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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Psychiatric disorders, psychosocial dysfunction, family pathology, and environmental stressors are thought to be risk factors for adolescent suicide attempts. Variables from each of these categories were examined, by means of a structured interview and questionnaires, to determine whether a group of 21 adolescent suicide attempters could be differentiated from a group of 34 normal control subjects and a group of 15 at-risk adolescents (teenagers with known risk factors but without recent suicide attempt). The attempters differed significantly from control subjects on a large number of variables, particularly in the areas of substance abuse, depression, self-image, interpersonal relationships, communication patterns, family support, and problem behaviors. Only three items--the Beck Hopelessness Scale score, the SCL-90-R Positive Symptom Distress Index, and a history of suicidal ideation--differentiated the attempters from the at-risk adolescents. A discriminant analysis revealed that hopelessness and suicidal ideation were able to identify 93% of the suicide attempters.
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PMID:Can adolescent suicide attempters be distinguished from at-risk adolescents? 188 47

The analgesic profile of epidural nalbuphine for postoperative pain relief and the impact of local anaesthetic choice upon this profile was investigated in 58 patients undergoing elective Caesarean delivery under epidural anaesthesia. Patients were randomized to receive either lidocaine 2% with 1:200,000 epinephrine or 2-chloroprocaine 3% for perioperative anaesthesia, followed by either 10, 20, or 30 mg of epidural nalbuphine administered at the first complaint of postoperative discomfort. Postoperative analgesia was quantitated on a visual analogue (VAS) scale, and by the time from the epidural opioid injection until the first request for supplemental pain medication. The duration of analgesia after lidocaine anaesthesia followed by 10, 20 or 30 mg nalbuphine was 77 (53-127) min, 205 (110-269) min, and 185 (116-241), respectively (median, 95% confidence interval, P less than 0.01, 20 and 30 mg vs 10 mg). Following 2-chloroprocaine anaesthesia, VAS remained consistently elevated: the median duration of analgesia was only 30-40 min and did not differ among the three doses of nalbuphine. Side-effects consisted only of somnolence, and were noted only following lidocaine anaesthesia. Somnolence was observed in 0, 20% and 50% of those receiving 10 mg, 20 mg and 30 mg of nalbuphine respectively (NS). No evidence of respiratory depression was noted in any patient. It is concluded that 20 or 30 mg of epidural nalbuphine provides analgesia for only two to four hours following Caesarean delivery with lidocaine anaesthesia, but anaesthesia with 2-chloroprocaine resulted in minimal or no analgesia from this opioid. Nalbuphine appears to be a disappointing agent for epidural use after Caesarean delivery.
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PMID:Epidural nalbuphine for analgesia following caesarean delivery: dose-response and effect of local anaesthetic choice. 191 55

The authors conducted a randomized, prospective study comparing epidural morphine with patient-controlled intravenous (iv) morphine in 30 patients recovering from total hip or total knee arthroplasty. Six, 18, and 24 hr postoperatively, patients used a 10 cm visual-analogue scale to indicate both their current degree of discomfort and the maximum discomfort they had experienced since the previous evaluation. Pain at the time of evaluation did not differ between patients receiving epidural (2.6 +/- 0.4 cm, mean +/- SEM) and patient-controlled iv morphine (3.4 +/- 0.3 cm). However, patients who received epidural morphine recalled less pain during the period preceding evaluation (4.2 +/- 0.5 cm) than did those receiving patient-controlled analgesia (5.5 +/- 0.4 cm, P less than 0.05). Patients receiving epidural morphine were more likely to require treatment for pruritus (4 of 15) than patients who received patient-controlled iv morphine (none of 15, P less than 0.05). Minimum respiratory rates were lower in patients receiving epidural morphine (15.0 +/- 0.3) than in those receiving patient-controlled analgesia (16.5 +/- 0.4, P less than 0.05), but no patients required treatment for respiratory depression. The authors conclude that epidural morphine may provide more consistent analgesia following joint replacement surgery than patient-controlled morphine; however, there is a higher incidence of side-effects with the epidural technique.
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PMID:Comparison of epidural and patient-controlled intravenous morphine following joint replacement surgery. 193 5

