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PubMed2005

Employment status in chronic fatigue syndrome. A cross-sectional study examining the value of exercise testing and self-reported measures for the assessment of employment status.

OBJECTIVE: To examine the value of exercise testing and self-reported disability for the assessment of employment status in patients with chronic fatigue syndrome. DESIGN: Cross-sectional observational study. SETTING: A university-based chronic fatigue clinic. SUBJECTS: Fifty-four consecutive, Flemish, employed (not self-employed) chronic fatigue syndrome patients (49/54 female). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were questioned about their current and premorbid employment status, filled in the Chronic Fatigue Syndrome Activities and Participation Questionnaire (CFS-APQ), the Medical Outcomes Short Form 36 Health Status Survey (SF-36), and performed a maximal exercise test on a bicycle ergometer with continuous monitoring of cardiorespiratory variables. RESULTS: A significant association was observed between the current employment rate and two SF-36 subscales (i.e., role limitations due to physical functioning and social functioning; rho = 0.39 and 0.35 respectively) (n = 54). Analysing only the female chronic fatigue syndrome patients (n = 49), the current employment rate correlated significantly with the peak workload (rho = 0.38). CONCLUSIONS: The associations between either exercise testing or self-reported disability and employment status are too weak to predict employment status.

Adolescent↗
PubMed2006

Comorbid substance use and age at onset of schizophrenia.

BACKGROUND: Substance use may be a risk factor for the onset of schizophrenia. AIMS: To examine the association between substance use and age at onset in substance use and age at onset in a UK, inner-city sample of people with recent-onset schizophrenia. METHOD: The study sample consisted of 152 people recruited to the West London First-Episode Schizophrenia Study. Self-reported data on drug and alcohol use, as well as information on age at onset of psychosis, were collected. Mental state, cognition (IQ, memory and executive function) and social function were also assessed. RESULTS: In total, 60% of the participants were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use (not including alcohol), and 68% reported lifetime substance use (cannabis and psychostimulants were most commonly used). Cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs. CONCLUSIONS: The strong association between self-reported cannabis use and earlier onset of psychosis provides further evidence that schizophrenia may be precipitated by cannabis use and/or that the early onset of symptoms is a risk factor for cannabis use.

Adolescent↗
PubMed1992

Impact of dyspnea and physiologic function on general health status in patients with chronic obstructive pulmonary disease.

STUDY OBJECTIVE: To examine the relationship among clinical dyspnea ratings, physiologic pulmonary function, and general health status in symptomatic patients with chronic obstructive pulmonary disease (COPD). DESIGN: Observational data collected at a baseline state. SETTING: Outpatient pulmonary disease clinics at a university hospital and two VA medical centers. PATIENTS: One hundred ten male patients with COPD with no significant comorbidity were recruited. MEASUREMENTS AND RESULTS: Clinical ratings of dyspnea were measured by the multidimensional baseline dyspnea index (BDI). Pulmonary function tests included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and maximal inspiratory mouth pressure (PImax). General health status was assessed with the Medical Outcomes Study short-form survey, which consists of 20 questions that cover six health components. The mean age of the patients was 67 +/- 8 yr (+/- SD). The mean value for FVC was 2.84 +/- 0.84 L (68 +/- 18 percent of predicted), for FEV1 was 1.28 +/- 0.59 L (44 +/- 17 percent of predicted), and for PImax was 59.0 +/- 25.0 cm H2O. The BDI score and PImax were significantly correlated with five of the six components of general health status. Only three of the six components of general health were significantly correlated with FEV1 as percent predicted (rs value range, 0.30 to 0.44) and with FVC as percent predicted (rs value range, 0.25 to 0.33). Statistical comparisons showed that the BDI score had significantly higher correlations than FVC (percent predicted), FEV1 (percent predicted), and PImax values with physical functioning and role functioning. Multiple linear regression analysis showed that the BDI score was the only statistically significant predictor of role functioning, mental health, and health perceptions for general health status, whereas both the BDI score and FEV1 (percent predicted) were independent predictors of physical functioning and social functioning. CONCLUSION: Dyspnea ratings influence and predict general health status to a greater extent than do physiologic measurements in symptomatic patients with COPD. A shift in focus from the pathophysiology of disease to assessment and relief of symptoms may provide more meaningful benefits for the individual patient in terms of quality of life. This consideration requires that health-care providers use available measuring tools in clinical practice to quantify symptoms, as well as overall health status.

