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Biomedical subjects

P Fink

Publications and source records attributed to P Fink.

At least 19 recordsLinked to original sources
PubMed2003

Mental illness in new neurological patients.

OBJECTIVE: To determine the prevalence of psychiatric disorders in new neurological inpatients and outpatients, and examine whether they are recognised, treated, or referred to psychiatric consultation. METHODS: 198 consecutive patients referred for the first time to a neurologist were studied using a two phase design. ICD-10 psychiatric diagnoses were established by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry). RESULTS: The overall prevalence of current mental disorders was 55.1% (95% CI: 46.2 to 63.8), and 65.0% (95% CI: 56.1 to 73.0) had at least once in their life had a psychiatric disorder. The most frequent current diagnoses were somatoform disorders (33.8%, (95% CI: 25.9 to 42.7%)), followed by phobias (21.8%; 95% CI: 15.3 to 30.0), substance use disorders (13.3%; 95% CI: 8.3 to 20.6) and depression/dysthymia (14.4; 95% CI: 9.1 to 21.8). The psychiatric morbidity markedly declined with increasing age. Compared with 63.5% of the women, 46.4% of the men had a psychiatric disorder. Substance use disorders were more frequent in men than women (p=0.002). Patients with a psychiatric disorder were more frequently seen in the outpatients' clinic than those without. The neurologists detected 14%-40% of the cases, 16.9% were in treatment, and only 4.6% were referred to mental health care. CONCLUSION: Psychiatric disorders, in particular somatoform disorders, are extremely common in neurological patients, especially in young and middle aged patients, outpatients, and women. The results call for more research on mental illness' impact on care and outcome in neurological patients.

Ambulatory Care↗
PubMed2001

Mental disorders among internal medical inpatients: prevalence, detection, and treatment status.

OBJECTIVE: To determine the prevalence of ICD-10 mental disorders among internal medical inpatients, the relation between mental disorder, age, and gender, and the recognition and referral of the disordered patients. METHOD: 294 consecutive medical inpatients were examined with a two-phase design using the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) for ICD-10 psychiatric diagnoses. Information from questionnaires and interviews with patients, doctors, nurses, and from medical records. RESULTS: The prevalence of current mental disorders was 38.7%, being heavily increased in young patients. Main diagnoses were somatoform disorders (17.6%), phobias (12.9%), substance use disorders (10.9%), and depression (8.3%). Psychiatric consultations were very few. About 38-56% of the cases were recognized by medical doctors and nurses, and only about 20% were in mental health treatment. CONCLUSION: The prevalence of mental disorders among internal medical inpatients is high and increased in young patients and women. Detection and referral are low, and few are treated.

Adult↗
PubMed2001

Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study.

AIMS AND OBJECTIVES: The relationship between mental disturbances - anxiety and depression, somatization and alcohol abuse - on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case-management on admission. DESIGN: The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study. RESEARCH METHODS AND INSTRUMENTS: In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based on the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care. RESULTS: Patients with high scores on anxiety and depression (SCL-8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse. CONCLUSIONS: The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes.

Activities of Daily Living↗
PubMed2001

Patients in general practice in Denmark referred to physiotherapists: a description of patient characteristics based on general health status, diagnoses, and sociodemographic characteristics.

BACKGROUND AND PURPOSE: Both musculoskeletal illness and mental illness characterized by somatic symptoms are common in primary care, and it is hypothesized that many patients with musculoskeletal illness have relatively poor mental health. The purpose of this study was to describe the characteristics of patients in general practice in Denmark who are referred to physiotherapists with signs and symptoms of musculoskeletal illness. SUBJECTS AND METHODS: One hundred ninety-four general practitioners, representing 124 practices, participated in a survey of 2,042 consecutive patients with musculoskeletal illness. RESULTS: The diagnoses were generally poorly defined. Compared with the general population, patients with musculoskeletal illness had markedly poorer physical health and poorer mental health. Patients with poorly defined diagnoses did not differ from patients with well-defined diagnoses in terms of physical health, but they scored lower on the mental health component summary scale of the Danish version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CONCLUSION AND DISCUSSION: Of patients referred to physiotherapists by general practitioners in Denmark, the subgroup with poorly defined diagnoses had lower mental health scores than those with well-defined diagnoses, suggesting that a biopsychosocial approach to care may be appropriate for this group of patients.

Adult↗
PubMed2000

Psychological distress and somatisation as prognostic factors in patients with musculoskeletal illness in general practice.

