Search PubMed⌕ Search

Biomedical subjects

J Canet

Publications and source records attributed to J Canet.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Depersonalization in panic disorder: a clinical study.

Panic disorder (PD) has been hypothesized to be a heterogeneous entity, with distinct clinical subgroups. The presence of depersonalization during panic attacks may distinguish a specific subgroup of PD. We sought to analyze the differential features of a subgroup of PD patients with depersonalization. A total of 274 patients with PD were assessed and divided into 2 groups according to the presence or absence of depersonalization. The Structured Clinical Interview for DSM-III-R (SCID-UP-R) was used to assess PD and comorbid disorders. The clinical scales administered included the Hamilton Anxiety and Depression Rating Scale (HARS and HDRS), the Marks and Mathews Fears and Phobia Scale, Panic-Associated Symptom Scale (PASS), and a panic attack symptoms inventory. A total of 66 patients (24.1%) exhibited depersonalization during the attacks. Patients with depersonalization appeared to be younger and had an earlier age at onset. PD was more severe in the depersonalization group (greater number of attacks, worse level of functioning, and higher scores on most self-rating scales). Also, depersonalization patients showed more comorbidity with specific phobia. Our results support the view that PD with depersonalization may be considered a distinct and more severe subcategory of PD.

Adolescent↗
PubMedDate not supplied

Differential clinical features of late-onset panic disorder.

OBJECTIVES: The aim was to analyse the sociodemographic and clinical characteristics of panic disorder (PD) in patients with a PD onset after 60 years of age, at two outpatient psychiatric clinics in Barcelona (northeastern Spain). MATERIAL AND METHODS: All patients presenting with PD at two outpatient clinics over a 4-year period were assessed by the same team. Patients with PD onset at 60 or after were grouped (late-onset), and compared with the group with an earlier onset. The instruments administered to the sample were: Global Assessment of Functioning scale, Panic-Associated Symptom Scale, Hamilton's Depression and Anxiety Scales and Marks-Matthews' Fear and Phobia scale. RESULTS: Of 5301 patients attended over a 4-year period, 64 (1.2%) were PD patients aged 60 or above. Age at PD onset was over 60 in 27 cases (0.4% of the total population, and 6.1% of all PD patients). The mean age in the late-onset group was 67.0+/-4.9 years. Late-onset PD patients were less likely to report family history of PD. They scored lower on most scales assessing clinical severity (excepting GAF and agoraphobia scores), and they exhibited fewer and milder panic symptoms during the attacks. However, dysthymic disorder, but not major depressive disorder, was more common among late-onset PD patients (P<0.05). COMMENTS: The most notable findings in our late-onset PD subgroup of patients were: lesser severity of the disorder, greater comorbidity with dysthymia, and less family history of PD. Prevalence rates of late-onset PD in our sample appeared to be rather high. Physical illness and less severe panic symptoms may contribute to underdiagnosing PD in this particular subpopulation.

Age of Onset↗
PubMedDate not supplied

[Validation of the Panic Attack Symptoms Scale].

INTRODUCTION AND METHOD: The ESAP is a self-rating scale based on the panic attack with 0 to 3 scoring and the total score is obtained by adding the 14 scores- the highest score thus being 42. Forty patients were included for the study, and the were assessed at their first visit, after one week and after one month in the treatment. RESULTS: The items at the first basal assessment followed a normal distribution (Test Shapiro-Wilk w: 0.97, p< 0.57). The mean score was 18.5 with a SD of 7.43. The scale's internal consistency was measured by Cronbach's alpha, which was 0.66 at the first visit, 0.60 at the second one and 0.90 at the third one. Test-retest reliability was good in most cases, with values greater than 0.7 (p< 0.001). The correlation between the first visit total score and the second one was 0.89 (p< 0.001). The correlation with other scales (concurrent validity was highly significant with Hamilton's anxiety scale, total PASS and most of the PASS sub-scales (unexpected panic, limited and anticipatory anxiety) and slightly significant with the number of crises in past month. Four factors accounting for 65% of variance were identified in the factor analysis.

Adult↗
PubMedDate not supplied

[Sevoflurane in airway management using fibrobronchoscopy: apropos of 2 difficult orotracheal intubation cases].

We report two cases of difficult orotracheal intubation in which intubation with a fiberoptic bronchoscope was performed after induction with an inhalational anesthetic. Mild inhalational anesthesia with sevoflurane was started fairly rapidly, with no respiratory incidences. The tubes were then inserted through a fiberoptic bronchoscope, with no airway management problems.

Anesthetics, Inhalation↗
PubMedDate not supplied

[Causes of failure in psychopharmacological treatment of anxiety disorder].