Adult↗
PubMed2003

Evaluation of health-related quality of life in low-income patients with COPD receiving long-term oxygen therapy.

STUDY OBJECTIVE: To assess health-related quality of life (HRQL) in a low-income population of patients with hypoxemia and COPD receiving long-term oxygen therapy (LTOT). DESIGN: Cross-sectional study. SETTING: Large, tertiary care, university teaching hospital. PATIENTS OR PARTICIPANTS: Thirty-six patients with COPD requiring LTOT (mean age, 63.5 years; mean FEV(1), 32.1% of predicted; PaO(2), 50.2 mm Hg) and 33 control subjects with COPD but no severe hypoxemia (mean age, 63.1 years; FEV(1), 35.7%; PaO(2), 66.5 mm Hg). INTERVENTIONS: Patients underwent pulmonary function testing to assess physiologic function and the degree of respiratory impairment. A baseline dyspnea index (BDI) was used to determine levels of dyspnea, and a 6-min walk test was performed to evaluate physical performance and exercise capacity. The St. George Respiratory Questionnaire (SGRQ) and the Medical Outcomes Study Short-Form 36-item questionnaire (SF-36) were used to assess health status and HRQL. MEASUREMENTS AND RESULTS: The scores on the SGRQ and SF-36 indicated severe impairment. Patients receiving LTOT showed a trend toward worse scores on most dimensions of the SGRQ and SF-36, but differences between groups were only statistically significant for the physical functioning and social functioning dimensions of the SF-36. Dyspnea, as measured by the BDI, significantly correlated with all questionnaire domains except the SF-36 pain index. CONCLUSIONS: The HRQL of these low-income patients with COPD was markedly impaired, with more pronounced impairment in those receiving LTOT. The severity of dyspnea was a significant predictor of various components of quality of life in these patients.

Cross-Sectional Studies↗
PubMed1999

Health-related quality of life in primary care patients with recognized and unrecognized mood and anxiety disorders.

OBJECTIVE: Primary care providers have been criticized for underrecognizing and undertreating mental health disorders. This criticism assumes patients with recognized disorders and those with unrecognized disorders suffer the same burden of illness. This study describes differences in health-related quality of life (HRQOL) in patients with recognized and unrecognized mood and anxiety disorders in a primary care setting. METHODS: A probability sample of 500 adult ambulatory patients from a university-based, family practice clinic, completed the PRIME-MD mood and anxiety disorder modules and the SF-36 Health Survey. Computerized patient records were reviewed retrospectively to determine recognition of mood and anxiety disorders. The Mental Health (MCS) and Physical Health (PCS) Component Summary scales of the SF-36 served as the primary outcome measures. RESULTS: Sub-threshold mood and anxiety disorders were less likely to be recognized by physicians than disorders meeting DSM-III-R criteria. Recognized mood disorders were associated with a significant decrement in MCS scores (poorer HRQOL) compared with unrecognized disorders. In contrast, recognized mood disorders demonstrated slightly higher PCS scores. Recognized and unrecognized mood disorders differed significant ly in physical functioning, vitality, social functioning, role functioning related to emotional state, and mental health. Recognition of anxiety disorders was not related to HRQOL. CONCLUSIONS: Patients with mental health disorders that have been recognized by their health providers appear to suffer from poorer HRQOL than patients whose disorders have not been recognized. This relationship, though, is only apparent for mood disorders. Poorer physical functioning may mask less severe emotional symptoms in mood disorders; profound emotional symptoms make recognition easier.

Adult↗
PubMed2001

Evaluation of the quality of life in Brazilian women with fibromyalgia, through the medical outcome survey 36 item short-form study.