BACKGROUND: Musculoskeletal illness is a common cause of absenteeism from work, workers' compensation, and disability retirement, and accounts for 9.3% to 17% of patient contacts in general practice. To understand the increase in self-reported musculoskeletal illness and to improve treatment and prevention, it is important to know which factors to target when dealing with these patients. AIM: To investigate whether the prognosis for patients with musculoskeletal illness referred to physiotherapy from general practice can be predicted by the presence of psychological distress and somatisation identified by a general practitioner (GP) and standard questionnaires. METHOD: A multi-practice survey based on questionnaires (index and three-month follow-up). Nine hundred and five consecutive patients referred to physiotherapy from 124 different general practices in Denmark were included. Outcome measures were physical health change, sick leave, patient self-rated improvement, and change in use of medication. RESULTS: Psychological distress and somatisation rated by both GPs and standard questionnaires acted with almost no exception as significant predictors of all four outcome measures. CONCLUSION: Psychological distress and somatisation are important factors when considering preventive initiatives and treatment of patients with musculoskeletal illness in general practice.

Absenteeism↗
PubMed1999

Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization.

The aim of this study was to investigate the internal and external validity of the Whiteley Index as a screening instrument for somatization illness. A 14-item version of the Whiteley Index for hypochondriacal traits was given to 99 of 191 consecutive primary care patients, aged 18-65 years, and to 100 consecutive patients, aged 18-60 years, admitted for the first time to a neurological ward. The primary care sample was, in addition, interviewed by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) psychiatric interview. The GPs and the neurologists were asked to rate various characteristics of the patients that might indicate somatization. The internal validity of the Whiteley Index was tested by means of latent structure analysis. On this basis, a reduced seven-item scale (Whiteley-7 scale) and two subscales (i.e., an Illness Conviction and Illness Worrying scale, each with three items) were constructed. All three had a high internal validity fitting into the very restricted Rasch statistical model (p>0.05) and an acceptable transferability between most of the subpopulations investigated. In the primary care population, the Whiteley-7 and the Illness Conviction scales at cut-point 0/1 showed 1.00 and 0.87 sensitivity and 0.65 and 0.87 specificity, respectively, using as "gold standard" the fulfillment of criteria for at least one ICD-10 somatoform disorder, and 0.71 and 0.63 sensitivity and 0.62 and 0.87 specificity, respectively, as gold standard for the fulfillment of criteria for at least one DSM-IV somatoform disorder, excluding the NOS diagnostic group. The Illness Worrying subscale showed less impressive performance in this respect. The agreement between the Whiteley-7 scale including the two subscales and neurologists' rating and the GPs' rating and the somatization subscale on the SCL-90 was modest or worse. It may be concluded that the Whiteley-7 scale and the Illness Conviction subscale had acceptable psychometric profiles, and both seem to be promising screening tools for not only hypochondriasis but also for somatoform disorders in general.

Adolescent↗
PubMed1998

Common mental disorders among patients in primary health care in Greenland.

Studies from all over the world have shown that well defined mental disorders are common in all general health care settings and that marked disability is associated with common mental disorders, more so than with chronic physical disorders without psychological disturbances. A majority of mental disorders are unrecognized and do not get appropriate treatment. No such study has been made in Greenland, but there are many indications that mental health is threatened and needs more attention. A two-stage study of common mental disorders among patients in the primary health service in Greenland is planned to take place from September 1996 to 1998. The research plan is presented as an invitation to replicate the study in other circumpolar areas.

Cross-Sectional Studies↗
PubMed1997

Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment.

A total of 1,281 patients were examined during consultation with their GP in a Nordic multicentre study focusing on the prevalence of psychiatric illness, hidden psychiatric morbidity, treatment and pathways to specialized care. The methodology and prevalence were reported in an accompanying paper. The present paper presents results concerning the variables hidden psychiatric morbidity, treatment and pathways to specialized care. The GPs detected 44% of the psychiatric cases compared with the result of a diagnostic interview (PSE). The distinction between psychosis and non-psychosis did not influence the GPs' ability to detect a mental illness. According to the GPs' assessment the majority of patients suffering from a mental disorder consulted their GP about physical complaints. The GPs treated the patients themselves, and only a limited number of cases were referred to psychiatrists or psychologists.

Adolescent↗
PubMed1997

Health services research on mental health in primary care.

