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PubMedDate not supplied

Types of psychological reactions in patients with lower-extremity amputations.

The aim of this study was to establish types of psychological reactions and conditions in patients with lower-extremity amputations. Apart from using psychological interviews, detection was performed using psychometric tests: Minnesota Multiphasic Personality Inventory and Beck Depression Inventory. Psychometric parameters were analyzed in a group of 20 examinees treated at the Medical Rehabilitation Clinic in Novi Sad. Out of the whole sample, 45% of patients presented with adaptive reactions to amputation and consequent disability, whereas 55% presented with maladaptive responses. The registered psychopathological symptoms included nosologic categories: reaction to stressful events and adjustment disorder (predominantly affecting other emotions; mixed disorder of conduct and emotions; prolonged depressive reaction) and dysthymia. When working with lower-extremity amputees, apart from adaptive, nonpathological forms of behavior, one also encounters maladaptive responses with predomination of mood disorders due to severe somatic stress.

Adaptation, Psychological↗
PubMed1992

MMPI-ER two-point codes of industrially injured Hispanic workers by DSM-III--R diagnosis.

The purpose of this study was to describe the MMPI-ER two-point codes of 492 Hispanic adults who had sustained work-related injuries and who had applied for workers' compensation benefits. More specifically, the focus was on whether there are unique MMPI two-point codes for Hispanic workers with three specific types of DSM-III--R diagnoses--adjustment disorder, anxiety disorder, and major depression. Analysis suggests that psychiatric condition or diagnosis may act as a moderator variable in Hispanic persons' MMPI performance, including MMPI two-point codes.

Accidents, Occupational↗
PubMed1992

Fear of future illness, chemical AIDS, and cancerphobia: a review.

A review of the literature indicates that fear of future illness shares many characteristics with a wide variety of conditions. Concepts such as hypochondriasis, adjustment disorders, generalized anxiety, and mass hysteria must be considered. Also, factors such as reporting bias, influential others, collective behavior, political groups, and litigation appear to induce symptom reporting from patients complaining of fear of illness and cancerphobia. Cancerphobia may result in impairment ranging from avoidance behaviors to cognitive dysfunctions. Various treatment modalities have been used successfully in treating cancerphobia, and the prognosis is typically good. Complaints of chemical AIDS, universal allergy, or twentieth century disease have little medical or empirical support and require further investigation. Researchers and clinicians must recognize multiple factors contribute to fear of future illness or cancerphobic complaints, and additional research must be undertaken if a thorough understanding of fear of future illness, cancerphobia, and perceptions of chemical AIDS is to be obtained.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Consultation-liaison psychiatry in obstetrics and gynecology.

Data documenting the activity of Modena and Reggio Emilia University Hospital Consultation-Liaison Psychiatry Psychosomatic Service (C-LPPS) to the 59 bed gynecological-obstetric unit are compared to the corresponding European Consultation Liaison Workgroup (ECLW) study results and discussed in the light of recent epidemiological studies suggesting a low rate of detection and psychiatric referral in obstetric and gynecological patients. All psychiatric consultations of gynecological-obstetric inpatients during a 3-year (1996-1998) period were included in this study and data were derived from valid and reliable consultation forms tested for reliability. Within the 3-year period 55 patients were referred to C-LPPS by the gynecological-obstetric unit for psychiatric consultation. Referral rate was 0.5% of the admitted patients in the unit. The gynecological-obstetric group represented 2.5% (vs. 4.5% ECLW study) of all psychiatric consultations requested in the study period. The most frequent reasons for referral were: current psychiatric symptoms (47.3% Modena study vs. 39% ECLW), psychiatric history (20% vs. 7.3%), unexplained physical symptoms (12.7% vs. 16.2%) and coping-compliance problems (3.6% vs. 16.6%). The most common ICD-10 psychiatric diagnoses were: neurotic, anxiety and adjustment disorders (41.8% vs. 31.2%), mood disorders (29% vs. 18.4%), personality disorders (7.3% vs. 6.1%), schizophrenic and other psychotic disorders (5.5% vs. 7%).

Adult↗
PubMed1994

Denial of pregnancy: obstetrical aspects.