PURPOSE: The purpose of this study is to assess the impact of Fibromyalgia (FM) on the female patient's quality of life who attended the Rheumatology Outpatient Unit of Sorocaba Hospital Complex and compare it to the quality of life of healthy control group, through the Medical Outcome Study Short-form 36 item Survey (SF36). SUBJECTS: 32 women who fitted the American College of Rheumatology Classification Criteria for Fibromyalgia and 28 healthy women. MATERIALS AND METHODS: The groups were submitted to 'Medical Outcome Study 36 Item Short-form Survey' (SF36). This questionnaire is composed of 8 scales about several aspects of the quality of life. RESULTS: The SF36 scales in the Fibromyalgia group presented the following results: general health--43.3; functional ability--39.4; bodily pain--26.5; physical functioning--14.8 (0-75); vitality--38.5 (5-85); emotional functioning--32.2; mental health--44.2; social functioning--45.1. The SF36 scales in the control group presented the following results: general health--73.2; functional ability--86.6; bodily pain--68.9; physical functioning--82.4; vitality--59.6; emotional functioning--78.5; mental health--67.4; social functioning--77.9. Significant statistics variations in all evaluated scales were presented by the survey group. CONCLUSION: Fibromyalgia has had a negative impact on the quality of life.

Adaptation, Physiological↗
PubMedDate not supplied

[The psychopathological symptoms of the preclinical stages of Alzheimer's disease].

The aim of the undertaken studies based on many years' observation of the group of elderly people was to describe psychopoathological pictures typical of preclinical phase of Alzheimer disease (AD) as well as the changes in social functioning. The obtained data were to serve to work out the criteria making initial recognition of preclinical phase of AD possible. Estimation of direct degree--in the perspective of next few years--of the danger of dementia of Alzheimer type should simplify making a decision about including therapeutic activities. 204 persons have completed the five-year-observation (70% of the qualified). During the observation AD has developed at 19 persons, five of the examined at the beginning of the observation were described as "no disturbances of cognitive functions"--I according to the GDS scale and 14 were qualified as "slight impairment of cognitive functions"--GDS II. The basis for further conclusions was the comparison of the results obtained in the groups of people at whom, during the five-year-observation, in the examination with the GDS scale, no changes regarding cognitive functions have been observed, with those examined in whom dementia has been recognised. Statistic analysis has been done mostly for the results obtained before the appearance of the dementia. The conducted studies made it possible to verify the stated hypotheses and draw the following conclusions: preclinical period of AD is connected with intensification of psychopathological disturbances, especially depression; in the period preceding the development of AD usually slight disturbances of cognitive functions appear which are most often revealed during the particular examination of cognitive functions; clear decrease in social activity is typical of the preclinical phase of AD; people in premorbid period showed various disturbances but no symptom has been observed that would be pathognomic for the preclinical phase of AD; it is possible, on the basis of the examination by means of proper clinical scales, to predict the danger of dementia but it is necessary to take into account various elements of psychic state and social functioning.

Aged↗
PubMed2002

The SF-36 general health status survey documents the burden of osteoarthritis and the benefits of total joint arthroplasty: but why should we use it?

OBJECTIVES: To document the disease burden of osteoarthritis and the benefits of total joint replacement by using the Short Form Health Survey (SF-36) general health status survey and evaluate other factors that could affect scores. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: All patients scheduled for primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) (n = 622 preoperatively) in 2 years were surveyed using the SF-36, which assesses health-related quality of life (HRQOL) in patients' physical and social functioning and mental health. Follow-up surveys were administered 12 months after surgery to all patients and 3 and 24 months after surgery to a subset of patients. RESULTS: Preoperatively, patient scores were significantly lower than normative scores in the physical functioning, bodily pain, and social functioning domains. Preoperative scores were not different between THA and TKA patients. Women scored lower than men. Comorbid conditions were weakly associated with low SF-36 scores. Postoperatively, the largest incremental improvement in scores was seen at 3-month follow-up. Scores improved sooner and more substantially in THA vs TKA patients and in men vs women, paralleling improvement in clinical and subjective ratings of postoperative physical function and pain. CONCLUSIONS: The SF-36 has the sensitivity to document improvement in HRQOL after surgery and to reveal differences in THA vs TKA and in men vs women. However, routine use of outcome assessment instruments to monitor this patient population is costly and unjustified in our current healthcare environment.