OBJECTIVE AND METHODS: A comprehensive review of literature on the causes of failure in pharmacologic treatment of panic disorder (PD). RESULTS: PD has high rates of response to psychopharmacological treatment, reaching up to 80-90%. However, in a small percentage of cases (10-20%), the disorder is refractory to the combination of drugs and psychotherapy, at correct dosages and during adequate time periods. Refractoriness in PD is not a well-known issue as few studies have addressed this question. Intolerance to psychotropic drugs is usually reported to be the commonest cause, especially to antidepressants. Other causes are: comorbidity (especially with depressive disorders, personality disorders, and alcohol abuse, as well as with medical conditions); severe panic attacks; severe agoraphobia; and long illness duration. < > PD is to be ruled out, since incorrect diagnosis, incorrect treatment, or bad compliance are common causes of a poor response. We review treatment approaches for PD when no response is achieved with antidepressants (TCA, SSRI, MAOI), alprazolam and cognitive-behaviour therapy. Two recommended strategies are drug potentiation and use of clonazepam.

Antidepressive Agents↗
PubMedDate not supplied

[Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

Anesthesiology↗
PubMedDate not supplied

[Survey of nursing roles in anesthesiology, postoperative recovery care and pain management in Catalonia, Spain: analysis of the current situation].

OBJECTIVE: To determine nursing functions in anesthesiology, postoperative recovery care, and pain management in Catalan hospitals and to analyze the roles of nurses in this specialty. METHODS: Development of a mail questionnaire sent to 70 public and private hospitals in Catalonia, to be filled in and returned separately by the nursing supervisor and by the anesthesiology department of each hospital. The survey included questions on whether tasks were or were not carried out by nurses. RESULTS: Responses were received from 31% of nursing supervisors and 45% of anesthesiology departments. Only 22% of the hospitals employed nursing staff with duties exclusively in the anesthesiology department. Nurses took on more responsibilities in major outpatient surgery services and postanesthetic recovery care units than in other areas. Significant discrepancies were found between answers given by nursing supervisors and those returned by anesthesiology departments regarding tasks of nurses in this specialty. Items with the greatest agreement were those related to maintenance of material. Those with the lowest agreement were related to drug management. CONCLUSIONS: Although responses came from only a third of the target population, the information obtained suggests a lack of definition in Spain of nursing tasks in the field of anesthesiology. This situation is different from that of most European countries and of the United States of America.

Anesthesia↗
PubMedDate not supplied

[Problem-based learning in an undergraduate medical school course on anesthesiology, recovery care, and pain management].

INTRODUCTION: We describe our experience with problem-based learning (PBL) in an undergraduate course in anesthesiology and recovery care. MATERIAL AND METHODS: The study was carried out over 5 consecutive academic years from 2000 through 2005. In total, 168 students took part. PBL was started in seminars in the first 3 years the course was given. In the last 2 years, PBL was used throughout the entire course, which consisted of 12 seminars. At the end, each student evaluated the activities overall, the tutor's intervention, the student's own participation, and the time invested in searching for information and preparing for discussions. RESULTS: In the first 3 years, most students considered they had better assimilated the knowledge presented and that they had participated more. In the last 2 years, assessment of the course overall reached a score of 8.47 (SD, 1.24); of the instructor, 8.84 (0.98); and of student participation, 7.38 (1.29). The students used 2.11 (1.43) hours to search for information and 1.74 (1.14) hours to prepare for discussion. CONCLUSIONS: The medical students' level of satisfaction with and acceptance of PBL in this anesthesiology course were high. The instructor's intervention and student participation were assessed highly. A large amount of time was used for study.

Adult↗
PubMedDate not supplied

[Ineffectiveness of arterial pressure measurement and cardiac rate in detecting hypoxemia in the postanesthetic period].

The purpose of the study was to analyze the hemodynamic response to hypoxemia induced during the first postoperative hour. We studied 151 patients who underwent general anesthesia for elective surgery. Arterial saturation of oxyhemoglobin (SpO2), heart rate (HR), and systolic arterial pressure (SAP) during respiration with atmospheric air were measured 20 min and 80 min after admission at the recovery room. We compared HR and SAP between hypoxemic (SpO2 less than or equal to 90%) and non-hypoxemic patients (SpO2 greater than 90%) and we did not find significant differences. SpO2 failed to correlate with HR or with SAP in any of the time samples. This lack of correlation was also observed between patients with or without halogenated anesthetic treatment. Our results indicate that the possible inhibitory effect of anesthesia on hemodynamic response to hypoxemia lasts at least during the first postoperative hour and it does not depend on the administration of halogenated anesthetics. We also conclude that postoperative hemodynamic stability is not an accurate index of the status of arterial oxygenation.

Adult↗
PubMedDate not supplied

[Psychiatric evaluation of organic diseases].

The psychiatric assessment of the patients with organic illnesses is very difficult because of the bias related to physical symptoms (asthenia, anorexia). This could produce an over-diagnosis of the psychiatric disorders. The use of the specific psychiatric diagnosis criteria in the organic illnesses avoids this kind of problems and allows an improvement of their clinical assessment.

Humans↗
PubMedDate not supplied

[Anesthesia of a woman with extreme morbid obesity (260 kg)].

Patients with morbid obesity present a series of functional and morphologic alterations and require a careful planning for anesthetic management. We report a case of a woman weighing 260 kg who was operated on twice for the treatment of her base condition. In the first operation, general anesthesia was carried out and in the second one, epidural anesthesia was conducted. Main complications included hypoxemia and hypercapnia which persisted during the first week after operation carried out under general anesthesia.

Adult↗