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PubMed1989

The prevalence of major depression in black and white adults in five United States communities.

There have been inconsistent findings on race differences in the rates and nature of depression, which are probably due to methodological differences between studies. Data are presented on the prevalence of major depression in white and black adults from the Epidemiologic Catchment Area Study, which examined a large community sample of five United States sites using diagnostic criteria based on the American Psychiatric Association Diagnostic and Statistical Manual, Third Edition. A total of 16,436 adults living in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), the Piedmont area of North Carolina, and Los Angeles (California) were surveyed in 1980-1983. In the five sites, age-adjusted analyses by site and sex did not show any consistent black excess in lifetime prevalence or six-month prevalence; white men as compared with black men in particular tended to have slightly higher prevalence of major depression. At all sites, in the 18-24 years age group, black women as compared with white women showed a trend for higher six-month prevalence. White men in the 18-24 years age group showed a trend for higher six-month prevalence than black men. In New Haven, Baltimore, and the Piedmont area of North Carolina, logistic regression analyses of lifetime prevalence (by site and sex) showed no significant or consistent interaction of race with household income or age. Controlling for age and household income, whites tended to have higher lifetime prevalence than black at each of these three sites, regardless of sex.

Adult↗
PubMedDate not supplied

Relationship between clinical pain complaints and pain sensitivity in patients with depression and panic disorder.

OBJECTIVE: There is evidence that depression and panic disorder are both associated with an increased frequency of clinical pain complaints. A change in pain sensitivity is alleged to be involved in this phenomenon. However, few studies have assessed clinical pain complaints and pain sensitivity in the same group of patients. METHODS: Thirteen patients with a major depressive disorder, 13 patients with a panic disorder (diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition), and 13 healthy control subjects were investigated. None of the subjects were taking medications. Body maps were used to measure the number of painful sites as well as the intensity and unpleasantness of pain complaints in the previous 6 months. Furthermore, pain thresholds for pressure, cold, and heat were assessed at the forearm or hand. RESULTS: Patients with depression and panic disorder had significantly more frequent, more intense, and more unpleasant pain complaints than healthy control subjects. Despite this similarity, patients with depression had significantly higher pain thresholds than patients with panic disorder in two (pressure and cold) of three stimulus modalities and significantly higher pressure pain thresholds than the healthy control subjects. There were no differences between the pain thresholds of patients with panic disorder and healthy control subjects. The correlations between clinical pain measures and pain thresholds were generally weak. CONCLUSIONS: These findings suggest that the clinical pain complaints of patients with depression and panic disorder cannot simply be explained by changes in pain sensitivity.

Adult↗
PubMed2005

Postconcussional disorder: Are the DSM-IV criteria an improvement over the ICD-10?

Little is known about the characteristics and outcomes of patients diagnosed with postconcussional disorder (PCD) under the provisionally proposed criteria in the DSM-IV and how they differ from patients diagnosed with postconcussional syndrome (PCS) under the International Classification of Diseases, 10th edition clinical (ICD-10) criteria. This study investigated differences in outcome based on a diagnosis of PCD (DSM-IV) versus PCS (ICD-10 clinical criteria) as to which criteria set might be preferred for clinical practice. A consecutive series of adult patients with mild (N = 319) to moderate (N = 21) traumatic brain injury was assessed at 3 months postinjury with a brief neuropsychological battery and measures of specific outcome domains. In two separate series of analyses, patients with PCD were compared with those without PCD, and those with PCS were compared with those without PCS. Although the two criteria sets resulted in markedly different incidence rates, there was no substantial pattern of differences between the DSM-IV and ICD-10 in the outcome domains of psychiatric symptoms and disorders, social and community integration, health-related quality of life, or global outcome as measured by the Glasgow Outcome Scale-Extended. In spite of significant differences between the two diagnostic criteria sets and different incidence rates for PCD/PCS, outcome in all measured domains was very similar at 3 months postinjury. There is no compelling evidence, based on these outcome domains, to suggest which of the two diagnostic criteria sets should be clinically preferred.