Aged↗
PubMed2003

[Evaluation of health-related quality of life in dialysis patients. Personal experience using questionnaire SF-36].

INTRODUCTION: Patients' perception of health is an important outcome measure in the assessment of influence of chronic disease and received treatment. The purpose of this study was: 1) to investigate the relation between selected demographic and clinical characteristics and Health-related Quality of Life (HRQoL) scores in patients with end-stage renal disease (ESRD) who receive dialysis, 2) to compare HRQoL in dialysis patients with their peers from the control group, 3) to evaluate the usefulness of SF-36 questionnaire. MATERIAL AND METHODS: We evaluated Health-Realated Quality of Life (HRQoL) of dialysis patients by the Polish version of the Short Form 36 Items Health Survey (SF-36). The SF-36 consists of eight scales: physical functioning (PF), social functioning (SF), role limitation attributable to physical problems (RP), role limitation attributable to emotional problems (RE), mental health (MH), vitality (VT), bodily pain (BP) and general health perception (GH). This study included 97 patients (44 men and 53 women), aged 28-86 years (mean age: 57.2) treated with HD (n = 77) and CAPD (n = 20) for 3-245 months (mean: 61 months). We compared the results with the data obtained from 217 healthy control subjects (105 men and 112 women), aged 20-92 years (mean age 51.1). The patients were divided into four age-groups and compared with the appropriate groups of controls. RESULTS: The perception of health of dialysis patients was worse than that of controls. We have found, that in the group aged over 65 years patients' scores were quite close to those of the control population. Our results show the following patient-connected factors to be independently associated with quality of life (QoL): age, sex, occupation, level of education, family situation and comorbidities. On average, females reported lower scores; the impact of ageing was more evident in physical scales. CONCLUSIONS: 1) age, sex, occupation, level of education, family situation as well as comorbidities are independent factors of HRQoL, 2) subjective QoL of elderly patients seems acceptable in comparison with healthier peers, 3) the SF-36 questionnaire is applicable in dialysis patients and SF-36 scores are related to important clinical aspects.

Adult↗
PubMed1992

[Assessment of health status of the elderly. Application of a Dutch version of the MOS scale].

The 'MOS Shortform General Health Survey', a measure for assessing general health, has been used in an elderly population in the Netherlands (N = 354). The 20-item (mail) questionnaire comprises six dimensions or subscales: physical functioning (6 items), role functioning (2), social functioning (1), mental health (5), health perceptions (5) and body pain (1). Our results show reasonable psychometric properties of the subscales (internal reliability, skewness and kurtosis of distribution, correlation between subscales and correlation with other health measures, 8 weeks test-retest reliability), which are comparable to those in the United States in a general patient population. The six subdimensions of the scale together seem to meet the criteria of the stochastic cumulative measurement model (Mokken-type scale). The results show that this instrument gives an opportunity to assess general health in the elderly within just a couple of minutes.

Activities of Daily Living↗
PubMed2005

[Prevalence and characteristics of different types of homeboundness among community-living older adults].

BACKGROUND: Little is known about the epidemiologic features of different types of homeboundness among the elderly. PURPOSE: This cross-sectional study examined prevalence and characteristics of "type 1" and "type 2" homeboundness (see definitions below) among community-living older adults. METHODS: The subjects comprised all residents aged 65 years and over living in Yoita, Niigata Prefecture, and Hatoyama, Saitama Prefecture. Subject data on sociodemographics, and physical, mental and social functioning were collected through in-person interview. Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3, 4, or 5). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e, levels 3, 4, or 5). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We focused on characteristics of "type 1" and "type 2" homeboundness as compared with those of respective controls, ie., non-homebound persons within the same mobility categories. RESULTS: Out of the eligible subjects (1588 in Yoita, and 1135 in Hatoyama), 1544 and 1002 persons participated in the survey (response rates of 97.2% and 88.3%, respectively). Among the participants, "type 1" and "type 2" homeboundness was found for 4.1% and 5.4%, respectively, in Yoita, and 3.3% and 6.8% in Hatoyama. After adjustment for potential confounders such as age, gender and mobility level, we found a significant regional difference in the prevalence of "type 2" but not of "type 1" (OR of "type 2" for Hatoyama/Yoita 1.44; 95% CI 1.02-2.03). Both types of homeboundness increased with advancing age; "type 1" and "type 2" featured in over 10% of persons aged at least 85 years and 80 years, respectively. Even after controlling for potential confounders, "type 2" showed a higher prevalence with walking disability and incontinence, and reported lower self-rated health, more depressed mood, lower functional capacity and lower social functioning. "Type 1" showed a higher prevalence with fear of falls, but a lower prevalence with basic ADL disability and a high score for Intellectual Activity, indicating reduced self-efficacy. CONCLUSIONS: Prevalence of "type 1" and "type 2" homeboundness among community-living older adults differs depending on the residential area and age of the subjects. A substantial proportion of "type 2" homebound persons are at high risk of functional decline, indicating that "type 2" as well as "type 1" homebound persons need care-preventive programs.

