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27 women with rheumatoid arthritis had elevated depression and social introversion scores in the Minnesota multiple phasic personality inventory (MMPI) tests, whereas their somatic activity appeared reduced. Age of the patient at time of investigation apparently had no influence on the degree of psychological changes, but was reflected in an increased social introversion. Most important for the degree of psychological impairment was the height of the ARA index, which correlated positively with the neurotic triad as well as the psychasthenia scale in the MMPI. An elevation of the neurotic triad is common in many somatic disease. Patients with rheumatoid arthritis had an additional, introversion and depression, and decreased somatic activity.
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PMID:[Psychological tests of patients with chronic rheumatoid arthritis(author's transl)]. 115 93

The sample for this psychosocial follow-up study was formed using the 71 surviving patients from a total of 100 who underwent heart transplantation up until March 1990 at Kiel University Hospital. Forty of these could be investigated comprehensively. The neurological investigation comprised EEG and auditory and visually evoked potentials. The psychological investigation started with several neuropsychological tests; additionally all patients were interviewed and they completed questionnaires concerning anxiety, depression, ways of coping, personality characteristics and life satisfaction. Within the entire sample, there were few indications for specific psychological impairment. The psychosocial status of the patients was not significantly related to the time which had elapsed since they underwent transplantation. There were few associations between neuropsychological and psychosocial data, and several indicators of early postoperative complications which are described in the literature (e.g., length of stay in the intensive care unit). Clinically relevant subgroups (formed on the basis of neuropsychological test results, anxiety and depression) did not differ in terms of these indicators. Nevertheless, a considerable proportion of the patients (25%) were characterized by having a higher level of affective and neuropsychological impairment. Although based upon retrospective investigations, the results of this follow-up generally correlate with those gained from Anglo-American countries. In interpreting the results one needs to consider the possible influence of premorbid personality characteristics as well as denial which may be typical for patients undergoing heart transplantation.
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PMID:Psychosocial, neuropsychological and neurological status in a sample of heart transplant recipients. 130 Nov 19

Most studies of exercise training in patients who have had a heart attack have concentrated on the influence such programmes have on physiological recovery rather than on possible psychological benefits. In order to study the latter, a group of 16 patients participating in the Cardiac Rehabilitation Programme run by the Cape Western Branch of the Heart Foundation of Southern Africa were asked to complete the Cattell Sixteen Personality Factor Questionnaire on entry to the programme and again 6 months later. Eight patients participated regularly in the programme for the full 6 months (the exercising group), while the other 8 (the control group) 'dropped out' within the first few weeks and remained physically inactive for the remainder of the 6 months. It was found that there were no differences in the personality profiles of the exercising and control groups on admission to the rehabilitation programme. Both groups exhibited considerable psychological impairment--in particular they were emotionally unstable with high levels of apprehension, tension and depression. Six months later the control group showed a further worsening as regards levels of depression and emotional stability, with a small reduction (2%) in tension and a small increase (1%) in imaginativeness. In contrast, the exercising group showed significantly large reductions in depression (10%) and tension (14%) levels, and marked increases in emotional stability (14%) and imaginativeness (12%). We conclude that attendance at the programme played an important role in normalizing their psychological constitutions.
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PMID:The psychological effect of exercise training on patients after a myocardial infarction. A pilot study. 662 25

Two hundred persons over 80 in two urban communities were interviewed. Of those interviewed, 21% evidenced psychological impairment as defined by the presence of at least one of the following self-report symptoms: 1) depression; 2) periods of inability to function; 3) suicidal ideation; 4) alcohol problems and 5) use of psychotropic medication. A profile of the psychologically impaired group compared to the psychologically healthy showed that accidents (mostly falls), eye problems and few social contacts were significantly associated with impairment. Approximately 75% had some restrictions on activity due to physical health problems. Social isolation was marked: 54% either had no children or saw them less than once a month; 38% visited with close friends or relatives less than once a month; 19% were rated as having very little or no social support; and 23% socialized beyond the household less than once a week. Social interaction was the strongest predictor of psychological wellbeing (Affect Balance Scale) in a multiple regression analysis that included physical health and socioeconomic variables. Questions about service needs and utilization indicated unmet needs in the areas of transportation, house maintenance, medical services, and a regular visiting service.
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PMID:Medical and social factors associated with psychological distress in a sample of community aged. 729 37

The present study investigated the relationship of a multivariate classification of alcoholic patients based upon Minnesota Multiphasic Personality Inventory profiles taken at admission to psychopathology and drinking behavior at a 6- to 12-month follow-up interval. It was found that a subtype of patients characterized as psychoneurotic, with reactive anxiety and/or depression, evidenced significantly higher levels of psychopathology at follow-up than the remaining three subtypes. Furthermore, this subtype demonstrated higher levels of physical, social, and psychological impairment from post-treatment drinking episodes. No differences were found among the four subtypes with respect to outpatient therapists' ratings of personality change and adjustment. The findings suggest that such a multivariate classification of Minnesota Multiphasic Personality Inventory profiles has predictive utility. The results also suggest that the present subtypes would be useful in investigating the potential utility of differential therapeutic intervention strategies for different patients.
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PMID:Relationship of alcoholic personality subtypes to treatment follow-up measures. 740 Jul 99