Adult↗
PubMedDate not supplied

Association between the Erectile Dysfunction Inventory of Treatment Satisfaction and the Self-Esteem and Relationship Questionnaire following treatment with sildenafil citrate for men with erectile dysfunction.

OBJECTIVES: Research is lacking on the correlation between treatment satisfaction and confidence, self-esteem, and relationships for men receiving treatment for erectile dysfunction (ED). We sought to correlate scores between the validated Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) index and the validated Self-Esteem And Relationship (SEAR) questionnaire following treatment with sildenafil citrate (VIAGRA). METHODS: This study was based on an open-label, flexible-dose trial of 93 sildenafil-naive patients with ED. Pearson correlation coefficients between EDITS index and SEAR questionnaire scores, each of which can range from 0 to 100 (most favorable), were calculated at end of treatment (EOT). An analysis of covariance model was applied to associate changes from baseline to EOT in SEAR scores with EDITS score at EOT, controlling for baseline SEAR score. RESULTS: Significant and sizable Pearson's correlations between SEAR and EDITS scores (P < or = 0.0001; range: 0.49-0.84) were observed. A 10-point higher EDITS scores at EOT corresponded to a significant and tangible average improvement in SEAR scores from baseline to EOT (P < or = 0.0001; range: 6.6-8.7). Average SEAR scores at EOT were markedly different between patients with greater treatment satisfaction at EOT (EDITS score > or = median EDITS score of 88.6; n = 50) and those with lesser treatment satisfaction at EOT (EDITS score <88.6; n = 43). CONCLUSIONS: The data add to the validity of the SEAR questionnaire, suggest a tangible relationship between treatment satisfaction and psychosocial benefit among men with ED treated with sildenafil, and highlight the importance of assessing the psychosocial impact of ED in men undergoing treatment.

Adult↗
PubMed2001

Predisposing factors for delirium in the surgical intensive care unit.

BACKGROUND: Delirium is a sign of deterioration in the homeostasis and physical status of the patient. The objective of our study was to investigate the predisposing factors for delirium in a surgical intensive care unit (ICU) setting. METHOD: Between January 1996 and 1997, we screened prospectively 818 patients who were consecutive applicants to the general surgery service of Dicle-University Hospital and had been kept in the ICU for delirium. All patients were hospitalized either for elective or emergency services and were treated either with medication and/or surgery. Suspected cases of delirium were identified during daily interviews. The patients who had changes in the status of consciousness (n = 150) were consulted with an experienced consultation-liaison psychiatrist. The diagnosis of delirium was based on Diagnostic and Statistical Manual of Mental Disorders (revised third edition) criteria and established through psychiatric interviews. Patients were divided into two groups: the "delirious group" (DG) (n = 90) and the "non-delirious group" (NDG) (n = 728). During delirium, all abnormal findings related to physical conditions, laboratory features, and additional diseases were evaluated as probable risk factors of delirium. RESULTS: Of 818 patients, 386 (47.2%) were male and 432 (52.8%) were female. Delirium developed in 90 of 818 patients (11%). The cases of delirium in the DG were more frequent among male patients (63.3%) than female patients (36.7%) (chi2 = 10.5, P = 0.001). The mean age was 48.9 +/- 18.1 and 38.5 +/- 13.8 years in the DG and NDG, respectively (t = 6.4, P = 0.000). Frequency of delirium is higher in the patients admitted to the Emergency Department (chi2 = 43.6, P = 0.000). The rate of postoperative delirium was 10.9%, but there was no statistical difference related to operations between the DG and NDG (chi2 = 0.13, P = 0.71). The length of stay in the ICU was 10.7 +/- 13.9 and 5.6 +/- 2.9 days in the DG and NDG, respectively (t = 0.11, P = 0.000). The length of stay in hospital was 15.6 +/- 16.5 and 8.1 +/- 2.7 days in the DG and NDG, respectively (t = 11.08, P = 0.000). Logistic regression was used to explore the associations between probable risk factors and delirium. Delirium was not correlated with conditions such as hypertension, hypo/hyperpotassemia, hypernatremia, hypoalbuminemia, hypo/hyperglycemia, cardiac disease, emergency admission, age, length of stay in the ICU, length of stay in hospital, and gender. It was determined that conditions such as respiratory diseases (odds ratio [OR] = 30.6, 95% confidence interval [CI] = 9.5-98.4), infections (OR = 18.0, 95% CI = 3.5-90.8), fever (OR = 14.3, 95% CI = 4.1-49.3), anemia (OR = 5.4, 95% CI = 1.6-17.8), hypotension (OR = 19.8, 95% CI = 5.3-74.3), hypocalcemia (OR = 30.9, 95% CI = 5.8-163.2), hyponatremia (OR = 8.2, 95% CI = 2.5-26.4), azotemia (OR = 4.6, 95% CI = 1.4-15.6), elevated liver enzymes (OR = 6.3, 95% CI = 1.2-32.2), hyperamylasemia (OR = 43.4, 95% CI = 4.2-442.7), hyperbilirubinemia (OR = 8.7, 95% CI = 2.0-37.7) and metabolic acidosis (OR = 4.5, 95% CI = 1.1-17.7) were predicting factors for delirium. CONCLUSION: We determined that conditions such as respiratory diseases, infections, fever, anemia, hypotension, hypocalcemia, hyponatremia, azotemia, elevated liver enzymes, hyperamylasemia, hyperbilirubinemia and metabolic acidosis were predicting factors for delirium.