Activities of Daily Living↗
PubMed2005

Urinary symptoms and quality of life changes in Thai women with overactive bladder after tolterodine treatment.

OBJECTIVES: To study the urinary symptoms and quality of life changes in Thai women with overactive bladder (OAB) after tolterodine treatment. MATERIAL AND METHOD: Thirty women (aged 30-77 years) diagnosed as having OAB at the Gynecology Clinic, King Chulalongkorn Memorial Hospital from January to April 2004 were included in the present study. Tolterodine 2 mg, twice daily was given. After 8 weeks treatment, changes in micturition diary variables and tolerability were determined. Short form 36 (SF36) questionaires (Thai version) were given before and after 8 weeks of treatment. RESULTS: At 8 weeks, all micturition per day decreased from 16. 7 +/- 5. 3 to 6. 7 +/- 2.4 times per day. The number of nocturia episodes decreased from 5.4 +/- 4.2 to 1.1 +/- 1.0 times per night. The most common side effect was dry month in 5 cases (16.7%) with 2 cases reporting a moderate degree and 1 case with severe degree. Only one case (3.3%) withdrew from the present study due to a severe dry mouth. The SF-36 scores changed significantly in the domains of physical functioning, role function emotional, social function and mental heath. CONCLUSION: Tolterodine was well tolerated and its effects improved the quality of life in Thai women with OAB.

Adult↗
PubMed1994

[The integrated approach to social reintegration: beyond "case management" and psychosocial rehabilitation].

Recently in western countries mental health systems are, slowly but systematically, adopting case management (CM) as a system of service delivery. Nonetheless, case management remains undefined, poorly described and its characteristics uncharted and unresearched. Social reintegration is a comprehensive model that incorporates strategies of service delivery aimed at solving the problems encountered by CM in the maintenance, enhancement of clients quality of life and social functioning and, social and community acceptance are addressed and issues of costs and collaboration between institutions is explored in depth.

Community Mental Health Services↗
PubMed2002

Functional recovery in pediatric traumatic brain injury during inpatient rehabilitation.

OBJECTIVE: To examine changes in functional status of children with traumatic brain injury by identifying the pattern and amount of change between and within the domains of self-care, mobility, and social function during inpatient rehabilitation and to examine the relationships of age and injury severity to functional recovery. DESIGN: Retrospective descriptive study. Seventy-nine children and adolescents with traumatic brain injury were assessed at inpatient rehabilitation hospital admission and discharge by using the Pediatric Evaluation of Disability Inventory's (PEDI) functional skills and caregiver assistance domains of self-care, mobility, and social function. RESULTS: Admission self-care functional levels were significantly greater than mobility and social function for both PEDI scales. At discharge, significant improvement was noted within all three domains and the amount of change between domains was significantly greater for the mobility domain on both scales. Age was not related to the amount of recovery. Admission functional status was moderately negatively correlated to the change in PEDI scores (ranging from r = -0.432 to -0.681). CONCLUSIONS: Variations exist in the recovery of self-care, mobility, and social function capability and independence during inpatient rehabilitation. Self-care was the least affected. Participants showed significant improvement in all domains, with the most recovery in mobility. Children with greater functional deficits demonstrated greater functional gains.

Activities of Daily Living↗
PubMed2005

What are the effects of group cognitive behaviour therapy for voices? A randomised control trial.

