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Biomedical subjects

R Mayou

Publications and source records attributed to R Mayou.

At least 55 records · Page 3Linked to original sources
PubMed1994

Use of psychiatric services by patients referred to a consultation unit.

The psychiatric case registers for the hospital catchment area were examined to determine the use of psychiatric services over a 14-year period by a 4-year cohort of consecutive inpatient referrals to the consultation-liaison service of a British general hospital. Two-thirds of the subjects had no other psychiatric care during the survey period, but a third made considerable use of a wide range of specialist psychiatric services. Alcohol problems and dementia were notably associated with complex history of psychiatric management. Management of patients with repeated episodes of psychiatric care requires close collaboration with other services.

Adolescent↗
PubMed1994

Non-cardiac chest pain and benign palpitations in the cardiac clinic.

OBJECTIVES: To assess the characteristics of consecutive patients referred from general practice with the presenting disorder of chest pain or palpitations, and to determine the outcome at six months and three years. SETTING: A single consultant teaching hospital cardiac clinic receiving new referrals from a health district. DESIGN: 94 consecutive referrals by general practitioners to a cardiac clinic with the presenting disorder of chest pain or palpitations were assessed at first attendance (research interview, cardiologists' ratings, systematic medical case note information), home interview six months later, and by a postal questionnaire at three years. OUTCOME MEASURES: Physical and psychological symptoms, limitation of activities, satisfaction with care, and use of health care resources. RESULTS: 39 patients were given a cardiac diagnosis and 51 patients were not given a cardiac or other major physical diagnosis. The non-cardiac group was more likely to be young women, and to report other physical symptoms and previous psychiatric problems. The cardiac and non-cardiac groups reported progressive improvement in presenting symptoms and disability at the six months and three year follow up, but little change in mental state. Even so, three quarters of the non-cardiac subjects described continuing limitation of activities, concern about the cause of their symptoms, and dissatisfaction with medical care. CONCLUSIONS: A substantial proportion of the consecutive referrals continued to describe symptoms and disability throughout the three years after clinic attendance. Outcome was poor for those who had negative investigations and were reassured that they had no cardiac disorder or other serious physical finding. These results have implications for defining the role of psychological assessment and for the formulation of cost effective clinical measures to (a) minimise disability associated with cardiac disorder; and (b) prevent and treat handicaps in those without major physical diagnoses.

Activities of Daily Living↗
PubMed1994

Why do doctors find some patients difficult to help?

Almost all doctors encounter difficulties in managing some patients. Previous studies have examined the characteristics of such patients: we have additionally studied the reasons why hospital doctors find these patients 'difficult to help'. Three clinics (two medical and one surgical) were studied. The consultants rated 60 (22%) of 293 attenders s severely or extremely difficult to help. Difficulty was associated with greater patient distress (odds ratio 3.9; 95% CI 2.0-7.7), less patient satisfaction (2.6; 1.3-5.0) and chronic attendance (5.0; 1.4-17.3). An interview study of 40 'difficult' patients indicated that doctors considered psycho-social factors more important in difficult patients (3.2; 1.3-7.7). Objective differences between the doctor's and the patient's aims for care also occurred more frequently for difficult patients (2.8; 1.1-7.2). Three common types of difficulty were identified; medically unexplained symptoms; co-existing social problems; and severe untreatable illness. A review of the management aims for patients whom doctors find 'difficult to help', combined with improved access to psycho-social care, could improve both the quality and the cost-effectiveness of hospital out-patient services.

Adolescent↗
PubMed1993

Psychiatric consequences of road traffic accidents.

OBJECTIVE: To determine the psychiatric consequences of being a road traffic accident victim. DESIGN: Follow up study of road accident victims for up to one year. SETTING: Emergency department of the John Radcliffe Hospital, Oxford. SUBJECTS: 188 consecutive road accident victims aged 18-70 with multiple injuries (motorcycle or car) or whiplash neck injury, who had not been unconscious for more than 15 minutes, and who lived in the catchment area. MAIN OUTCOME MEASURES: Present state examination "caseness"; post-traumatic stress disorder and travel anxiety; effects on driving and on being a passenger. RESULTS: Acute, moderately severe emotional distress was common. Almost one fifth of subjects, however, suffered from an acute stress syndrome characterised by mood disturbance and horrific memories of the accident. Anxiety and depression usually improved over the 12 months, though one tenth of patients had mood disorders at one year. In addition, specific post-traumatic symptoms were common. Post-traumatic stress disorder occurred during follow up in one tenth of patients, and phobic travel anxiety as a driver or passenger was more common and frequently disabling. Emotional disorder was associated with having pre-accident psychological or social problems and, in patients with multiple injuries, continuing medical complications. Post-traumatic syndromes were not associated with a neurotic predisposition but were strongly associated with horrific memories of the accident. They did not occur in subjects who had been briefly unconscious and were amnesic for the accident. Mental state at three months was highly predictive of mental state at one year. CONCLUSIONS: Psychiatric symptoms and disorder are frequent after major and less severe road accident injury. Post-traumatic symptoms are common and disabling. Early information and advice might reduce psychological distress and travel anxiety and contribute to road safety and assessing "nervous shock."

Accidents, Traffic↗
PubMed1993

Somatization.

Medically unexplained symptoms are common in the general population and in all medical settings. Although often transient, a sizeable proportion are persistent and associated with considerable effects on quality of life. Aetiology is often multi-causal, and associated psychiatric disorder is frequently, but not invariably, present. General principles of treatment and specialist procedures are reviewed.

Combined Modality Therapy↗
PubMed1992

The psychological treatment of patients with functional somatic symptoms: a practical guide.

