. Since the time of Descartes, we sought to find certain truth through decontextualizing and abstracting problems, and through separation of the observer from the thing observed, with a focus on finding universal timeless laws that could be generalized. By the mid-1950s, it was clear that this agenda was insufficient to answer important questions about what it means to be human and to live a healthy and happy life. Balint's experiment was a return to a method of knowledge creation that is case based, narrative, local, timely, particular, and especially considers specific contexts for finding solutions to problems. For current healthcare reform efforts to be effective, we must include Balint's focus on the context of the doctor, patient, and their relationship, as well as development of practical wisdom (i.e. Aristotelian phronesis) that we know in medicine as professional judgment. The case study method of the Balint group is one of the few and best formal methods to teach and practice this way of knowing.

Irritable bowel syndrome and quality of life in a community-dwelling population in Japan.

Abstract: Objective Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders and is characterized by recurrent abdominal pain or abnormal defecation. This investigation evaluated the relationship between IBS and self-reported quality of life in a community-dwelling population in Japan. Methods For this cross-sectional survey, we enrolled 1002 volunteers who participated in the Iwaki Health Promotion Project in 2013. IBS symptoms were evaluated using the criteria from the Japanese version of the Rome III Questionnaire. The assessments included an interview to obtain sociodemographic data, the second version of the Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale. Multiple regression analysis was used to assess the relationship between IBS symptoms and scores on the SF-36. Results A total of 59 subjects (5.9%) were classified as having IBS. Scores for all eight domains of the SF-36, the physical component summary, and the mental component summary were significantly and negatively associated with the Center for Epidemiologic Studies Depression scores. Physical functioning, role physical, vitality, mental health, and physical component summary scores were significantly and negatively associated with IBS. Conclusions The burden of IBS symptoms affects both physical and mental wellbeing, even after adjusting for confounders. Our findings suggest that screening for IBS symptoms and evaluating the need for medical care is important for community health workers.

Mapping the Balint groups to the Accreditation Council for Graduate Medical Education family medicine competencies.

Abstract: IntroductionBalint group discussions provide learning opportunities for many of the competencies and milestones put forward by the Accreditation Council for Graduate Medical Education. The current ...

Possible role of stress, coping strategies, and life style in the development of breast cancer:

Abstract: Objective The aim of the present study was to investigate the possibility of the effect of life long stressful events, along with coping method used, perception of social support, and life style on the development of breast cancer. Methods In this hospital-based case control study, the study group comprised 250 women with breast cancer who were followed by Florence Nightingale Breast Study Group. Control group included 250 women, who had similar sociodemographic characteristics to the study group. Data were collected with semi-structured interview form, Healthy Life Style Behavior Scale, Coping Strategy Indicator, and Stress Evaluation Form developed by us. Results In multivariate analysis, family history of cancer (OR: 1.55, 95% CI: 2.29-1.05), inadequate social support (OR: 1.83, 95% CI: 1.23-2.73), and loss of father during childhood (OR: 2.68, 95% CI: 5.52-1.30) and serious stressor within the last five years (OR: 4.72, 95% CI: 7.03-3.18) were found to be risk factors increasing the risk of breast cancer. When family history of cancer was excluded from the model, the presence of psychiatric disorder history (OR: 1.95, 95% CI: 3.26-1.17) and major life events (OR: 2.24, 95% CI: 4.07-1.24) were added to the model as risk factors. Conclusion The present study indicates that especially the stressful events experienced within the last five years plays an undeniable role in the risk of breast cancer. Social support may be as important in the period before the diagnosis as in the period after diagnosis.

Demystifying Balint culture and its impact: An autoethnographic analysis.

Abstract: Balint groups are a structured group process designed for physicians and other helping professionals to provide feedback to each other concerning troublesome patient encounters. The process of Balint groups has survived and even thrived for more than a half century since their inception, suggesting their inherent value. However, measuring the impact in order to communicate the nature of that value has been elusive. A recent literature review highlighted the equivocal nature of research results and suggested that well-designed qualitative research may be more effective in selecting target measures which could result in better evidence for this group process. This paper describes such an effort using a qualitative analysis of the author's own reflections about significant moments and learnings while participating in Balint groups.