Between 1987 and 1990 27 women were observed who professed they did not know they were pregnant until term or until premature contractions set in. The aim of this study was to evaluate obstetric history and pregnancy outcomes and assess defence mechanisms and coping strategies which contribute to negation of pregnancy. In 11 women pregnancy was denied until delivery, five of these had breech presentations. In nine women denial ended between 27 and 36 weeks and in seven women between 21 and 26 weeks of gestation. Three of the four fetal deaths that occurred and two of the three cases of prematurity occurred in the last group. There was no infanticide but one woman delivered her infant alone and concealed. Most women reported irregular, sometimes menstruation-like bleedings during pregnancy, three women had taken oral contraceptives during pregnancy. Few women reported actual symptoms of pregnancy, such as nausea and weight gain. Denial of pregnancy is a heterogeneous condition with different meanings and different psychiatric diagnoses in different women. Stressors (e.g. separation from partner, interpersonal problems etc.) do play an important role as precipitating factors for the development of an adjustment disorder with maladaptive denial of pregnancy. There is a fluid transition between conscious coping strategies and unconscious defence mechanisms.

Adult↗
PubMed1994

Detection of psychiatric morbidity in gynecology patients by two brief screening methods.

Psychiatric morbidity was studied in 100 women attending gynecological outpatient and inpatient set-ups using two brief screening instruments: the General Health Questionnaire, 12 items, and the Present State Examination, ten short questions. Psychiatric morbidity was detected in 36% and was found to be higher in women with uterine prolapse and infections but not in those with menstrual irregularities (p < 0.001). The commonest psychiatric symptoms detected in this population were worrying (50%), aches and pains (51%), depression (50%) and disturbances of biological function (51%). The commonest diagnoses were neurotic depression (70%) and adjustment disorders (23%). The screening instruments used were found to be simple, sensitive, specific, with high identification indices and easy to administer.

Adult↗
PubMed1993

Clinical correlates of self-mutilation among psychiatric inpatients.

The charts of 660 consecutive admissions to a university psychiatric hospital were examined. After excluding those with mental retardation, 32 patients who had mutilated themselves and 88 patients admitted for unsuccessful suicide attempts were identified. Women were significantly overrepresented among the mutilators, but the groups did not differ with respect to age. Most analyses were restricted to women, of whom 27 were self-mutilators and 51 were nonmutilating suicide attempters. Mutilators were less likely to receive diagnoses of major depression or adjustment disorder but were more likely to have a history of substance abuse and receive Axis II diagnoses. The mutilative behavior was generally repetitive. The most common form was superficial cutting of the arms and wrists. Reports of lifetime sexual or physical abuse were more common among mutilators. Mutilators also had frequent histories of suicide attempts distinct from their mutilation behavior, multiple hospitalizations, and transfer to state hospitals for longer-term care. These findings suggest a chronic course with significant morbidity and associated features which may be of clinical significance.

Adult↗
PubMed2003

Psychological, neuropsychological, and electrocortical effects of mixed mold exposure.

The authors assessed the psychological, neuropsychological, and electrocortical effects of human exposure to mixed colonies of toxigenic molds. Patients (N = 182) with confirmed mold-exposure history completed clinical interviews, a symptom checklist (SCL-90-R), limited neuropsychological testing, quantitative electroencephalogram (QEEG) with neurometric analysis, and measures of mold exposure. Patients reported high levels of physical, cognitive, and emotional symptoms. Ratings on the SCL-90-R were "moderate" to "severe," with a factor reflecting situational depression accounting for most of the variance. Most of the patients were found to suffer from acute stress, adjustment disorder, or post-traumatic stress. Differential diagnosis confirmed an etiology of a combination of external stressors, along with organic metabolically based dysregulation of emotions and decreased cognitive functioning as a result of toxic or metabolic encephalopathy. Measures of toxic mold exposure predicted QEEG measures and neuropsychological test performance. QEEG results included narrowed frequency bands and increased power in the alpha and theta bands in the frontal areas of the cortex. These findings indicated a hypoactivation of the frontal cortex, possibly due to brainstem involvement and insufficient excitatory input from the reticular activating system. Neuropsychological testing revealed impairments similar to mild traumatic brain injury. In comparison with premorbid estimates of intelligence, findings of impaired functioning on multiple cognitive tasks predominated. A dose-response relationship between measures of mold exposure and abnormal neuropsychological test results and QEEG measures suggested that toxic mold causes significant problems in exposed individuals. Study limitations included lack of a comparison group, patient selection bias, and incomplete data sets that did not allow for comparisons among variables.

Adult↗
PubMed2003

The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals.

The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.

Deinstitutionalization↗
PubMed1995

Implantable cardioverter-defibrillators: implications for the nonelectrophysiologist.

