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

The nature of psychiatric disorders in tropical regions is affected much more by the effect on the patient of certain environmental and cultural factors than by any specific features of tropical diseases. In places where the standards of health care and health education are not yet fully developed, abnormalities of physical development, particularly those affecting the development of the cerebral cortex, are of great importance. For example, protein-energy malnutrition may result in deficits in cerebral maturation and efficiency that reduce the capacity of the brain to manage its behavioural functions and may give rise to impaired capacities for concentration, foresight, and judgement and impairment of inhibitory control over intensely experienced emotions. In addition, certain cultural attitudes that are widespread in pre-literate societies influence the type of secondary reaction to disease: for example, acute symptoms tend to be florid and uninhibited, and violently experienced and externalized emotions such as hilarity, terror, anger, and grief are the rule rather than the exception.Certain tropical diseases are, however, the direct cause of severe disturbance of cerebral functioning, while others affect only the finer cerebral controls so that normally controlled fears, anxieties, and other personality traits emerge. These specific brain syndromes may be acute or chronic and may be triggered by an apparently trivial physical cause. Acute brain syndromes appear to be more common in tropical countries perhaps because in the adult the cerebral cortical reserve is less than it ought to be because of the prevalence of earlier minimal brain damage. Formal psychiatric reactions are, of course, also seen in tropical countries, but the expression of, for example, schizophrenia, hypomanic and manic states, and depression is coloured by the underlying personality and the cultural background of the patient. Perhaps in no other setting is the intimate relationship between behaviour and the physical body seen more clearly than in populations living in the tropics and it is important that health workers in these regions should be aware of the role played by earlier or concurrent physical disease in behavioural disturbance.
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PMID:The psychiatric aspects of tropical disorders. 31 50

Neuropsychological findings in 10 clinical cases of progressive supranuclear palsy are presented. Patients were aged 52 to 80 and the duration of their illness was 1 to 5 years. Severe psychological disturbances e.g. depression or outbursts of irritability were prominent features in 5 patients. Formal neuropsychological testing disclosed mental slowing, impaired attention, reduced verbal fluency and elaborated linguistic abilities, poor abstract thinking and reasoning, mild to moderate memory loss, dynamic apraxia, grasping, motor impersistence, imitation and utilization behaviour. The clinical similarities between these neuropsychological changes and frontal lobe syndromes, together with the lack of cortical involvement, suggest that the "dementia" of progressive supranuclear palsy could be explained by deactivation of the frontal cortex by subcortical lesions. The special importance of pallidal and mesencephalic reticular involvement in the syndrome is hypothetized.
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PMID:[Frontal syndrome of progressive supranuclear palsy]. 408 15

The social adjustment and psychological characteristics of a group of patients with lesions presumed to be representative of an 'ordinary' pain clinic population have been examined. As expected there was a significant degree of disturbance of work, sleep, sport, exercise, leisure and social activities and sexual relationships. Patients with back pain found sitting to be particularly troublesome (P less than 0.0001) which suggests that they would have physical reasons for responding to programmes emphasizing 'activity.' They used more affective words proportionately to describe it than those with pain elsewhere, but both groups used far more sensory words overall than affective ones. Formal depression of the type measured by the Levine-Pilowsky Depression Questionnaire which corresponds to the psychiatric interview was not prominent. On the SCL-90, a more widely ranging type of psychological test, there were marked elevations on the somatization scale which are partly artifact, and also significant elevations for obsessive traits, depression, anxiety and general symptoms. Questions in the tests concerning irritability and frustration were frequently answered affirmatively. Low-back pain patients and compensation patients did not differ significantly from the remainder on the SCL-90 or on the Levine-Pilowsky Questionnaire. The findings are taken to indicate an understandable pattern of emotional response to chronic pain whether in the low back or elsewhere, as well as a specific difference in descriptions in patients with low-back pain. They are held to support the view that many patients receiving compensation have the same pattern of emotional response as those who do not obtain financial payment because of their illness.
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PMID:A description of the psychological effects of chronic painful lesions. 621 63