OBJECTIVE: The article seeks to provide an international perspective on the facilitating role of health services research in the treatment of psychiatric disorders in primary care. It builds on Goldberg and Huxley's model describing pathways to mental care for the psychiatrically ill in the community. METHOD: Seventy studies were selected for review by Medline search, sixteen studies by contacting prominent researchers in the field. All studies are discussed more or less extensively. RESULTS: Case identification strategies including screening tools and diagnostic modules have been developed. Other strategies include educational training programs and psychiatric consultation services designed to facilitate psychopharmacological and other types of treatment of psychiatric disorders in primary care. Several models for the linkage of primary care and specialty mental health providers are discussed, and a primary care psychiatry programme is examined. CONCLUSION: Better psychiatric training of general practitioners (GPs), on-site consultation, and better communication between mental health professionals and GPs can improve the recognition, management, and referral of psychiatrically ill primary care patients. The further development of guidelines focusing on anxiety disorders, somatization, subthreshold disorders, and effectiveness in primary care is recommended.

Forecasting↗
PubMed1996

Sustained antidepressant effect of PEA replacement.

Phenylethylamine (PEA), an endogenous neuroamine, increases attention and activity in animals and has been shown to relieve depression in 60% of depressed patients. It has been proposed that PEA deficit may be the cause of a common form of depressive illness. Fourteen patients with major depressive episodes that responded to PEA treatment (10-60 mg orally per day, with 10 mg/day selegiline to prevent rapid PEA destruction) were reexamined 20 to 50 weeks later. The antidepressant response had been maintained in 12 patients. Effective dosage did not change with time. There were no apparent side effects. PEA produces sustained relief of depression in a significant number of patients, including some unresponsive to the standard treatments. PEA improves mood as rapidly as amphetamine but does not produce tolerance.

Adult↗
PubMed1995

A cDNA encoding the human type I hair keratin hHal.

A full-length cDNA of a human type I hair keratin was isolated that encodes a protein of 416 amino acids. Northern blot analysis shows that the mRNA is present in human scalp but not in hairless skin. Based on sequence homology comparisons with the four known mouse type I hair keratins mHal-4 the keratin could be identified as the human hair keratin hHal.

Amino Acid Sequence↗
PubMed1995

Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity.

The prevalence of mental illness in five different Scandinavian primary care populations was investigated in this study. Patients consecutively consulting their general practitioner a particular week-day were included in the study. Initially the SCL-25 was applied and next the high scores and a sample of the low scores were interviewed by the PSE. In the analysis the screening procedure was first validated. The internal validity of the SCL was tested by means of Rasch latent structure analysis and the external validity tested by ROC/QROC analysis. Based on this, a short 8-item version of the SCL was developed. The prevalence of mental illness in all centres was 0.26 with a minimum of 0.14 in Nacka and a maximum of 0.34 in Turku.

Adolescent↗
PubMed1995

Psychiatric illness in patients with persistent somatisation.

BACKGROUND: This study explores the incidence and nature of mental illness among persistent somatisers, and analyses their use of mental health services. METHOD: Individuals with at least ten admissions to non-psychiatric departments during an 8-year period were studied. Persistent somatisers (n = 56) were compared with other frequent users (n = 57) of non-psychiatric services. RESULTS: Of the persistent somatisers, 82% had been examined by a psychiatrist at least once (median, 3 times). Sixteen per cent were mentally retarded, 48% were dependent on alcohol or drugs, and 48% had DSM-III-R personality disorder. The most prevalent ICD-10 diagnoses were anxiety states (54%), depressions (30%), phobias (18%) and psychoses (20%). CONCLUSIONS: Persistent somatisation is associated with severe mental illness and a broad spectrum of heterogeneous psychiatric diagnoses and syndromes. Persistent somatisers impose a serious burden on the mental health care system.

Adolescent↗
PubMed1994

Retinoic acid-induced normal and tumor-associated aberrant expression of the murine keratin K13 gene does not involve a promotor sequence with striking homology to a natural retinoic acid responsive element.