PURPOSE: To review clinical scenarios in which nonelectrophysiologist physicians may interact with patients who have implantable defibrillators. DATA SOURCES: Peer-reviewed original articles and reviews addressing aspects of implantable defibrillator therapy that are relevant to the clinician. DATA SYNTHESIS: The capacity of implantable defibrillators to recognize and treat tachyarrhythmias can be temporarily disabled by placing a magnet on top of all devices. General surgery, radiotherapy, lithotripsy, and electroconvulsive therapy can usually be safely done under continuous electrocardiographic monitoring in patients with implantable defibrillators. The device should be deactivated before the procedure is done and reactivated and reassessed immediately afterward. Magnetic resonance imaging is usually contraindicated in patients wit implantable defibrillators. The presence of an implantable defibrillator should not deter standard resuscitation techniques. Multiple defibrillator discharges in a short period of time represent a serious problem. Causes of multiple discharges include ventricular electric storm, inefficient defibrillation, nonsustained ventricular tachycardia, and inappropriate shocks caused by supraventricular tachyarrhythmias or oversensing of signals. These patients should be initially evaluated in a setting that allows electrocardiographic monitoring and cardiac resuscitation. The defibrillator should be deactivated if inappropriate firing is documented. Infections of implantable defibrillator systems are potentially life-threatening, and empiric oral antibiotic therapy should never be given when this possibility exists. Adjustment disorders specific to the defibrillator, including anxiety with secondary panic reaction; defibrillator dependence, abuse, or withdrawal; and imaginary shocks are not uncommon. CONCLUSIONS: Defibrillator therapy has become increasingly popular and complex. A basic understanding of these devices and skills in the short-term management of device-related problems is valuable for most physicians. These management guidelines will facilitate delivery of optimal care when specialized staff and material resources are not available.

Cardiopulmonary Resuscitation↗
PubMed1999

[Severe pediatric psychiatric problems in a Danish county. Admitted patients during a 10-year period in the county of Funen].

This retrospective case record describes all the child psychiatric in- and day-patients in one Danish county in the period 1978-1987. A total of 148 patients (18% of all the child psychiatric patients) was treated as in- or day-patient. Sixty-two percent were boys, with a mean age of 8.1 years, the mean-age for girls was 9.0 years. Adversities in the family appear to be great in this population. The families had experienced broken homes (44% of the inpatients vs 29% of the daypatients), parental death (18% vs 9%) and/or parental mental illness (21% vs 15%). The diagnoses and the treatment modalities agree well with investigations from other Nordic countries. Neurosis infantilis (19% vs 9%) and anorexia nervosa (18% vs 0%) are more common among inpatients, whereas adjustment disorder (18% vs 32%) is more common among daypatients. The treatment modalities include parent-guidance, psychotherapy, dyadic relationship and pharmacotherapy. At discharge 18% of the inpatients and 6% of the daypatients were placed in institutions and 12% and 4% respectively in foster families, and respectively 38% and 42% needed to be moved from an ordinary school to a specialized school. There is a need for documentation of the effectiveness of inpatient and daypatient treatment.

Adolescent↗
PubMed1999

A clinical study of 100 new admissions to an adolescent psychiatric inpatient unit in Singapore.

BACKGROUND: Psychiatric inpatient services for children and adolescents in Singapore began in 1982 when Woodbridge Hospital started the Child and Adolescent Inpatient Unit. To date, this is the only unit with specialised facilities and staff in the management of young patients. Admissions were mainly based on a need for custodial management of acute major behavioural disturbances. Patients were discharged for outpatient treatment once these behaviours subsided. METHODS: This is a retrospective clinical study of 100 consecutive new patients admitted from April 1993 to August 1994. RESULTS: Majority of admissions (92%) were adolescents above age 12, who were either attending secondary or vocational school. Most came from nuclear families. Forty-eight percent of referrals were intradepartmental. Ten percent were from general hospitals with 16% as self referrals. Psychoses accounted for the diagnosis in 43%, schizophrenia being the main type. Neurosis and adjustment disorders formed the other main diagnoses. All patients received individual and family treatment. Liaison with schools was required in a third of the cases. Sixty-one percent received pharmacological treatment. Ninety-one percent were discharged home after a stay of less than 3 months. Majority returned to school upon discharge from the hospital. CONCLUSION: The main criteria for admission in this unit, located in an adult psychiatric hospital, is that of custody of young patients with disturbed and unmanageable behaviour. This provides additional stigma for the admissions of young patients with minor psychiatric problems and interferes with comprehensive care including admission required for some adolescents with psychiatric problems.