The aim of this study was to explore the association between psychosocial variables and somatic complaints in terms of the biopsychosocial model. The analysis showed that both socioeconomic and psychological variables play a prominent role in the subjective complaints of coronary symptoms as follows: (1) Functional class: A low occupational index was found to be a predictor of much disability. Subjects with higher self-ratings of psychiatric symptoms (i.e. phobia, depression, interpersonal hypersensitivity), lower personal well-being (i.e. esteem, competence), and major social maladaptation had significantly more disability. (2) Chest pain: Patients with a higher morbidity of chest pain were more likely to be female, have less education, have more social maladjustment, and have less social support. Higher scores of psychiatric symptoms (i.e. anxiety, depression, hostility) and a perception of threatening by others were highly correlated with the severity of chest discomfort. Physicians should be aware of the ways in which psychosocial and biomedical variables may interact at many levels, especially for the patients with unexplained physical symptoms or social dysfunction.
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PMID:[Psychosocial aspect of somatic complaints in patients after myocardial infarction]. 197 6

The use of psychotropic drugs in general has become more extended in the past 20 years. The elderly, particularly geriatric inpatients, are the group with the highest consumption. The aim of the present study was to evaluate in two groups of elderly, hospitalized patients (H) vs. nonhospitalized subjects (nH), psychotropic drug consumption related to psychological distress. This was carried out in a total 238 subjects aged above 65 years (112 geriatric inpatients and 126 interviewed in social welfare centers). Sociodemographic, clinical and pharmacological data, general health and psychological distress were evaluated. The latter was assessed by means of the Symptom Distress Checklist (SCL-90) which included 9 subscales. 23% of the subjects received psychotropic drugs (P), of which 84% were benzodiazepines, 10% antidepressants and 1.5% antipsychotics. After evaluating the SCL-90 subscales, it was noted that anxiety, depression and obsessiveness/compulsiveness scored higher in P subjects than in those not receiving psychotropic drugs (nP). When treated nH and H were analyzed separately, it was observed that the former scored higher in anxiety and depression, while the latter showed higher scores in anxiety and obsessiveness/compulsiveness. Considered globally, the H group compared to nH showed higher scores in depression. Although evaluating psychotropic drug utilization in geriatric patients is complex due to the large number of influencing factors, SCL-90 has proved to be useful for assessing the qualitative aspects of this drug consumption in the elderly.
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PMID:Evaluation of psychotropic drug consumption related to psychological distress in the elderly: hospitalized vs. nonhospitalized. 198 Jul 27

The development of the Tinnitus Reaction Questionnaire (TRQ), a scale designed to assess the psychological distress associated with tinnitus, is described. Psychometric analyses of the TRQ are examined with a total of 156 subjects in three separate samples. The results indicate very good test-retest reliability (r = .88) and internal consistency (Cronbach's alpha = .96). Factor analysis yielded four factors that were interpreted as General Distress, Interference, Severity, and Avoidance. Moderate to high correlations were found between the TRQ and clinician ratings (r = .67) and self-report measures of anxiety and depression (r = .58-.87), but a low correlation was found with neuroticism (r = .27). It is concluded that the TRQ provides a useful index of distress related to tinnitus for subject selection and clinical assessment and has potential as a measure of change in coping ability.
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PMID:Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. 200 74

To determine whether gains from exposure therapy are lasting in patients with chronic obsessive compulsive disorder, the authors followed up 34 (85%) of 40 such patients who had been treated 6 years earlier with exposure therapy for 3 or 6 weeks and with clomipramine or placebo for 36 weeks. Severity of obsessive compulsive disorder was assessed by rating the discomfort caused by the time devoted to four target rituals, the Behavioral Avoidance Test, and the Compulsion Checklist. Mood was assessed by the 17-item Hamilton Rating Scale for Depression, the Wakefield Self-Assessment Depression Inventory, and the Anxiety scale. In addition, the patients' general adjustment was assessed. The authors found that the group as a whole remained significantly improved on obsessive compulsive symptoms, work and social adjustment, and depression; however, the group returned to pretreatment levels (slight to moderate) of general anxiety. They found that neither clomipramine nor placebo affected long-term outcome and that the majority of patients who were taking clomipramine or other antidepressants at follow-up were no more improved that those who were not taking antidepressants. Better long-term outcome correlated with more exposure therapy (6 weeks of therapy vs. 3 weeks) and with better compliance with the exposure therapy homework. The best predictor of long-term outcome was improvement at the end of treatment. Subjects who had initially been most depressed were more likely to receive psychotropic medication during follow-up. Initial severity of illness did not preclude benefit from exposure therapy.
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PMID:Six-year follow-up after exposure and clomipramine therapy for obsessive compulsive disorder. 201 46