The aim of the study was to investigate differences in some temperamental traits during depressive phase and in remission. The group of 30 patients with endogenous depression was compared with 30 healthy controls. All subjects completed Formal Characteristic of Behaviour-Temperamental Questionnaire (FCZ-KT by Zawadzki-Strelau) and were investigated by computer exposed task from Wiener-Testsystem (WT). Alertness subscale from FCZ-KT differentiates affective patients (in depression and remission) from healthy persons. Improvement of results during remission in scales from FCZ-KT: Alertness, Perseveration and Activity was observed. WT was more a sensitive method to show differences between patients with affective disorders and healthy persons. Results in WT during remission have demonstrated that deficits in Alertness, Perseveration, Reaction Time, Decision Making Time tasks even after depressive phase are still present.
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PMID:[Evaluation of selected temperamental traits in depression and in remission]. 897 62

Depression frequently coexists with dementia, although in many cases the depression is not recognized clinically. Depression represents a major additional burden in dementia, not only for the patients but also for families, caregivers, and, economically, society as a whole. However, depression in patients with dementia does respond to treatment, and appropriate therapy can significantly improve the well-being of these patients. Depression in patients with dementia is currently treated with a variety of standard antidepressive agents (tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors), but none is free from significant side effects. Moreover, the use of these drugs is often complicated by a number of age-related factors or effects on the cholinergic neurotransmitter system. Consequently, an antidementia treatment with concomitant antidepressive properties and an acceptable benefit/risk ratio would represent an attractive therapeutic option. The pathogenesis of depression in patients with dementia is not well understood, but may be related to increased intracellular calcium ions in the CNS, the so-called "calcium hypothesis." This hypothesis may explain why some calcium antagonists exert psychotropic effects, including putative antidepressant activity. Animal models and clinical data provide support for the use of calcium channel antagonists for the treatment of depression, with the potential for good tolerability. The latter aspect is especially important for elderly patients with dementia. Although antidepressive effects have been seen with a number of calcium channel antagonists, the dihydropyridine derivative nimodipine shows particular potential for clinical use, perhaps because nimodipine is one of the most lipophilic of these drugs and therefore achieves high concentrations in the CNS, and because of the unique biochemical properties of the dihydropyridine compounds compared with other L type calcium channel blockers. Nimodipine also increases somatostatin levels in CSF, one of the cardinal biochemical deficits in Alzheimer's disease. Data obtained incidentally from the use of nimodipine in the treatment of elderly demented patients clearly demonstrate significant antidepressant activity by the drug in this patient group. Formal clinical evaluation is therefore recommended to establish more clearly the therapeutic benefits offered by nimodipine in patients who suffer from both dementia and depression.
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PMID:The management of coexisting depression in patients with dementia: potential of calcium channel antagonists. 903 70

Quality of Life (QOL) questionnaires contain two different types of items. Some items, such as assessments of symptoms of disease, may be called causal indicators because the occurrence of these symptoms can cause a change in QOL. A severe state of even a single symptom may suffice to cause impairment of QOL, although a poor QOL need not necessarily imply that a patient suffers from all the symptoms. Other items, for example anxiety and depression, can be regarded as effect indicators which reflect the level of QOL. These indicators usually have a more uniform relationship with QOL, and therefore a patient with poor QOL is likely to have low scores on all effect indicators. In extreme cases it may seem intuitively obvious which items are causal and which are effect indicators, but often it is less clear. We propose a model which includes these two types of indicators and show that they behave in markedly different ways. Formal quantitative methods are developed for distinguishing them. We also discuss the impact of this distinction upon instrument validation and the design and analysis of summary subscales.
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PMID:Causal indicators in quality of life research. 929 Mar 6

Although evaluation of psychosocial risk factors prior to perinatal hospital discharge has been advocated, the means for accomplishing such an evaluation are not well established. This article reviews several major psychosocial risk factors together with instruments that have been utilized to assess them during the perinatal period. Formal constructs reviewed include anxiety, depression, self-concept, general attitudes, life events, stress, adaptation, social support, marital and family functioning, and the home environment. Ongoing assessment of psychosocial status using formal instruments during routine perinatal care may provide a more complete picture of the psychosocial needs of the individual mother and her family, allowing for more appropriate, timely intervention and utilization of social and health care resources.
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PMID:The perinatal assessment of psychosocial risk. 964 2