Supporting families managing parental mental illness: Challenges and resources.

Abstract: Over five million children in the United States have a parent living with a serious mental illness. These offspring are at higher risk for developing mental health problems themselves due to a complex interplay of biological, psychological, and psychosocial factors. Life with a parent with psychiatric symptoms can be scary, confusing, overwhelming, and sad; children often blame themselves for their parent's problems, find their parent's behavior embarrassing, and struggle to explain the illness to their friends. Unfortunately, these children's needs and experiences are often ignored by overwhelmed parents, worried family members and relatives, separate mental health systems of care for adults and children that often fail to coordinate care, and even well-intentioned health-care providers. Family medicine teams have an opportunity to detect and support these families in unique ways. We offer four recommendations for family medicine teams to help families managing parental mental illness including assessing functioning, treatment needs, and impacts on each family member; educating all family members about mental illness; instilling hope, noting the range of effective treatments for mental illness; and encouraging the use of supports and referral options. Providers can leverage family members' strengths, work with community-based resources, and offer continuity to these families, as they struggle with an oftentimes chronic, relapsing disease that has ripple effects throughout the family system.

Psychiatric diagnoses and their influencing factors in patients complaining of sleep problems: A study of a psychiatric consultation-liaison service.

Abstract: ObjectiveThis study aimed to identify misdiagnosed or undiagnosed psychiatric disorders and the factors associated with these disorders in patients with sleep problems who are referred to a consult...

Brief behavioral interventions at free medical fairs

Abstract: Free medical fairs have emerged to compensate for the lack of access to affordable health care in rural areas of the United States. Mental health services are offered less frequently than other medical services, despite a documented need, perhaps due to a belief that mental health interventions could not be effective in a single session. We examined the types of problems presented at three rural medical fairs, and whether single session mental health interventions affected participants' health confidence, distress, or progress toward health-related goals. Problems presented included mental health, legal, financial, tobacco cessation, and relationship problems. Findings indicated that, on average, participants gained health confidence and reduced distress and found the service very helpful. The majority of those reached for phone follow-up reported progress on one or more health goals. Goals that involved manageable steps within the participants' own control, such as gratitude practices or progressive muscle relaxation, were the most likely to be completed. Implementation lessons included the importance of learning about the fairs' cultures, advertising the services, location of services, being proactive in connecting with patients, and preparing resources for community referrals. Overall, findings suggest that mental health interventions can have a positive impact on some people at free medical fairs. Given that tens of thousands of people attend each year, the fairs offer a fruitful opportunity to reach some of our most underserved citizens.

Race matters: Addressing racism as a health issue.

Abstract: The World Health Organization proclaimed in 1948 that "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." In many underserved communities, the individual and social well-being of patients of color is threatened. The United States is currently experiencing an exacerbation of racial tensions, and as health-care providers, we are dealing with the effects of racism on a daily basis. To effectively address patients' needs, it is imperative that physicians and behavioral health providers acknowledge the racial and socioeconomic challenges that patients face and recognize how these factors transcend to the physical and psychological medical conditions that patients experience. This article highlights an ongoing program that espouses the importance of addressing racism as a health issue and will reveal individual experiences and challenges in addressing it within urban underserved residency program settings. Various viewpoints on racism as a health issue will be offered and will be further clarified by the authors. Collaborators on this project are two underrepresented minority residency program faculty, a resident who is passionate about social justice and who is ethnically different from the majority of his patients, and lastly an international resident of color who has experienced racism directly and indirectly during residency training.

Teaching ethics that honor the patient's and the provider's voice: The role of clinical integrity.

Abstract: Medical ethics training is as variable as it is widespread. Previous research has indicated that medical learners find systematic approaches to ethical dilemmas to be helpful. This article describes a bioethics educational module. It includes an overview of common bioethical principles and presents a tool for organizing health-care providers' thinking and discussions about challenging ethical dilemmas. We discuss an area of bioethics that is often neglected, clinical integrity, and the role that a health-care provider's clinical integrity plays in ethical decision-making. We provide several hypothetical ethical vignettes for practice and discussion using the clinical integrity tool. The article also describes how this module has been implemented in one medical education setting and provides suggestions for educators.

Turning the tables: Using resident physicians' experiences as patients for leveraging patient-centered care.

