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

We explored individual differences in health-seeking behavior and health status in a primary care population. Specifically, we compared high monitors (those who typically scan for threat-relevant information) with low monitors (those who typically ignore threat-relevant information), while controlling for depression. Overall, high monitors came to the physician with less severe medical problems than did low monitors. Nevertheless, high monitors reported equivalent levels of discomfort, dysfunction, and distress compared with low monitors. Furthermore, during the week following their visit, high monitors expressed less symptom improvement in both physical and psychological problems than did low monitors. Finally, high monitors demanded more tests, information, and counseling during their visit than did their low monitoring counterparts, yet desired a less active role in their own care. The theoretical and practical implications of these findings are discussed.
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PMID:Styles of coping with threat: implications for health. 334 3

Fourteen patients with severe rheumatoid arthritis refractory to hydroxychloroquine, gold-thioglucose, D-penicillamine and azathioprine completed a 6-month open study with oral methotrexate (2.5 to 5 mg every 12 hours, three doses weekly). Twelve of them were followed up for 12 months. Compared with pretreatment values, there was a significant reduction in duration of morning stiffness (p less than 0.01), in the number of tender or painful joints (p less than 0.02), number of swollen joints (p less than 0.01), visual analog scale, patient's assessment of joint discomfort and overall well-being (p less than 0.01) after 2, 6 and 12 months. Likewise there was an improvement in the erythrocyte sedimentation rate (p less than 0.001) C-reactive protein (p less than 0.01) and the levels of IgG, IgM and IgA (p less than 0.01). Two patients were withdrawn from the study, one for severe diarrhoea and one because of a depression. Adverse reactions during methotrexate therapy included nausea (5/16) and transaminase elevation (4/16). We conclude that this pilot study provides evidence that a weekly low dose of methotrexate is effective in the short-term treatment for patients with rheumatoid arthritis, refractory to hydroxychloroquine, auriothioglucose, D-penicillamine and azathioprine.
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PMID:Methotrexate in refractory rheumatoid arthritis. 341 68

Bulimic and non-bulimic anorexics were compared on psychological variables during a hospital treatment study. Although before treatment bulimic anorexics displayed more overall psychopathology than non-bulimics, many of the differences disappeared with treatment. There was no difference in severity of depression or body size estimation in these groups both before and with treatment. There was no difference in treatment response as measured by rate of weight gain. More expression of discomfort by bulimic anorexics during the acute phase of illness may in part account for some described differences in these two groups.
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PMID:Comparison of bulimic and non-bulimic anorexia nervosa patients during treatment. 343 63

Twenty patients with severe tinnitus who had undergone behavioural treatment, including applied relaxation and perceptual restructuring, were re-assessed 9 months after completion of treatment. Among the self-recorded variables, tinnitus loudness, discomfort from tinnitus, depression, and irritation, discomfort from tinnitus was the only variable which was still significantly reduced. As part of the 9-month follow-up assessment, the patients' recall of the loudness and discomfort from their tinnitus was studied. Correlations between original recordings and recall data were low.
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PMID:Long-term effects of psychological treatment of tinnitus. 343 95

Patients with the fibrositis syndrome experience moderately severe musculoskeletal discomfort, mood changes associated with nonrestorative sleep, and tenderness to palpation at specific body sites. There is no characteristic abnormal laboratory finding in these patients to help identify the population. A report by Moldofsky and Warsh (Pain 1978; 5: 65-71) of low serum levels of free tryptophan in patients with severe fibrositis syndrome is intriguing but remains unexplained. Those data plus the observation by Hudson et al (Am J Psychiatry 1985; 142: 441-446; Biol Psychiatry 1984; 19: 1489-1493) that patients with fibrositis syndrome exhibit an increased prevalence of anxiety and depression suggest a number of possible avenues for further study. They include potential alterations in the homeostasis of catecholamines, corticosteroids, serotonin, aromatic amino acids, platelet membrane receptor levels, and the activity of platelet membrane monoamine oxidase. Among these possibilities, evidence is now available that suggests an increased production of catecholamines in fibrositis syndrome.
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PMID:Is there a metabolic basis for the fibrositis syndrome? 346 8