This study was undertaken to explore the motivations and problems shared by adult orthognathic surgical patients over the age of 25. Objective findings included demographic information and reasons for seeking surgery. The majority of 65 respondents cited functional problems as their primary reason for seeking treatment. Eighty-nine percent were pleased with esthetic changes, and 83% responded that the functional problem had been corrected. For most, the greatest discomfort related to the surgery was the postoperative intensive care unit. Two of the most common side effects of the surgery were the loss of sensation in the lips and chin area and a short period of depression. Women had depression more often than men but were more enthusiastic about the final results of the procedure. Two major areas of interest to surgeons emerged from the research. First, although women have functional problems, the majority seem to have a desire for cosmetic improvement. Having a functional problem seemed to provide the psychological permission necessary to spend the time and money for a cosmetic change. The second point focused on the need for good communication between surgeon and patient. The patients who were more positive toward the procedure and more satisfied with the results were those who were better informed and who thought they had a good system of communication with the orthodontist, surgeon, and their respective staffs.
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PMID:Psychological aspects of orthognathic surgery: how people respond to facial change. 204 92

Acupuncture was given to patients before (preoperative-acupuncture group, PRE-ACU, n = 25) or after (postoperative-acupuncture group, POST-ACU, n = 25) operative removal of impacted mandibular third molars. Sixty patients did not receive acupuncture and participated as a control group (CG). All patients completed a questionnaire in order to characterize state tension and stress, degrees of neuroticism, extroversion, depression and psychosomatic disorders. We also recorded intraoperative discomfort and pain intensity, postoperative pain intensity and consumption of analgesics for 72 h. The PRE-ACU was significantly more tense following surgery and found the operative procedure more unpleasant than the other two groups. The PRE-ACU further rated intraoperative pain intensity higher than the CG and experienced higher pain intensity immediately postoperatively compared with POST-ACU and CG. Of the PRE-ACU patients 15/24 needed additional local anesthesia intraoperatively while none in the POST-ACU or CG requested extra lidocaine. Postoperatively patients in both PRE- and POST-ACU reported a higher total sum of pain scores (pain intensity) and the PRE-ACU consumed more analgesics compared with the CG. A significantly larger number of patients suffering from "dry socket" (a complication during wound healing) was found in both PRE- and POST-ACU compared with the CG. No correlation was found between assessed personality characteristics and reported postoperative pain/consumption of analgesics in any group and could thus not explain the observed differences between the groups. The reason for our unexpected "negative" findings is unclear but some hypothetical explanations are discussed.
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PMID:Increased postoperative pain and consumption of analgesics following acupuncture. 205 92

At best, most individuals are able to recount two to three of the seven warning signs of cancer [1]. However, this finding is primarily based on free recall of symptoms personally experienced by the respondent. In the present study, a new approach is introduced as an alternative to traditional assessment of knowledge of cancer warning signs. The Knowledge of Cancer Warning Signs Inventory (KCWSI) is a 25 item self-report questionnaire which yields three scores concerning probability judgments about symptoms: basic recognition of the seven warning signs (BRCWS), the extent to which nonwarning signs are perceived to be warning signs (NSPWS), and the extent to which one can accurately discriminate between real and false positive warning signs (accurate knowledge of cancer: AKC). The KCWSI was given to a population who live in a community facing a perceived toxic waste hazard, based on the hypothesis that such a group should be cognizant of the warning signs of cancer because of the serious health threats posed by toxic exposure and the presumed need to engage in greater health preventative activities when living with such an environmental threat. Results show that basic knowledge of the seven cancer warning signs is predicted by AKC, fear of cancer, and a family history of cancer. Misperception of common distress symptoms (of anxiety, somatization, and depression) as symptoms of cancer (nonwarning signs perceived as warning signs: NSPWS) is predicted by fear of cancer, a composite scale of perceived susceptibility to cancer and other health-related problems, Global Symptom Distress, and higher order interactions among the demographic variables of race, gender, income and education. Accurate Knowledge of Cancer (AKC) is associated with lower fear of cancer and lower psychological distress than the other two knowledge measures. The Knowledge of Cancer Warning Signs Inventory yields complex information about how symptoms are perceived and may prove superior to other methods in understanding what people believe about the warning signs of cancer and how this understanding relates to health care behaviors. This study also illustrates the need to pay attention to how health information is measured.
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PMID:Measuring knowledge of cancer. 206 7


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