Abstract: Training physicians to become person-centered is a primary goal of behavioral health curriculum. We have curriculum on doctor-patient communication skills and patient narratives to help physicians relate to the patient's experiences. However, there is nothing more effective than actually being the patient that gives providers an "aha" experience of the patient's perspective. In this article, we will share personal resident physician-patient stories based on their experiences within acute urgent care, chronic disease management, and routine well health care. In each narrative, the physician-patient will describe how their experiences had an impact in three areas: (1) their professional identity, (2) their connection with patients, and (3) their experience of the health-care system and teams. Drawing from the key emotional and cognitive experiences from these stories, we will identify training strategies that can bridge the personal to professional experiences as a way to enhance person-centered care. Our goal is to use the physician's insider perspective on the patient experience as a means to augment the awareness of professional physician role, team-based care, and navigating the health-care system.

Characterizing the good-enough Balint group: A work in progress.

Abstract: Many changes have occurred in the years since Michael Balint published The Doctor, His Patient, and the Illness in 1957. Does it follow that our conception of a “good-enough” Balint group is still identical to Dr. Balint’s original model or are there deeper elements to identify that would permit our model today to differ from his and still be legitimately recognized as a Balint group? Three changes in the context of Balint practice in the United States are particularly relevant:

Prior disclosure and emotional expression: Interactive effects on post-traumatic stress disorder symptoms.

Abstract: BackgroundPrevious research has revealed mixed findings with regard to the effects of disclosure on trauma recovery. More recently, studies on psychological trauma have found associations among religion, meaning, and health. This study investigated prior disclosure as a moderator for the association between religious emotional expression and adaptive trauma processing, as measured by post-traumatic stress disorder (PTSD) symptoms.MethodsUsing Pennebaker’s written emotional expression paradigm, 105 participants were assigned to either a conventional trauma-writing condition or religious trauma-writing condition. PTSD symptoms were assessed at baseline and again at one-month post writing.ResultsA two-way interaction was found between prior disclosure and writing condition on PTSD symptoms at follow-up. For the religious trauma-writing condition only, there was a significant difference between low versus high disclosure participants in PTSD symptoms at follow-up, such that low prior disclosure participants r...

Evaluation of the value of team-based psychiatric consultation in a general hospital setting.

Abstract: Background With the increase use of pay for performance in healthcare, 30-day readmissions after discharges are critically important. Objective A team-based psychiatric consultation approach was tested in an inpatient hospital setting. This is the first study that examines 30-day readmission rate with this approach. Methods In this quality improvement study, 164 patients received a team-based psychiatric consultation that included daily meetings during the weekdays between psychiatrists and hospitalists and 436 received care of treatment-as-usual or traditional consultation-liaison services. Results Overall 30-day readmission rate was not significantly different between intervention and nonintervention groups. However, in subgroups with high risk of mortality or severe illness, the intervention group had a 0% 30-day readmission rate for both high risk of mortality and severe illness subgroups, while the nonintervention group's readmission rate was 5% for high risk of mortality group and 3% for severely ill patients. Annual hospital cost saving is estimated between a quarter million and 1.5 million dollars for these subgroups. Conclusion The team-based psychiatric consultation approach demonstrated the potential for substantial cost savings in providing care for patients with high risk of mortality and severe illness. Thus, this intervention may be very useful in caring for patients with complex chronic conditions.

Clinical and care intensity differences among patients suffering from somatic diseases electively referred to a consultation and liaison service.

Abstract: BackgroundThis investigation mainly explores possible care differences among patients hospitalized because of medical conditions being electively referred to a psychiatric-psychosomatic consultation and liaison service.MethodsA four-year survey (N = 2518 individuals) based on clinical and care variables selected from the basic documentation. Statistics: Chi-square tests, analysis of variance, logistic and multivariate regression analyses, considering statistical modeling assumptions.ResultsA current psychiatric comorbidity has been found in 75% (less in cancer patients), mainly adjustment and anxiety (45%), mood (22%), and organic mental disorders (12%). The functioning score (Global Assessment of Functioning) was 59.4 and was especially low in patients suffering from unclear medical conditions. The performance status (Eastern Cooperative Oncology Group) amounted to 1.63 and was especially high in patients suffering from orthopedic conditions, infections, and cancer. Each patient received on average of 2....