Functional somatic symptoms (FSS) are bodily sensations which do not result from physical disease, but which the patient responds to as if they did. Such symptoms are common and usually transient. In some patients they become persistent and associated with distress and disability. In such cases specific treatment is indicated. A cognitive-behavioural model of the aetiology of FSS and a psychological treatment approach based on the model, are outlined. The practical details of treatment are described.

Cognitive Behavioral Therapy↗
PubMed1992

Psychological factors in patients with non-specific abdominal pain acutely admitted to a general surgical ward.

Non-specific abdominal pain is the commonest reason for acute admission to a general surgical ward. The present study assessed the importance of specific symptom patterns, psychological and behavioural factors in a group of acute admissions and compared patients with appendicitis with those with no specific diagnosis. Psychiatric symptoms were no more prominent than in subjects with appendicitis as measured by psychological rating scales. Patients with non-specific abdominal pain had a poor symptomatic prognosis with continuing use of medical services. NSAP is best seen as a behavioural syndrome with repeated consultation over a long period before and after the index admission for both abdominal and other non specific symptoms.

Abdomen, Acute↗
PubMed1992

The outcome of unexplained dyspepsia. A questionnaire follow-up study of patients after endoscopy.

Ninety-three consecutive patients referred to a gastroenterology unit with unexplained dyspeptic symptoms were sent a postal questionnaire 6-12 months after endoscopy. It inquired into their current physical symptoms and subjective improvement since investigation, satisfaction with treatment, past history and current psychological well-being. A comparison group of 47 patients with peptic disease were similarly surveyed. Those with unexplained dyspepsia reported more current physical symptoms, more dissatisfaction with their treatment and less subjective improvement than those with peptic disease. The two groups were similar in terms of psychological distress but previous consultation for abdominal and other somatic complaints were more common in those with unexplained dyspepsia. The implications for management of dyspeptic patients are discussed.

Adult↗
PubMed1991

Use of psychiatric services by patients in a general hospital.

OBJECTIVE: To identify physical disorders associated with increased rate of use of psychiatric services. DESIGN: Retrospective analysis of routine abstracts of general hospital inpatient records linked with those of psychiatric care, for inpatients with physical disorders with possible psychiatric associations and for controls. SETTING: Oxfordshire health district. SUBJECTS: Inpatients aged 15-64 years discharged from general hospitals during 1975-85 with a diagnosis among 14 selected diagnostic groups (including potentially life threatening conditions, chronic disabling diseases, and non-specific symptomatic conditions) and control inpatients with acute conditions. MAIN OUTCOME MEASURES: Observed and expected numbers of patients receiving psychiatric care. RESULTS: Observed use of psychiatric services before and after index admission was close to that expected for controls. For most other diagnoses the observed use was significantly increased in the year preceding and that subsequent to the admission. For four diagnostic groups it was significantly greater in the year after admission than in that before (acute myocardial infarction (ratio before to after 2.17, 95% confidence interval 1.5 to 3.3), cancer (2.05, 1.7 to 2.5), diabetes mellitus (1.89, 1.4 to 2.9), and chest pain (1.78, 1.3 to 2.4)). During four years after the admission the use of psychiatric services was significantly higher than in the general population for nonspecific symptomatic conditions (observed/expected: abdominal pain 1.7, chest pain 2.0, and headache 4.2), cirrhosis of the liver (10.4), and fractures in road accidents and other fractures (1.3, 1.6). CONCLUSIONS: More patients with certain physical conditions used psychiatric services. Alternative methods of service delivery may be needed, especially for disabling chronic physical illness, alcohol related disorders, and non-specific symptomatic conditions.

Adolescent↗
PubMed1991

The effects of road traffic accidents on driving behaviour.

Questionnaires about the effects of accidents on subsequent driving behaviour were sent to 869 people admitted consecutively to a general hospital as a result of involvement in road traffic accidents 4-6 years previously. There were 418 (48 per cent) replies, 67 per cent of delivered questionnaires. One-fifth of the motorcyclists had stopped using a motorcycle. Nearly one-half the motorcyclists and vehicle drivers reported that they now drove more slowly and that they were more cautious. A considerable proportion of replies described emotional distress, avoidance and limitation of activities. Lack of confidence in driving was common immediately after the accident. After 4-6 years, one-third of respondents reported that they still suffered specific anxiety about the place of the accident and about situations similar to the accident. Many people were anxious about being passengers. The findings have implications for road safety, for the recognition and management of a common, and often disabling, clinical problem, and for the assessment of disabilities in medical reports for compensation proceedings.

Accidents, Traffic↗
PubMed1991

Cardiac failure: symptoms and functional status.

The associations between exercise capacity, symptoms and specific aspects of quality of life were examined in subjects participating in a trial of the treatment of heart failure. Patients were assessed on entry and after three months treatment. The principle symptoms were fatigue, breathlessness and chest pain. These limited the extent and speed of physical activities, restricted social, leisure and family life and were associated with emotional distress. There were associations between baseline exercise capacity and measures of quality of life. Change in exercise capacity during three months treatment was correlated with changes in measures of symptoms, limitation of activity and quality of life. The findings confirm the value of change in exercise capacity as a measure of functional status and suggest that it should be supported by a limited number of specific measures of quality of life.

Activities of Daily Living↗
PubMed1991

Psychosocial factors and admission for poor glycaemic control: a study of psychological and social factors in poorly controlled insulin dependent diabetic patients.

Psychological and social factors were investigated in 89 poorly controlled insulin-dependent diabetic admissions matched with out-patient controls. Those admitted were found to suffer greater current and past psychiatric morbidity, to report more social problems and chronic difficulties and to experience more life events in the six months before interview. The occurrence of significantly more independent events and chronic difficulties among admissions suggests that social stress can lead to poor control. These results emphasize the importance of global assessment of diabetic admissions to include psychological and social aspects as well as medical status.

Adolescent↗