Adult↗
PubMed2005

Major depression is associated with significant diurnal elevations in plasma interleukin-6 levels, a shift of its circadian rhythm, and loss of physiological complexity in its secretion: clinical implications.

BACKGROUND: Major depressive disorder (MDD) is associated with increased risk for premature coronary heart disease and bone loss. Single time measurements of plasma IL-6, a good predictor of future risk for both cardiovascular disease and osteoporosis, revealed significant elevations in depressed patients. The objective of this study was to rigorously compare plasma IL-6 levels, measured over 24 h, in MDD patients and healthy controls. Given the activating role of IL-6 on the hypothalamic-pituitary-adrenal (HPA) axis, and the relevance of its dysregulation in MDD, we also analyzed the relations between IL-6 and cortisol levels. METHODS: We studied nine patients and nine controls, individually matched by gender, age (+/-5 yr), body mass index (+/-2 kg/m2), and menstrual cycle phase. Diagnosis of MDD was confirmed by structured clinical interview based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I diagnostic criteria. Self-reported mood ratings were assessed by multiple visual analog scales. The rhythmicity and complexity of IL-6 and cortisol secretion were tested by cosinor analyses, approximate entropy (ApEn) and cross-ApEn algorithms. RESULTS: MDD patients had significant mean IL-6 elevations from 1000-1200 h and at 1500 h (P ranging from <0.05 to <0.01) vs. controls. In addition, in MDD, the circadian rhythm of IL-6 was shifted by 12 h, and its physiological complexity was reduced, with no difference in the cross-ApEn of IL-6 and cortisol between the two groups, and significant time-lagged correlations only in the controls. IL-6 levels correlated significantly with mood ratings. CONCLUSIONS: We report profound morning elevations of plasma IL-6 and a reversal of its circadian rhythm in MDD patients, in the absence of hypercortisolism. These findings may be relevant to the increased risk for coronary heart disease and bone loss in MDD.

Adult↗
PubMed2005

A prospective study of predictors of poststroke depression.

OBJECTIVE: To investigate the association between early depressive behavior after stroke onset and occurrence of poststroke depression (PSD) at 3- and 12-month follow-up evaluations. METHODS: The study prospectively included 273 patients with first-ever single uncomplicated ischemic stroke. In the stroke unit, nurses scored crying, overt sadness, and apathy daily using an observational method to include patients with comprehension deficits. The Barthel Index was used to assess disability. Follow-up evaluation at months 3 and 12 included psychiatric assessment based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. RESULTS: Crying (19.8%), overt sadness (50.5%), and apathy (47.6%) were observed. Of the patients observed crying, 4 showed pathologic crying, 19 emotionalism, and 12 catastrophic reactions. Crying and overt sadness, but not apathy, were associated with a subjective experience of depression (p < 0.05). Thirty of 52 (58%) patients observed crying, 12 of 19 (63%) patients with emotionalism, and 5 of 12 (41%) patients with catastrophic reactions developed PSD within the first year. Multiple logistic regression analysis showed that only severe functional disability (odds ratio [OR], 4.31; 95% CI, 2.41 to 7.69), crying behaviors (OR, 2.66; 95% CI, 1.35 to 5.27), and an age <68 years (OR, 2.32; 95% CI, 1.30 to 4.13) were (p < 0.05) predictors of late PSD development (13% of the variance). CONCLUSIONS: In the stroke unit, crying and overt sadness are more reliable indicators of depressed mood than apathy. In patients with first-ever stroke, crying behaviors soon after stroke, a younger age, and severe disability are predictors of poststroke depression occurrence within the first year after stroke onset.