Forty-four chronic, but relatively well functioning, low back pain patients were assigned to either Cognitive Behaviour Therapy (CBT). Electromyographic Biofeedback (EMGBF) or Wait List Control (WLC). Both treatments were conducted over eight sessions in groups of four subjects. Results at post-treatment indicated significant improvements in functioning on measures of pain intensity, perceived level of disability, adaptive beliefs about pain and the level of depression in both the CBT and EMGBF conditions. These improvements were not evident for the WLC condition. At 6 months follow-up, treatment gains were maintained in the areas of pain intensity, pain beliefs, and depression, for both treatment groups, with further improvements occurring in anxiety and use of active coping skills. No significant differences were found between CBT and EMGBF on any of the outcome measures at either post-treatment or at 6 months follow-up. Further research is required to determine the degree to which these results reflect the mild level of psychological impairment and disability status of patients in the present study.
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PMID:Cognitive-behavioural therapy versus EMG biofeedback in the treatment of chronic low back pain. 765 61

Although stressful events have long been implicated in the onset of psychological disorder, available data suggest that the majority of individuals appear to escape serious impairment even following highly traumatic events. Related to this is the question of chronicity and whether those who do become impaired develop mental health problems of an ongoing nature. This paper documents the psychological adjustment of 194 women following a highly stressful event-the death of an infant due to stillbirth, neonatal death or SIDS. Anxiety and depression were measured on four occasions-at 2, 8, 15 and 30 months post-loss--using the Delusions Symptoms States Inventory (DSSI/sAD). For comparative purposes, the mental health of 203 mothers of a surviving infant was similarly assessed. The results demonstrate that bereaved mothers, as a group, manifest significantly higher rates of psychological distress than mothers of living infants for at least 30 months after their loss. Their impairment may be either acute or chronic in form. The majority of bereaved mothers appear not be develop serious mental health problems in response to the loss or experience psychological impairment that is usually self-limiting. For a smaller group of women, the death of a baby may herald serious and ongoing distress. Bereaved mothers who were not distressed soon (2 months) after the loss were unlikely to become so later, but those who were still distressed at 8 months were likely to remain so subsequently.
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PMID:The mental health impact of stillbirth, neonatal death or SIDS: prevalence and patterns of distress among mothers. 890 32

Stroke is a leading cause of morbidity and mortality in the United States. Physical and psychological impairment from stroke may negatively affect quality of life. From a psychological perspective, depression, which is common in stroke patients, may influence functional recovery and possibly mortality after a stroke. Although somewhat controversial, the risk of poststroke depression may be related to lesion location, specifically left anterior or left basal ganglia lesions. Because poststroke depression can affect recovery, treatment with antidepressants may be warranted. Emerging evidence suggests that nortriptyline and fluoxetine may be effective; paroxetine, sertraline, and other selective serotonin reuptake inhibitors have shown efficacy in treating a related phenomenon known as pathologic crying. The influence of depression on the risk of stroke has not been extensively studied; however, several epidemiologic studies raise the possibility that a relation exists. In one study of elderly individuals, higher depressive symptoms increased the risk of stroke. Many older individuals who have depression develop later in life have evidence of subtle cerebrovascular disease. Specifically, silent strokes that do not involve the sensory or motor parts of the brain are quite common in the elderly population. Vascular depression is depression that occurs in patients with cerebrovascular or ischemic changes in the brain. Preliminary evidence indicates that these vascular changes may be related to atherosclerosis, hypertension, or myocardial infarction. However, additional studies are needed to gain a better profile of these patients and to explore potential treatment modalities.
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PMID:Depression as a contributing factor in cerebrovascular disease. 1101 51

Stroke is the third leading cause of death and a major cause of disability in the United States. Individuals experiencing a completed stroke are faced with a multitude of challenges to restore their highest quality of life within the limitations of residual impairment. This research synthesis provides a summary of previous research on quality of life for stroke survivors. Research studies for inclusion in the review were identified by conducting a search of computerized databases through August 2000 and by using the ancestry method of reviewing reference lists from relevant publications. Thirty-nine studies were identified that focused on stroke survivors' quality of life during the recovery process. Stroke survivors' overall quality of life varied based on the country where the study was implemented. Variables positively associated with stroke survivors' quality of life were independence with activities of daily living, increased functional ability, social support, and healthcare resources. Variables negatively associated with stroke survivors' quality of life were psychological impairment, severity of impairment, severity of aphasia, inappropriate reactions to illness and pessimism, and inability to return to work. Specifically, 22% to 73% of the variance in stroke survivors' quality of life was primarily explained by presence of depression; functional ability, especially the upper extremities; and socialization, in particular, leisure activities. Implications for professional nursing practice to enhance stroke survivors' quality of life include encouraging independence, managing depression, and fostering interpersonal relationships. Areas for future research include longitudinal studies, rigorous psychometric assessment of quality of life instruments, and intervention studies.
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PMID:Quality of life of stroke survivors: a research synthesis. 1177 13

In their treatment of accident and assault victims, plastic surgeons have unique opportunities to identify and refer patients with posttraumatic stress symptoms. This article describes brief assessments that surgeons or their clinic staff can use to evaluate traumatically injured adults and children for trauma-related psychological symptoms. An immediate postinjury evaluation (within 10 days of the trauma) consists of 11 questions to determine the presence of the following risk factors for posttrauma maladjustment: panic during or immediately after the trauma, reexperiencing symptoms, avoidance, sleep disturbance, injury from an assault, previous trauma and psychiatric history, and blaming someone else for the injury. The seven follow-up interview questions assess reexperiencing symptoms, avoidance, trauma-related phobias, depression, irritability, and increased substance use, all of which, if present, suggest psychological impairment. Questions recommended for the evaluation of younger children assess changes in play and recreational activity, sleep disturbance, night terror, aggression, irritability, avoidance, emergence of new fears, and loss of recently acquired developmental skills. The assessments require less than 2 minutes and are easily integrated into the hospital or clinic examinations of these patients.
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PMID:Psychological impact of traumatic injuries: what the surgeon can do. 1178 86


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