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Biomedical subjects

J H Atkinson

Publications and source records attributed to J H Atkinson.

67 records · Page 4Linked to original sources
PubMed1983

The relationship of depression and thought disorder in pain patients.

In the recent literature, the presence of thought disorder occurring with depression has been both supported and contradicted. In order to clarify the relationship of thought disorder and depression this study examined three areas of cognitive function in depressed and non-depressed groups drawn from pain patients and normals. Subjectively, depressed subjects had significant deficits in abstraction, associative tightness, and speed of information processing. Across all subjects, increasing cognitive impairment in all three dimensions correlated significantly with increasing severity of depression. Pain per se and analgesics did not account for the results. There were several significant correlations between the cognitive measures, suggesting a general process mediating the thought disorder associated with increasing levels of depression. The results support and extend the known relationship of thought disorder and depression.

Adolescent↗
PubMed1982

Managing the violent patient in the general hospital.

Successful treatment of aggressive behavior depends on promptly addressing it, preventing violence by timely intervention, and proceeding with differential diagnosis and definitive medical or psychiatric treatment. Whenever a frightened, threatened, or hostile patient is identified, the staff should address this mood and begin measures to prevent a violet outcome, keeping safety uppermost in mind. Paradoxically, ignoring anger or beligerency augments its development by increasing the patient's suspiciousness, frustration, helplessness, or out-of-control feelings. Whenever possible the staff should adopt a conciliatory but firm approach aimed at resolving the crisis. Resolution may require force, which should be left to security personnel or effected only with overwhelming staff power. Armed patients are always the province of the police. Medication can be extremely effective as an aid in subduing patients, as short-term symptomatic treatment, and often in long-term management.

Anti-Anxiety Agents↗
PubMed1980

Pain and its modulation. Part 1. Afferent mechanisms.

Our understanding of pain and its afferent modulation has undergone a great deal of modification in recent years as our knowledge of the sensory nervous system has expanded. In this review, current concepts are detailed in the perspective of present and potential clinical applications of basic science principles and theories to neurosurgical interventions. Beginning with peripheral receptors and fibers and traversing the peripheral nervous system to ultimately reach the central nervous system, the nociceptive information undergoes much integration and modification to affect the ultimate response of the organism to the original stimulus. At each point in the afferent pathways, various alternative neurosurgical ablative or augmentive approaches are available and might be appropriate for pain relief. For a variety of reasons many ablative procedures are being used less often in the treatment of chronic pain of a noncancerous origin, while the newer augmentive techniques are becoming more popular. On the other hand, at present ablative procedures are still used frequently for chronic pain associated with cancer, although the newer augmentive approaches are being tried in this area as well.

Afferent Pathways↗
PubMed1980

Pain and its modulation. Part 2. efferent mechanisms.

Recent studies of central nervous system effects on pain and on its efferent modulation have created new theories and have led to direct clinical applications that may in time eclipse more classical interventions. In this review electrical stimulation analgesia is presented as a paradigm of how basic science work has been applied clinically to produce some of the most exciting advances in recent years in the treatment of chronic pain. Opiate receptors and analgesia are presented in relationship to the descending inhibitory systems used in electroanalgesia. Neuromodulators and neurotransmitters important in pain modulation through complex inhibitory and excitatory pathways are discussed, with the roles of B-endorphin, enkephalin, serotonin, and other important biogenic amines being stressed. The neuropharmacology of pain as it is currently understood clinically suggests that psychotropic interventions may be quite useful in treating difficult pain problems.

Analgesia↗
PubMed1980

The family meeting in critical care settings.

A routine, carefully planned meeting with families of patients in a trauma unit or critical care setting can improve coping and enhance patient care. Even though staffs in intensive care units realize that families may profoundly influence a patient's psychologic state, or may themselves be severely stressed, few units systematically address the needs of families in crisis. Common needs of families of acutely injured patients are the need to be with the patient, to learn about his condition, to feel useful, to express feeling about the situation, and to obtain emotional support. Besides addressing these needs, a family meeting can reduce family turmoil, help dispel family-staff conflict, and provide a format for educating staff about psychologic responses to life-threatening illness. The experience with eight patients in an ICU is described, and guidelines given for family meetings. Factors assuring a successful family meeting include careful attention to leadership, timing, communication, and clear priorities.

Adolescent↗
PubMed1980

A three year follow-up of elderly alcoholics.

This a 3 year follow-up of the psychiatric status of 280 consecutive men age 65 and over who were admitted to the San Diego Veterans Administration Medical Center for medical or surgical problems. Eleven percent of the individuals were found to have active or remitted primary alcoholism. Over the 3 years only 20% of the surviving active alcoholics became abstinent. Most of the inactive alcoholics remained alcohol problem-free after 3 years. Affective disorder and dementia were common intercurrent psychiatric disorders arising during follow-up. The 3 year mortality rate was significantly higher for remitted alcoholics when compared to those without psychiatric illness.