This study examined (1) the direct effect of the duration of caregiving on caregiver psychological distress, and (2) two- or three-way interactions between duration, stressors (elderly's physical and cognitive impairments), and personal (caregiver's economic or work status) or social (informal or formal supports) resources. We interviewed 833 primary family caregivers of non-institutionalized frail elderly who had been selected through a screening process of all residents aged 65 and over (21,567 persons) in a suburban area of Tokyo. Caregiver psychological distress was evaluated by "Caregiving Burden Scale" as a caregiving-specific psychological measurement, and "Center for Epidemiologic Studies Depression Scale (CES-D)" as a general psychological measurement. The results were as follows. 1. For Caregiving Burden, duration showed a direct effect, as those who had been providing care for a longer duration of time reported higher burden. We found no interactions between duration, stressors, and resources on caregiving burden. 2. For CES-D, duration had interactions, but no direct effect. (1) Two-way interactions were observed between duration and caregiver's economic or work status, as caregivers with a low economic status or who were unemployed showed a stronger negative impact from duration of caregiving. (2) Three-way interactions were observed between duration, the elderly's ADL impairment, and informal support. Informal support, such as a secondary caregiver, buffered the negative impact of the elderly's ADL impairment in cases with a shorter duration of caregiving, but not for those with longer duration. (3) Three-way interactions were observed between duration, the elderly's cognitive impairment, and formal emotional support. Formal emotional support buffered the negative impact of the elderly's cognitive impairment for those with a longer duration of caregiving, but not for those with a shorter duration. These findings suggest that stress-buffering resources differ according to duration of caregiving.
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PMID:[Impact of duration of caregiving on stress among primary caregivers of elderly]. 969 62

We prospectively screened for anxiety and depression by administering the HAD scale to consecutive general medical patients admitted to a Scottish District General Hospital (DGH) over a calendar month. Age, gender, and use of psychotropic medications were also recorded. Of 119 patients (49 male) aged 16 to 92 years, "Probable presence of anxiety" was recorded in 23%, and "Probable presence of depression" in 19%. There was no significant difference between male and female patients or between different age groups. Formal psychological management was not available on site. Sixty-seven per cent of patients with "Probable presence of anxiety" and 61% with "Probable presence of depression" received no psychotropic medications. Despite a high prevalence of psychological distress amongst general medical in-patients, anxiety and depression are consistently under-diagnosed and under-treated. Screening for psychological distress, followed, where indicated, by psychological and/or pharmacological intervention, should be a fundamental element of holistic, patient-centred care in general medicine.
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PMID:Screening for anxiety and depression in adult general medical in-patients in a Scottish District General Hospital. 992 55

This paper presents data on the experience of hysterectomy from a sample of 656 women aged between 30 and 50 years recruited from patients of a random sample of 50 general practices in Perth. Respondents were identified as women who: had undergone hysterectomy for reasons other than cancer; were affected by gynaecological conditions; had neither gynaecological problems nor had undergone hysterectomy. Respondents voluntarily completed a self-administered questionnaire which covered demographic information, general health, gynaecological problems and hysterectomy, sexual activities, and family relationships. Formal measures of depression and self-esteem were included. The main concern was with the psychological and social outcomes of hysterectomy rather than its physical results. The findings showed that of 107 women who had undergone hysterectomy, only two had negative comments about the outcome. There were significant effects on both work and sexual relationships for women in the gynaecological condition group, with 52 per cent reporting adverse effects on work and 46 per cent believing that their sexuality was affected. Few women regarded the uterus as 'essential to femininity or womanhood' and very few saw it as affecting sexuality. Women in the hysterectomy group reported that their satisfaction with sexual activity had improved, whereas those with gynaecological conditions believed that it had deteriorated. Depression and self-esteem scores were significantly worse for women with gynaecological conditions.
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PMID:Women's subjective experience of hysterectomy. 1018 60


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