Aged↗
PubMed2006

Drinking status and fatal crashes: which drinkers contribute most to the problem?

OBJECTIVE: The object of this study was to estimate the relative contribution of various classes of drinkers (including those with alcohol-use disorders) to alcohol-related fatal motor vehicle crashes. METHOD: Using the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2000, the percentage of state residents falling into six nonoverlapping alcohol-user categories-dependent drinkers, abusive drinkers, dependent and abusive drinkers, heavy episodic drinkers, current normative drinkers, and current nondrinkers- was determined based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, classifications. The percentage of residents in each state in each of these user categories and their relationships to the number of drinking drivers involved in fatal crashes in that state were determined through regression analysis using data from the Fatality Analysis Reporting System. RESULTS: The proportion of drinkers in a state in each of the six consumption categories was positively related to the number of drinking drivers in fatal crashes in that state. Conversely, the percentage of the state's population who were current nondrinkers was negatively related to the number of drinking road users in crashes. CONCLUSIONS: Although alcohol abusive and heavy episodic drinkers had substantially higher associations with impaired drivers in fatal crashes, half of such drivers were associated with the percentage of current nominative drinkers in the state. Despite the relevancy of these findings, they must be qualified by statistical limitations associated with the use of state as the unit of analysis.

Accidents, Traffic↗
PubMed2006

Psychophysiological differences in identical twins discordant for schizophrenia: a critical index for the onset of schizophrenia.

It has been hypothesized that not only genetic but also environmental factors contribute to the onset of schizophrenia. We therefore conducted psychophysiological studies on a pair of identical twins discordant for schizophrenia, to differentiate non-genetic from genetic indexes possibly associated with this disease. The affected and unaffected twins were 28 year-old females. The affected twin was diagnosed as having schizophrenia based on the Diagnosis and Statistical Manual of Mental Disorders, third edition revised (DMS-III-R), whereas the unaffected twin had no psychiatric disorders. The brain potentials evoked by visual stimulation (visual event-related potential [visual ERP]) were recorded. The components of the visual ERP, which are believed to reflect pattern cognition, semantic processing and the failure to use preceding word information, were compared with normal subjects. Both twins showed abnormal semantic processing and similar failure to use preceding word information. Abnormality of semantic processing was marked in the affected twin. These results indicate that failure to use preceding word information might reflect only genetic factors, whereas abnormal semantic processing might reflect both genetic and non-genetic factors because the affected twin was considered to show accelerated deterioration after the disease onset. However, only the affected twin showed abnormal pattern cognition, which might be attributable to non-genetic factors such as an acquired vulnerability to schizophrenia. We suggest that the impairment of pattern cognition evaluated by visual ERP may be a critical index for the onset of schizophrenia.

Adult↗
PubMed1993

Correlations between scores on the Wechsler Intelligence Scale for Children-III and the General Purpose Abbreviated Battery of the Stanford-Binet IV.

Estimations of some relationships among scores on the "General Purpose Abbreviated Battery" of the Stanford-Binet: Fourth Edition and the Wechsler Intelligence Scale for Children-III were based on the responses of 14 boys and 18 girls enrolled in Grades 3, 4, and 5 and who took both tests. Of 13 Pearson correlations between the Binet IV composite score and the Wechsler subtest scores and IQs 12 were statistically significant (rs = .45 to .74). The new Wechsler scale appears to be a valid instrument for the 32 children (8-8 to 11-11) who were tested.