Aged↗
PubMedDate not supplied

Neuropsychological impairment in human immunodeficiency virus-infection: implications for employment. HNRC Group. HIV Neurobehavioral Research Center.

Individuals infected with the human immunodeficiency virus-Type 1 (HIV-1), are at increased risk for neurobehavioral impairment, particularly in later stages of the disease. Even patients in the medically asymptomatic or minimally symptomatic stages of infection may show mild deficits on comprehensive neuropsychological (NP) test batteries, although the clinical significance of such deficits remains uncertain. The present study used vocational difficulties as markers of clinical significance of NP impairment. In a sample of 289 HIV-infected, nondemented men, those who evidenced NP impairment had a higher unemployment rate (p < .001) than did their unimpaired counterparts. In HIV-positive subjects who remained employed, NP impairment was strongly associated with subjective decreases in job-related abilities. Neither depression nor medical symptoms could explain the relationship between the NP impairment and employment problems. These results are consistent with previous studies investigating other neuropsychiatric disorders, which suggest that even mild NP impairment can interfere with employment status. From this standpoint, such impairment in HIV-infected persons may be described as "clinically significant."

AIDS Dementia Complex↗
PubMedDate not supplied

Somatization symptoms in chronic low back pain patients.

Chronic low back pain (CLBP) patients often are described as "somatizers", who report multiple somatic complaints beyond back pain itself, but the nature and clinical significance of this observation is poorly understood. To clarify the characteristics, correlates and severity of somatization in CLBP, we rigorously assessed somatization symptoms in a sample of patients not selected for psychiatric or pain clinic referral. Male CLBP patients (N = 97), attending a primary care orthopaedic clinic, and matched healthy controls (N = 49), were assessed using the Diagnostic Interview Schedule III-A (DIS), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRSD), McGill Pain Questionnaire (MPQ), Sickness Impact Profile (SIP), and the Pain and Impairment Relationship Scale (PAIRS). Although none of the subjects met strict DSM-III criteria for a lifetime diagnosis of Somatization Disorder, 25.8% of CLBP patients reported a lifetime history of 12 or more somatic symptoms, as compared to only 4.1% of controls. In the less symptomatic ranges, patients still generally reported more symptoms than controls, with 51.5% of patients vs. 8.2% of controls reporting 7-11 symptoms, and 22.7% vs. 87.8% of controls reporting 0-6 symptoms (p < .001). Major depression and alcohol dependence were significantly associated with increased severity of somatization (p < .05). Lower mood and increased impairment, but not pain intensity, were related to greater number of somatic complaints. Symptoms of somatization are prevalent, but not universal, in CLBP and the pattern of these symptoms is reminiscent of the "spectrum of severity" reported in other medical populations. Recognizing this spectrum of somatization may lead to better patient-treatment matching and improved clinical outcomes.

Adaptation, Psychological↗
PubMedDate not supplied

Validity of the Quality of Well-Being Scale for persons with human immunodeficiency virus infection. HNRC Group. HIV Neurobehavioral Research Center.

To evaluate the validity of the Quality of Well-Being Scale (QWB) for studies of patients with human immunodeficiency virus (HIV) disease, 514 men were studied who were divided among four categories: Centers for Disease Control and Prevention (CDC) Group A (N = 272), CDC-B (N = 81), CDC-C (N = 47), and uninfected male controls (N = 114). The QWB and a variety of medical, neuropsychological, and biochemical measures were administered to all participants. When QWB scores were broken down by HIV group, the CDC-C group was significantly lower (.614) than the CDC-B (.679), CDC-A (.754), or control group (.801). The difference between Groups CDC-C and CDC-A was about .14 units of well-being, which suggests that individuals lose 1/7 equivalents of 1 well year of life for each year they are in Group CDC-C in comparison to the asymptomatic group (Group CDC-A). In comparison to the controls, this would equal a 1-year of life loss for each seven infected individuals. The QWB was shown to be significantly associated with CD4+ lymphocytes (p < .001), clinician ratings of neuropsychological impairment (p < .04), neurologists ratings of dysfunction (p < .001), and all subscales of the Profile of Mood States. Baseline QWB scores were significant prospective predictors of death over a median follow-up time of 30 months. Multivariate models demonstrated high covariation between predictors of QWB. It was concluded that the QWB is a significant correlate of biological, neuropsychological, neurological, psychiatric, and mortality outcomes for male HIV-infected patients.

AIDS Dementia Complex↗
PubMedDate not supplied

The influence of HIV-related support groups on survival in women who lived with HIV. A pilot study.

To determine the effect of support groups on survival, the authors retrospectively studied 21 HIV-seropositive women who died during the course of participation in a natural history study of HIV. Groups were composed of women who self-selected HIV support groups before death (n = 11) and a comparison group (n = 10). Survival analysis found group participation to be associated with increased longevity (73 months vs. 45 months; P = 0.011). Proportional-hazards regression demonstrated that HIV-related support groups and smaller family size significantly influenced survival (P = 0.0002). Factors related to group participation and ways in which support groups might promote longevity are discussed.

Adaptation, Psychological↗