BACKGROUND: Little evidence exists for the effects of psychological treatment on voices even though it is clear that CBT does affect delusions and symptoms overall. This study tested whether a group based on cognitive behavioural principles could produce beneficial effects on hallucinations. AIM: To test the effectiveness of group CBT on social functioning and severity of hallucinations. METHOD: Participants were included if they had a diagnosis of schizophrenia and experienced distressing auditory hallucinations (rated on the PANSS). They were randomly allocated to group CBT (N = 45) or a control group who received treatment as usual (N = 40). The two main outcomes were social functioning as measured by the Social Behaviour Schedule and the severity of hallucinations as measured by the total score on the Hallucinations Scale of PSYRATS. Assessments were carried out at baseline, 10 weeks (post therapy) and 36 weeks (six months following therapy). RESULTS: Mixed random effects models revealed significant improvement in social functioning (effect size 0.63 six months after the end of therapy). There was no general effect of group CBT on the severity of hallucinations. However, there was a large cluster effect of therapy group on the severity of hallucinations such that they were reduced in some but not all of the therapy groups. Improvement in hallucinations was associated with receiving therapy early in the trial and having very experienced therapists (extensive CBT training which included expert supervision for a series of individual cases for at least a year following initial training). CONCLUSION: Group CBT does improve social functioning but unless therapy is provided by experienced CBT therapists hallucinations are not reduced.

Adaptation, Psychological↗
PubMed2003

A statewide evaluation system for early psychosis.

OBJECTIVE: We describe a system of outcome evaluation for early psychosis programmes and present preliminary data. The Early Psychosis Outcome Evaluation System (EPOES) was designed for use in a naturalistic, prospective study of a cohort of early-episode psychosis patients. We describe patients in terms of symptoms, substance use, social functioning and family burden, and examine the effectiveness of treatment programmes. METHOD: Four sites in Perth, Western Australia, participated. Outcome was evaluated from three sources: case manager (CM), patient (P) and family member (FM). Seven clinical outcome measures were used: the Brief Psychiatric Rating Scale (CM), Brief Symptom Inventory (P), Substance Use (CM); Social Functioning Scale (P); Global Assessment Scale (CM); Burden Assessment Scale (FM), and the General Health Questionnaire-12 (FM). Measures were collected at intake (baseline) into a specialist early psychosis service and thereafter every 6 months until discharge from the service. RESULTS: After the first year of data capture, 84 baseline assessments have been completed, and 23 patients have been followed up at 6 months. Clinicians and patients reported significantly less psychopathology at 6 months. Sixty per cent of patients reported marijuana use within 3 months of baseline assessment, and 30% amphetamine, ecstasy or cocaine use. Increased levels of psychopathology were recorded for substance-using patients. Family members (59%) reported psychological distress at baseline; this was reduced at 6 months. Patient social functioning and family burden did not improve measurably. CONCLUSIONS: The EPOES is an effective system that provides feedback on the clinical status of early-episode psychosis patients. Both observed and self-rated psycho-pathology and family psychological distress, is improved after 6 months of intervention. Family burden and patient social functioning did not demonstrate improvement. Patient social functioning is an important area for treatment. Substance use is associated with poorer psychopathology. EPOES provides a feasible system of measuring outcome in early psychosis intervention.

Adult↗
PubMed2000

Reboxetine: its effects as measured by the Social Adaptation Self-evaluation Scale.

The determination of the outcome of treatment for depression is important both for the symptoms of depression and social functioning. The aim of this review is to evaluate the outcome of two clinical trials comparing reboxetine and fluoxetine on depressive symptoms and social functioning. These studies used both conventional measures of outcome such as the Hamilton Rating Scale for Depression (HAM-D) and the Social Adaptation Self-evaluation Scale (SASS), a patient-centred, disease non-specific scale of social functioning, which was developed for measuring social functioning in depressed people. These findings, set against a background of all studies in which antidepressants have been compared using quality of life instruments, suggest that while some patients may appear to the clinician to have recovered, they may remain less than fully well and differences in selectivity for neurotransmitter systems may play a part in the degree of wellbeing that recovered patients might expect.

Adrenergic Uptake Inhibitors↗