The type I keratin K13, normally restricted to suprabasal cells of internal stratified epithelia, is aberrantly expressed in 7,12-dimethylbenz[a]anthracene (DMBA)-12-O-tetradecanoyl-phorbol-13-acetate-induced murine epidermal tumors and constitutes an early marker of malignant progression. Aberrant K13 expression also occurs in epidermal cell lines derived from DMBA-TPA-induced tumors. As in cultured primary keratinocytes from normal internal stratified epithelia, the in vitro expression of K13 in transformed epidermal cell lines can be induced either by Ca2+ or by retinoic acid (RA). We have found that the promoter of the K13 gene contains a sequence element GGTTCA(N)5TGTTCT, in the following referred to as K13-RARE, that is highly related to the natural retinoic acid responsive element (RARE) of the retinoic acid receptor beta 2 gene. Both elements differ only in the second half-motifs, in which the first and sixth position is occupied by thymidines (K13-RARE) instead of adenines (beta 2-RARE), as well as in their pentameric spacer sequences. Despite this striking homology in the receptor binding domains, we show by transfection of reporter gene constructs of the elements into primary fore-stomach keratinocytes and transformed epidermal cell lines that in both cell systems, unlike beta 2-RARE, the wild-type K13-RARE completely lacks transactivating properties in the presence of RA. A recent hypothesis proposes that aberrant gene expression during tumorigenesis may occur through conversion of inactive response elements with high homology to hormone response elements into functional enhancers by carcinogen-induced point mutations at critical positions (Nawaz et al., Mol. Carcinogen., 7, 76-82, 1993). To investigate whether the aberrantly expressed K13 gene falls into the category of those genes, reporter gene constructs of K13-RARE variants in which either the initial or the terminal thymidine of the second half-motif was replaced by adenine were transfected into epidermal cell lines. Neither mutant exhibited RA-dependent transactivating properties. Strong transactivation could only be achieved by a K13-RARE mutant in which both critical thymidines were substituted by adenines. This type of closely spaced base exchange, unlikely to be created during DMBA initiation of mouse epidermis, was not detectable on sequencing genomic DNA of a squamous cell carcinoma and a transformed epidermal cell line. Instead, in both cases, only the wild-type K13-RARE could be demonstrated. A regulatory role of this RARE-like sequence in the promoter of the murine K13 gene for both normal and aberrant expression of the gene can therefore be excluded.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1994

Somatization in patients newly admitted to a neurological department.

The incidence of somatization and sociodemographic, clinical and mental factors in 100 consecutive patients newly admitted to a neurological department was investigated. Forty percent of the neurological inpatients were somatizers; they reported higher levels of distress and hypochondriacal concerns and were more often considered as having significant mental disorders by the neurologists. The somatizers were similar to patients with organic symptoms with respect to sociodemographic factors, duration of and number of symptoms, mode of admission and earlier consultations of and number of symptoms, mode of admission and earlier consultations of psychiatric or other specialists. Most of the patients with somatization only believed that psychological factors influenced their somatic symptoms. No sex differences were found except that female somatizers had shorter duration of admission.

Adult↗
PubMed1993

Admission patterns of persistent somatization patients.

Persistent somatization patients put a serious burden on the health care system with multiple admissions, tests, surgeries, and medications. This study reports on factors relevant to the health-seeking behavior of somatizing patients and aspects of the health care system that facilitate their overutilization of health resources. Individuals (age 17-49 years) from the general population of two Danish municipalities with at least 10 general admissions during an 8-year period were studied comparing persistent somatizers with other high utilizers of medical admissions. Results are reported on geographical mobility, change in family doctors, route and distribution of admissions by time of day or week, discharges against medical advice, physical disease overlooked, and distribution of admissions to specialties. Although the health-seeking behavior of persistent somatizers may in part explain their overutilization of health care resources, such overutilization could be reduced and much suffering avoided if physicians displayed the same enthusiasm in diagnosing somatization as in ruling out organic pathology.

Adolescent↗
PubMed1993

A study of hospital admissions over time, using longitudinal latent structure analysis.

The aim was to study patterns of utilization of non-psychiatric admissions over time and factors affecting the utilization. The study cohort includes all individuals born 1934-66, living in one of two Danish municipalities and admitted to a non-psychiatric department at least once in 1977 (n = 2,686). The hospitalizations of the cohort were followed during a 5-year period by means of the Danish National Patient Register. The data were analysed using a longitudinal latent class (LC) model and a longitudinal latent Markov (LM) model. The LC model suggests that among the cases in the cohort there were 4 variants of utilization patterns. The LM model adequately described the sample in only 3 variants or classes. These classes may be interpreted as a small group of "chronically ill" individuals (1.9% of the cohort), a major group of "healthy" individuals, with no, or only a single, random re-admission during the follow-up period (74.4% of the sample), and finally an intermediate group of "high utilizers" (23.7% of the sample). This "chronicity" variable was markedly associated with mental illness, multiple discharge diagnoses from non-psychiatric departments and total utilization of hospitalizations during the follow-up period. Conversely, gender, age and days in hospital per admission were without importance. The study implies that the analysis of patterns of hospital admissions over time can yield important insight into health service utilization and that longitudinal latent structure analyses are powerful statistical tools in this aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