Adolescent↗
PubMedDate not supplied

[Evaluating the quality of life of 42 heart transplant patients and candidates: a cross-sectional study].

OBJECTIVE: Although evaluation of heart transplant candidates and recipients is usually based on objective clinical variables, self-assessment has been proved to be an important component of treatment evaluation. Quality of life is a multidimensional concept, a mix of objective and subjective measures, that could reflect the adjustment to the illness and its treatment. Few studies have reported on quality of life in heart transplantation candidates. This exploratory study, conducted in Bordeaux (France), was designed to assess both objectively and subjectively the quality of life in heart transplant candidates and recipients and to determine the relationships between subjective and objective variables. METHOD: The assessment was cross-sectional; 21 candidates evaluated at an average of 10 (Sd 21.4) months into the waiting period, were matched with 21 recipients at 29.5 months post operative. Subjective evaluation of the quality of life was self-assessed by the Tableau d'évaluation assistée de la qualité de la vie (TEAQV) and the Nottingham Health Profile (NHP). A semi structured psychiatric interview, and the NYHA (New York Heart Association) cardiac insufficiency score provided objective measurements. RESULTS: The NHP and TEAQV mean scores were not not significantly different between the two groups: candidates (C) and recipients (R) reported similar subjective data regarding positive quality of life experience. The objective data indicated significant disadvantages for the candidate group: the cardiac insufficiency score was worse in the candidates [(NYHA mean score: (C) = 2.7 Sd 0.56 vs (R) = 0.7 Sd 0.8, t de Student p < 0.01)] and the DSM III-R axis 1 diagnoses were more frequent in the candidates [(C) = 16/21 vs (R) = 9/21 Chi2 p < 0.05)]. There was a prevalence of adjustment disorders in the candidates. Significant correlations were found between NYHA and NHP mean scores (r = 0.6, p < 0.01) and NYHA and physical and psychological dimensions of the TEAQV (r = -0.65 and r = -0.55, p < 0.01) in the recipient group. In the candidate group, no correlation was found between these scores. CONCLUSION: In the recipient group, objective and subjective assessment showed greater concordance than in the candidate group. Despite more objective physical and moderate yet frequent psychiatric complications, the candidate group reported as positively as did the recipients upon the quality of their life experience. This could be the result of psychological adaptation to the stressful situation. These data were in accordance to several earlier reports. However, the literature has remained controversial upon the evaluation of the quality of life of the candidates. The results of this study, limited by some methodological bias (the small number of patients assessed), need to be confirmed in a prospective study.

Adaptation, Psychological↗
PubMedDate not supplied

Regional cerebral glucose metabolism of patients with malignant diseases in different clinical phases.

BACKGROUND: Psychological and psychiatric aspects of cancer patients have not been studied well in terms of functional neuroimaging. The aim of this pilot study was to investigate the relationship between regional cerebral metabolism and different clinical phases. MATERIAL AND METHODS: Relative cerebral glucose metabolism of 77 Japanese patients with various types of malignant diseases was studied by positron emission tomography with 18F-fluorodeoxyglucose. They were subgrouped into the 1) pre-treatment, 2) post-treatment, 3) recurrence and 4) terminal patient groups. These subgroups were compared to the control group of 17 in-patients with benign diseases, using voxel-based Statistic Parametrical Mapping software (SPM). RESULTS: Relative reduction in the regional cerebral metabolism was detected in the prefrontal and basolateral (inferolateral) prefrontal cortex, orbitofrontal cortex, anterior and posterior cingulate gyrus, insula, basal ganglia, hippocampus and thalamus in the pre-treatment group. The anterior and posterior cingulate gyri were hypometabolic only in the pre-treatment group. Hypometabolic areas were detected only in the basolateral prefrontal cortex, orbitofrontal cortex, ventral part of cingulate gyrus and insula in the post-treatment group. In the terminal group, the hypometabolic pattern seemed very close to that in the pre-treatment group. The results seemed to suggest that hypometabolic findings before treatments could reverse after treatments but became prominent again in terminal stages. These results do not contradict with previous epidemiological findings that high incidence of adjustment disorders was seen in earlier stages and more brain organic syndromes were seen in terminal stages. CONCLUSION: It could be speculated that decreased metabolism in early stages reflects state-dependent changes and that decreased metabolism in the terminal stages reflects organic brain damages. brain of cancer patients show a fluctuation in the regional metabolism. This finding might give a suggestion that functional imaging could be used as a supplementary method for psychological evaluation of patients with severe diseases.