Child↗
PubMed2001

The relation between the psychological functioning of children with Down syndrome and their urine peptide levels and levels of serum antibodies to food proteins.

AIMS: To investigate the relation between psychological functioning of subjects with Down syndrome, and their levels of urine peptide and serum antibodies to food proteins. METHODS: 55 children with Down syndrome in a cross-sectional study. Psychological functioning was measured by the Stanford-Binet Intelligence Scale: Fourth Edition, McCarthy Scales of Children's Abilities and Fagan's computer based test of novelty preference. RESULTS: The participants, and their siblings, were found to have significantly increased total urine peptide levels. There were no significant correlations between peptide levels and psychological functioning. Significantly increased levels of IgG activity to gliadin and gluten, and IgA activity to gliadin, gluten and casein were found. There were significant negative correlations (Spearman r = -0.13 to -0.51) between psychological functioning, and IgG and IgA activity to gliadin and gluten. CONCLUSIONS: A significant relation between antibodies to gluten and psychological functioning was documented. The mechanism and potential causal link are still unknown.

Child↗
PubMed1993

Psychiatric morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome.

Sixty consecutive patients admitted to an oncology unit in a general hospital were systematically assessed to determine the prevalence of psychiatric disorders. Patients' awareness of the diagnosis of cancer and their perception of treatment intention and outcome were assessed independently by another investigator who was blind to the psychiatric diagnosis. Forty percent of the sample had a diagnosis of psychiatric disorder, based on the Diagnostic and Statistical Manual for Mental Disorders (3rd edition, revised). Adjustment disorders comprised most of the psychiatric diagnoses. Major depression was seen in 8 (13%) patients. One third of the patients were estimated to be unaware of the diagnosis of cancer, and 82% of patients perceived the treatment given as curative. Psychiatric morbidity was significantly less common in patients who did not know they had cancer, and in those who considered treatment as curative. The prevalence of depressive disorders in our sample was higher than in medical inpatients. It is concluded that psychiatric disorders, especially affective disorders, are common among cancer patients. Awareness of nature of the illness and expected outcome can affect the prevalence of psychiatric morbidity. Further studies investigating the relationship between psychiatric morbidity and duration of illness, type and stage of cancer, disabilities and coping strategies are warranted.

Adjustment Disorders↗
PubMed1987

Medicare program; changes to the DRG classification system--HCFA. Final notice.

This final notice specifies certain changes in the Diagnosis-Related Group (DRG) classification system. It also lists diagnosis and procedures for which new or revised identifying codes (in the coding system of the International Classification of Diseases-9th Edition-Clinical Modification (ICD-9-CM) on which DRG assignments are based) have been approved. This final notice also specifies the changes to the classification of alcohol and drug abuse DRGs and lists the revisions to the surgical hierarchies.

Alcoholism↗
PubMed1995

[Origin of gestation theory in Tibetan medicine].

Generally, it is claimed that gestation theory was originated locally in Tibet, with only a single origin. This author proves that there are two sources, both derived from India. One is a combination of gestation theory from rGyud-bzhi, i.e. Astangahrdayasamhita, and the Great Ratnakuta, and the other, from Somaradza, also derived from the Great Ratnakuta. The dates of writing of modern edition of Somaradza and rGyud-bzhi are still uncertain yet. Based on the linguistic features, this author claims that Somaradza was written before the Tibetan version of Great Ratnakuta (9 century), while rGyud-bzhi, after the translation of Astangahrdayasamhita (10-11 century).

Buddhism↗
PubMed2002

Patient and physician explanatory models for acute bronchitis.

