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Biomedical subjects

R Mayou

Publications and source records attributed to R Mayou.

At least 91 records · Page 5Linked to original sources

Quality of life after coronary artery surgery.

Seventy-nine men were assessed using standard interview procedures before and at three and 12 months after coronary artery surgery. At one year, the majority reported relief of angina and reduced difficulty in performing everyday activities, but there was considerable individual variation in changes in quality of life. Overall, there were improvements in mental state, leisure activity, satisfaction and family life, but few benefits for work and sexual relations. For a fifth of patients global quality of life was no better or was worse than before surgery and this poor outcome was not closely related to physical state. Patients who described psychological symptoms or had a 'passive' approach to their illness before operation were less likely to have a good outcome. It is probable that the benefits of surgery could be substantially increased by provision of better facilities including simple individually planned preparation and rehabilitation. The study demonstrates that specific interview based ratings can be used to quantify changes in those aspects of quality of life which are most important to patients and their families.

Angina Pectoris↗

Psychiatric disorder in medical in-patients.

Four hundred and fifty-three general medical in-patients were screened for mood disorder (anxiety and depression), organic mental states and alcohol problems. Using the Present State Examination, affective disorder was identified in 14.6 per cent, being especially common in younger women. Organic psychiatric disorder was very common in the elderly, occurring in 31 per cent of those over 70 years, and 18 per cent of men and 4 per cent of women admitted to a drink problem. Mood disorder was not related to the type or severity of physical illness, but was significantly associated with previous psychiatric history and social problems. Two-thirds of those with mood disorder on admission who were still alive four months after discharge were improved. House officers and family doctors identified approximately half the cases of depression and anxiety, but house officers were no more likely to recognise the more severe cases than the milder ones. Organic psychiatric disorder was often missed, alcohol problems less so.

Adolescent↗

Hospital doctors' management of psychological problems.

Psychological and social difficulties are common amongst both medical and surgical patients, but psychiatrists are able to see only a very small proportion, and though hospital doctors have the main responsibility for psychological treatment, very little is known of what they actually do. Physicians and surgeons in Oxford answered a questionnaire on their attitudes and clinical practice: virtually all believed that emotional care is important, but what they do and what they would like to do in the assessment, treatment, and referral of their patients varied widely. There were associations with the extent of responsibility for chronic care, speciality, and seniority.

Antidepressive Agents↗

Psychiatric disorder in the general hospital.

There have been many reports of psychiatric disorder in medical populations, but few have used standard methods on representative patient groups. Even so, there is consistent evidence for considerable psychiatric morbidity in in-patient, out-patient and casualty department populations, much of which is unrecognised by hospital doctors. We require a better classification of psychiatric disorder in the general hospital, improved research measures, and more evidence about the nature and course of the many different types of problem so that we can provide precise advice for their management of routine clinical practice.

Alcoholism↗

Prediction of emotional and social outcome after a heart attack.

Data from two prospectively studied series of patients recovering from heart attacks (n = 129 and 100) were analysed to determine the extent to which early findings can predict later psychological and social outcome. Some aspects of early and late outcome can be predicted with modest accuracy by multiple regression analysis of information obtained during the acute hospital admission. More accurate, and therefore clinically more useful, prediction of late outcome is possible in early convalescence. It is suggested that systematic clinical assessment during admission and a few weeks after return home could detect most patients in need of extra specialist rehabilitation.

Convalescence↗

Management of neurotic problems in general practice.

Very little is known of how general practitioners assess and treat psychological problems, which make up a substantial proportion of consultations. Sequential case histories were used as a basis for interviews with 20 experienced doctors. There was considerable agreement about diagnosis but wide variation in treatment. It is argued that clarification of precise strategies could be a basis for evaluation and improved care.

Adult↗

The course and determinants of reactions to myocardial infarction.

The growth of speculative theories about response to physical illness has not been backed by quantitative information. The introduction of standardized measures of psychological and social adjustment has allowed description and analysis of disability for 100 patients and their spouses two and twelve months after a first myocardial infarction. (1) Global measures of social outcome were found to be inadequate and misleading and therefore work, leisure, marriage and family relationships, sex and compliance were separately examined. (2) There was considerable continuity in individual reactions throughout convalescence and it was possible (3) to identify factors in the premorbid psychosocial state predictive of outcome and (4) to describe characteristic patterns of coping. (5) Outcome for spouses can be similarly described and understood. The findings have clinical applications for diagnosis, prophylaxis, treatment and the evaluation of medical care. The conclusion also extend our understanding of the basic principles underlying response to physical illness.

Adult↗

The psychological and social effects of myocardial infarction on wives.

Eighty-two wives of men suffering a first myocardial infarction were interviewed while their husbands were in hospital, and again two months and a year after they went home. The wives had substantial and persistent psychological symptoms, and the husbands' illness had continuing effects on their work, leisure and social activities, and family life and marriage, their psychosocial disability being comparable to that of the patients. Measures of psychosocial adjustment before the illness and the quality of the marriage and of family life were good predictors of outcome for the wives. The women had a major role in the patients' readjustment during convalescence, and their attitudes and behaviour as well as the general quality of family life were important determinants of the rate and extent of the patients' recovery. The wives of patients with myocardial infarction should have more practical help and advice during the hospital period, and the whole family should be given advice and help throughout the convalescence.

Activities of Daily Living↗

Psychiatric decision-making by medical students.

Analysis of medical students' formulations and replies to clinical problems indicates difficulty in deciding on the nature and organization of treatment. A programme describing a problem-solving approach was devised, and students taught in this way were shown to be significantly more able to formulate organized treatment plans with more precise aims. It is suggested that problem-solving methods are likely to be much more effective than conventional teaching of psychiatry.

Decision Making↗