Brain↗
PubMed2001

[Psychological intervention during pregnancy. A multidisciplinary hospital network].

INTRODUCTION: Pregnancy and the puerperium are vulnerable periods in every woman's life. It is important to catch and treat signs of mental distress so as to prepare the woman for her approaching delivery, to optimize her role as a mother, and to prevent development of severe psychopathology. We describe a professional network (midwife, obstetrician, psychologist, and child psychiatrist) at a Danish county hospital, which offers the pregnant woman psychological therapy and/or psychiatric treatment when needed. MATERIAL AND METHODS: The study includes a retrospective analysis of 106 consecutive referrals from the department of obstetrics to the department of psychiatry in the period 1994-1999. The variables were frequency and reason for referral, the diagnostic profile according to ICD-10, the number of therapeutic sessions, and registration of pregnancy/birth complications (PBC). RESULTS AND DISCUSSION: Anxiety and crisis reactions owing to previous PBC, family problems, and concerns about the fetus were the predominant reasons for referral. A total of 87% met the ICD-10 criteria for adjustment disorder (F 43.2), whereas psychotic disorders were infrequent. In 52%, 1-4 sessions were sufficient to stabilise the condition. The frequency of PBC in the 106 women was significantly higher when compared to the background sample (n = about 15,000). The establishment of an effective network is recommended for pregnant women suffering from mental distress in order to prepare her for the approaching delivery, to optimise her forthcoming role as a mother, and to prevent development of severe psychopathology.

Denmark↗
PubMed2002

An instrument for assessment of depression among spinal cord injury patients: comparison between the CES-D and TDI.

OBJECTIVE: To search for a simple, practical and appropriate instrument for the assessment of depression among Thai SCI patients: comparison between two self-rating instruments. MATERIAL AND METHOD: Eighty-three SCI patients were asked to complete a questionnaire composed of the Thai depression inventory (TDI) and the Center for Epidemiological Studies Depression Scale (CES-D), Thai version. All subjects were interviewed by a psychiatrist and were diagnosed according to the categories of depression of the Diagnostic and Statistical Manual of Mental fourth edition, (DSM-IV). STATISTICS: Receiver Operating Characteristic (ROC) curve and Logistic regression analysis. RESULTS: Twenty patients were confirmed to have a depressed mood or adjustment disorder. The area under the ROC curve for the CES-D and TDI was 0.826 and 0.827. The sensitivities and specificities of the CES-D and TDI were 80.0, 69.8 per cent and 70.0, 79.4 per cent respectively. The positive predictive value and negative predictive value of the two tests were 45.7, 91.7 per cent and 51.9, 89.3 per cent. Using Logistic regression analysis, the CES-D produces a better model than the TDI (Chi-square value = 23.196 and 4.578). CONCLUSION: The CES-D is more appropriate for screening for depression in SCI patients than the TDI.

Adult↗
PubMed1992

Psychiatric hospitalization: treatment or triage?

We examined the outcome of active duty psychiatric inpatients (N = 101) 2 years after admission. Most patients were young with minor diagnoses (adjustment disorders), yet only 20% were still on active duty 2 years later. This compared poorly with national retention rates for all lengths of time in service (p < 0.0001). Longer time in service and low severity of diagnosis predicted a better outcome. We discuss implications of these findings.

Female↗
PubMed1992

Youth suicides unknown to psychiatric care providers.

Less than 50% of young suicides have consulted psychiatric care providers. Thus the population not found within the psychiatric care sector is described in this paper. Fifty-eight consecutive suicides among adolescents and young adults, studied by psychological autopsies, were classified according to presence or absence of previous psychiatric care. Fifteen of the sixteen subjects without previous care were males, six of these were diagnosed as having an adjustment disorder related to a recent event. Unemployment was less common (p < 0.01), the suicidal processes were shorter (p < 0.001), and previous parasuicide was less frequent (p < 0.001) among nonpatients. Evaluation in accordance with DSM-III-R criteria showed fewer substance abuse disorders (p < 0.01). Open suicidal communication prior to the suicide was less frequent but active methods were used by this population as often as by subjects known to care providers.

Adolescent↗