There appears to be as yet undefined but significant and possibly multifactorial elements of personality, stress, or depression in the manifestations and possibly the pathogenesis of FS. If these factors, perhaps amplified by the neurophysiologic effects of disturbed sleep, produce a neurochemical disturbance in CNS function, and if this perturbation includes a reduction or impairment of function involving the pain-modulation pathways, then a simple and perhaps compelling explanation for the experience of pain in FS becomes apparent. Reduced midbrain/brainstem inhibition of ascending nociceptive impulses would clearly explain the finding of tender points in normal-appearing areas of the body, as well as the lack of segmental distribution of discomfort in FS. Local anesthetics, injected peripherally into tender points, would be expected, as is the case, to block pain and tenderness in the local area for the duration of action of the agent used. Analgesics with peripheral activity, such as aspirin and NSAIDs, are relatively ineffective in treating FS, and would be predictably so in a disorder involving reduced central pain inhibition as opposed to increased peripheral nociceptive input. It would not be surprising to find that centrally acting agents, particularly those producing enhancement of serotonergic neurons such as amitriptyline, would provide substantial or total pain relief as well as improvement in mood in a significant number of patients. Most importantly, this concept would highlight the real pain experienced by these patients and the obligation of involved physicians to appropriately diagnose and treat this common pain syndrome. Avoiding excessive conjecture, it is then permissible at the present time to conclude that: FS is a characteristic, clinically common pain syndrome in which aspects of the pain itself appear to be of physiologic origin. Although stress or inherent personality traits may play a role in FS, the relative uniformity in symptomatology virtually excludes conversion hysteria as a major factor in this disorder. The lack of evidence for a disturbance in muscle, fascia, and other soft tissues in FS, the lack of adequate response to NSAIDs, and the frequent response to TCAs suggest that specific dysfunction of the CNS may play a major role in the symptomatology of this entity. Impaired function of the pain-modulation system, located anatomically in the midbrain and brainstem, provides a plausible explanation for the pain and finding of tender points in FS, as well as a potentially rational basis for therapy.
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PMID:"Fibrositis" syndrome. 351 33

Although the Willoughby Personality Schedule appears to be widely used to assess interpersonal anxiety, there are few studies of its clinical validity or psychometric properties. The purpose of this study was to investigate the factor analytic structure of the Willoughby Schedule in an inpatient psychiatric population. It also explored the relationship of the Willoughby Personality Schedule to the Beck Depression Inventory (BDI), the Gambrill-Richey Assertion Inventory and patient perception of treatment outcome. In contrast to three Willoughby Schedule factors previously reported in research with outpatients, six factors were found in this study. These were moderately correlated with scores on the BDI and the Assertion Inventory discomfort scale. Two Willoughby factors were related to the Assertion Inventory probability of assertive response scale and only one Willoughby factor was related to patient perception of treatment outcome. The overall results raise questions as to the usefulness of the Willoughby Schedule with inpatient populations.
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PMID:A reconsideration of the Willoughby Personality Schedule with psychiatric inpatients. 355 47

In a study of 60 elderly patients in a general hospital referred for psychiatric assessment, the commonest psychiatric disorders were depressive illness (41.6%) and dementia (35.0%). Patients with depression (mean age 69.5 years) were a younger age group compared with dementia (mean age 75.8 years)--this difference is statistically significant (p less than 0.01). Seven patients with depression were admitted for attempted suicide and 5 were referred because of headache and chest discomfort. The main reasons for referral of patients with dementia were disturbed and confused behaviour. The other psychiatric disorders in the sample were delirium (6.7%), paraphrenia (6.7%), alcohol dependence syndrome (5.0%) and anxiety neurosis (5.0%).
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PMID:Psychiatric referrals of elderly patients in a general hospital. 359 77

The safety and efficacy of a disposable, nonelectronic, patient-controlled-analgesia (PCA) device for alleviating postoperative pain were evaluated. Patients who were to undergo abdominal surgical procedures under general anesthesia were instructed in the use of the Travenol Infusor with Patient Control Module. Patients used the PCA device upon emerging from anesthesia in the recovery room. The PCA device delivered a 1-mg i.v. injection of morphine sulfate upon patient demand, with a relative delay of six minutes between allowable administrations. Nursing staff evaluated pain and sedation every four hours using a five-point scale. In the 50 patients evaluated, the highest analgesic use occurred during the first four to eight postoperative hours. After the immediate postoperative period, patients experienced either mild or no pain during approximately 90% of the evaluation periods. No patient suffered respiratory depression during self-dosing. Results of a poststudy self-assessment questionnaire showed that 90% of the patients reported experiencing mild to moderate pain overall, and 78% reported only mild discomfort throughout the postoperative period. Ninety-two percent of the patients strongly preferred PCA therapy over intramuscular injections. The Travenol Infusor with Patient Control Module represents a safe and effective device for PCA therapy of postoperative pain.
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PMID:Evaluation of a disposable, nonelectronic, patient-controlled-analgesia device for postoperative pain. 366 83

Differences between distress ratings of anticipated and experienced life events were examined (N = 168). Results showed significant differences between perceived and experienced aversion across events predicting symptoms of stress, depression, anxiety, and somatic discomfort in occupational, social, and familial situations. Gender differences were also found. Women reported significantly greater ratings of distress than men. Results reinforce the use of experienced events in overall distress assessment for individual clients, bring to question the existence of anticipated or perceived stress, and suggest that gender differences should be accounted for in the interpretation of distress measures.
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PMID:Differences between experienced and anticipatory distress. 376 Jan 99


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