Biomedical subjects
Publications and source records attributed to R M Hamer.
The authors investigated the importance of severity and duration of illness in schizophrenia with regard to findings on computerised tomographic (CT) scans. Two groups are compared, one from a state hospital's chronic ward and the other group from a university hospital. They provide evidence to propose increased ventricular size is an indicator of severity of illness.
Denial may be adaptive during hospitalization for acute coronary disease. We studied the impact of denial in 48 patients referred to a tertiary care center for treatment of unstable angina. Using the Hackett-Cassem Denial Scale, we divided the group into 25 high deniers and 23 low deniers. The two groups were comparable in baseline demographic and social data, coronary risk factors, cardiac history, medical treatment, vital signs, and cardiac catheterization results (number of diseased vessels and ejection fraction). Compared to low deniers, high deniers had half as many episodes of angina during hospitalization (1.3 vs. 2.5; p less than 0.03, t = 2.2, df = 46) and were more likely to reach medical stabilization, i.e., pain free for 36 hr (92% vs. 65%, p less than 0.03, Fisher exact probability test). Intravenous nitroglycerin drips were also required less often in high deniers (32% vs. 78%, p = 0.002, Fisher exact). Two myocardial infarctions and one death occurred, all in low deniers. We conclude that denial independently predicts better medical outcome during acute hospitalization for unstable angina.
Late-life depression may have different clinical features, hospital utilization patterns, and natural history, depending on whether the illness begins in midlife or late life. This historical cohort study examined three patient groups, late-onset geriatric depressed patients, early-onset geriatric depressed patients, and young adult depressed patients, to determine hospital utilization patterns, readmission rates, and whether specific clinical symptoms on admission predisposed patients to readmission. The two geriatric patient groups had similar demographic, medical comorbidity, and hospital utilization profiles, except that the early-onset geriatric depressed group had longer hospital lengths of stay. Hospital utilization patterns for the young adult patients were different from the geriatric patients, but in the expected direction, ie, less medical comorbidity and shorter lengths of stay. Patients with late-onset geriatric depression had the highest 24-month readmission rate (47.4%), followed by early-onset geriatric depression patients (23.1%) and young adult patients (16.7%). Delusional symptoms and agitation were similar across the three patient groups and, as expected, somatic complaints were more frequent in the geriatric patient groups. The relative risk for readmission was greatest for geriatric patients who were somatic. Readmission risk was increased for agitated late-onset geriatric depressed patients and young adult patients, but not for early-onset geriatric depressed patients. Delusional symptoms did not predict readmission for any patient group.