Creation of a family medicine residency blog

Abstract: ObjectiveTo describe the process of creating the Family Medicine Vital Signs blog, curated and edited by residents and faculty at the University of Utah Family Medicine Residency Program and to obtain feedback from participants regarding educational impact.MethodsEach resident and faculty member contributes at least one blog post per year (with other invited authors), resulting in one post per week on the blog site. An editorial board composed of residents and faculty provides direction and editorial assistance for each post. Residency staff assist in providing authors with reminders and logistical support. A survey was conducted of blog contributors to understand their perceptions of the blog’s educational value.ResultsThe Family Medicine Vital Signs blog was started in July 2014, with 40% (n = 68) of the 170 posts provided by residents, 38.2% (n = 65) by faculty, and 21.8% (n = 37) by invited authors through June 2017. It has averaged nearly 100 unique readers per week and has had 15 posts republished i...

Forgotten, silent, and overruled: Hearing the voice of the nursing home patient.

Abstract: As the population ages, more Americans are moving into nursing homes/long-term care facilities. Per Accreditation Council for Graduate Medical Education 2017 guidelines, family medicine residents are required to gain experience and competence working in long-term care facilities; however, this unique environment poses several challenges for residents to hear the wishes of their patients over the demands of the patient's medical care team and family members. Also, many patients in long-term care facilities have sensory impairments (e.g., poor eyesight, deafness) and/or cognitive deficits (e.g., dementia). One solution for hearing the patient's voice over the demands of medical professionals and family members is to train physicians on how to overcome communication barriers with their patients. This article will discuss solution-focused approaches to reducing the barriers of sensory and cognitive impairments through the use of adaptive communication behaviors and adaptive equipment. Ways to improve communication between physicians, nursing-home staff, and patients' family in order to improve the care patients receive in long-term care facilities will also be addressed. These recommendations are designed to assist with reducing physician frustration, increasing each patient's input in medical decision-making, and improving communication across the patient care team.

Personal characteristics associated with the effect of childhood trauma on health

Abstract: Objective This article will describe a pilot study to explore associations between adult attachment style, resilience, Adverse Childhood Experiences, and adult health. Method A self-report survey was mailed to 180 randomly selected primary care patients and linked to a retrospective chart review. The patients met the following criteria: (1) enrolled for at least the previous year at their primary care clinic, (2) 21 years of age or greater, (3) English as their primary language, and (4) were seen by their provider on selected dates of the study. The survey was made up of three instruments: (1) the Adverse Childhood Experiences Questionnaire which consists of 10 questions about the respondent's adverse experiences during their first 18 years of life; (2) the Relationship Scales Questionnaire which measures adult attachment style; and (3) the Connor-Davidson Resilience Scale, a self-report scale that measures individual's perceptions of their resilience. For each returned questionnaire, we calculated a measure of medical complexity using the Elixhauser Comorbidity Index. Results Of the 180 randomly selected patients from four clinic sites, 84 (46.6%) returned completed questionnaires. We found that Adverse Childhood Experience scores were significantly correlated with health and attachment style and trended toward association with resilience. Conclusion This pilot study revealed expected relationships of the complex associations between Adverse Childhood Experiences, attachment style, and resiliency. Further research with more subjects is warranted in order to continue to explore these relationships.

A 90-year-old man with factious disorder: Separating fact from fiction.

Abstract: ObjectiveFactitious disorders are known to exist in the medical community but are not commonly diagnosed in clinical practice. The majority of the literature on factitious disorder comes from case reports or case series. This particular case is unusual because it describes a patient who initially presented with purely physical complaints, but over time, the symptoms transitioned into predominantly psychiatric concerns. This case describes the patient's unique presentation and is followed by a discussion of the management of factitious disorder.MethodsThe patient was seen during the course of an inpatient psychiatric hospitalization. Electronic chart review was conducted, and information from each prior hospitalization was gathered between the dates of first initial documented presentation available in the electronic record in 1995 to most recent hospitalization in 2017.ResultsThe patient still continues to present to the emergency department. Upon each presentation, staff work to objectively assess his co...