OBJECTIVES: Our goals were to develop explanatory models to better understand how physicians diagnose and treat acute bronchitis; to describe patient expectations and needs when experiencing an episode of acute bronchitis; and to enhance communication between physician and patient. STUDY DESIGN: We used qualitative, semi-structured, in-depth interviews to generate patient and physician explanatory models. POPULATION: We had a purposeful, homogeneous sample of 30 family physicians and 30 adult patients. OUTCOMES MEASURED: Our multidisciplinary team of investigators used an editing style of analysis to develop patient and physician explanatory models based on the following topics: (1) what caused my illness/etiology, (2) what symptoms I had/onset of symptoms, (3) what my sickness did to me/pathophysiology, (4) how severe is my sickness/course of illness, and (5) what kind of treatment should I receive/treatment. RESULTS: We found that patient and physician models were congruous for symptoms of acute bronchitis and incongruous for etiology and course of illness. Models were congruous for treatment, although for different reasons. CONCLUSIONS: Patients may have a very vague understanding of the process of infection and the difference between bacteria and viruses. Compounding this confusion is frequent miscommunication from physicians regarding the clinical course of untreated illness. These factors and non-communicated expectations from patients and fear of missing something on the part of physicians contribute to the decision to treat with antibiotics.

Acute Disease↗
PubMed2003

Profile of child and adolescent psychiatry in Oman.

OBJECTIVE: To find the common behavioral problems in youth, their co-morbidity, treatment, and other variables in Oman. METHODS: All patients who attended the child psychiatric clinic in Sultan Qaboos University Hospital (SQUH), Muscat, (the only child psychiatry clinic in Sultanate of Oman) for a 3-month period were investigated for behavioral problems, particularly hyperactivity (by Conners' Questionnaire). The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. RESULTS: Of the total 212 cases, Omani nationals constituted 89% and the rest were expatriates. Sixty five percent were boys, 57% were of school age, 26% were adolescents, 9% were preschoolers and 5% were toddlers. Consanguinity among their parents was high at 52%. The majority (60%) of the patients exhibited hyperactivity. Aggression was found in 49%, while stealing and lying were found in 25% and 22%. Approximately one-third suffered from headache and abdominal pain. The majority (62%) were of below-normal intelligence. Anxiety affected 14%, depression 4%, and conduct disorders 8%. One-third of the patients were taking psychostimulants and another one-third were taking tricyclics. The results were compared with those from other developing countries. CONCLUSION: Behavioral problems among children and adolescents are high in Oman, same as other developing countries, though the type of disorders is different here. This calls for the attention of the health policy makers for diagnosing and treating such disorders in Oman as well as in the other developing countries.

Adolescent↗
PubMed1986

A technique for multiplanar reformation and three-dimensional analysis of computed tomographic data: application to adult hip disease.

A commercially available system which is able to accept input from computed tomographic (CT) or magnetic resonance (MR) scanners was used preoperatively to generate multiplanar reformations (MPR) and three-dimensional (3D) images depicting the osseous morphologic alterations and femoral-acetabular relationships in 25 adult patients with a variety of hip diseases. Polyethylene surface representations of femora and acetabulae were constructed by the 3D-contouring of CT data and were then compared to resected specimens from patients who subsequently underwent total hip arthroplasty. Information provided by this imaging strategy was useful in both selecting and guiding the most appropriate surgical procedure, and the models depicted actual osseous contours with reasonable accuracy. The system employed has distinct advantages over other previously described 3D imaging strategies, which include a menu-driven user-friendly interface, data base access via reference images, 3D sectional analysis, and contour file editing for selective visualization of desired structures.

Acetabulum↗
PubMed1983

[Michael Servetus' physiology in the light of his anthropology].

This essay starts with a short description of the life and works of Michael Servetus. Then the part of the innovator the Spanish physician played in describing the minor circulation is being examined alongside the contributions made by other contemporary physicians who tried to explain this physiological process. The ideas of the philosophical anthropology of Servetus are represented with special stress of the fact that beyond the theological frame, in his main opus Christianismi restitutio there are typical characteristics from the Renaissance (i.e. ethic relativism etc.). At the end it becomes clear that the description of the minor circulation is only to serve the purpose of explaining Servetus's theological thesis according to which the seat of the soul is in the blood. He stipulates that the "sensible soul" is to be found in the choroidal plexus of the ventricles of the brain or else in the pineal gland. It is one of the merits of Servetus, too, that he had foreseen the capillaries (capillares) which he describes as well in the case of the lung vessels as in the case of the choroidal plexus in the brain. The last part deals with the history and background of the new edition of Christianismi restitutio, published 1790 in Nuremberg, which again is based on some recent archival research.

Anthropology↗