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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To improve recognition and treatment of depression in primary care it would be advantageous to have criteria for identification of later depression. Only a few studies were performed on primary care samples to examine risk factors for new depressive episodes. These were mostly cross-sectional and did not include psychiatric symptoms as possible predictors. This is the first one-year-follow-up study investigating prospectively psychiatric symptomatology as risk factors for depressive episodes in a primary care sample. An international primary care sample of initially non-depressed subjects (n = 2,445) was examined for the presence of depression (ICD-10) at follow-up. Initial measures addressed presence of psychiatric symptoms according to the CIDI-Primary Health Care Version and sociodemographic variables. Logistic regression analysis was carried out to determine the relationship with the development of new depressive episodes. After one year, 4.4% of primary care patients met ICD-10 criteria for a depressive episode. Logistic regression analysis revealed that symptoms of depression and physical, mainly pain-related symptoms were associated with depression at follow-up. General practitioners therefore should be careful in the consideration of depressive symptoms but also of somatic complaints which might precede depression or mask depressive symptomatology. The present results might be helpful for future development of prediction scales.
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PMID:Identification of items which predict later development of depression in primary health care. 1182 30

Primary care for patients suffering from chronic pain is regularly provided by either family physicians or inpatient medical wards. A delay in initiating specific pain treatment is associated with poor outcome in terms of pain intensity, work disability and diminished quality of life. We present a diagnostic classification scheme for chronic pain disorders following the biopsychosocial disease model. This classification may help primary care providers initiate appropriate treatment early in the course of chronic pain, and aid in referral of their patients to services familiar with the treatment of chronic pain. Given increasing requests for quality control in health care and for transparency in disease management by health insurance companies, we propose a coding system of chronic non-malignant pain syndromes with the ICD-10.
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PMID:[Differential diagnosis of chronic pain syndromes of the musculoskeletal system--coding according to ICD-10]. 1199

Recently, device-based low energy cardoversion shocks have been used as therapy for AF. However, discomfort from internal low energy electrical shocks is poorly understood. The aim of this study was to evaluate pain perception with low energy internal discharges. Eighteen patients with ICD devices for malignant ventricular arrhythmias were recruited to receive shocks of 0.4 and 2 J in the nonsedated state. Discharges were delivered in a blinded, random order and questionnaires were used to determine discomfort levels and tolerability. Patients perceived discharges at these energies as relatively uncomfortable, averaging a score of 7.3 on a discomfort scale of 0-10, and could not distinguish 0.4-J shocks from 2-J shocks. Second shocks were perceived as more uncomfortable than initial discharges, regardless of the order in which the shocks were delivered. Despite the perceived discomfort, 83% of patients stated that they would tolerate discharges of this magnitude once per month, and 44% would tolerate weekly discharges. Patients perceive low energy discharges as painful and cannot distinguish between shocks of 0.4 and 2 J. The results suggest that ICD systems developed to treat atrial tachyarrhythmias should minimize the number of shocks delivered to terminate an atrial tachyarrhythmia episode. The majority of the patients tolerated low energy shocks provided the discharges are infrequent (once per month).
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PMID:Internal defibrillation: pain perception of low energy shocks. 1216 52

The Beck Depression Inventory (BDI) is widely used to assess depression in chronic pain despite doubts about its structure and therefore its interpretation. This study used a large sample of 1947 patients entering chronic pain management to establish the structure of the BDI. The sample was randomly divided to conduct separate exploratory (EFA) and confirmatory factor analyses (CFA). EFA produced many satisfactory two-factor solutions. The series of CFA generated showed reasonable fit for ten of those solutions. All included a first factor identified as negative view of the self (items: failure, guilt, self-blame, self-dislike, punishment and body image change), and a second factor identified as somatic and physical function (items: work difficulty, loss of appetite, loss of libido, fatigability, insomnia and somatic preoccupation). The remaining items (suicidal ideation, social withdrawal, dissatisfaction, sadness, pessimism, crying, indecisiveness, weight loss, irritability) loaded infrequently or not at all in the CFA solutions. They did not form a coherent factor but comprised items associated with negative affect. When compared with published data from samples of depressed patients drawn from mental health settings the mean item scores for items reflecting the negative view of the self were consistently statistically lower that that observed in samples; there was no consistent difference between the samples on the items reflecting somatic and physical function; but the mean scores for the remaining affect items were significantly greater in the mental health samples. This version of depression is strikingly different from the psychiatric model of depression (e.g. DSM-IV or ICD-10), which is primarily defined by affective disturbance, and secondarily supported by cognitive and somatic symptoms. The finding is consistent with a reconsideration of what constitutes depression in the presence of chronic pain. It also has important clinical implications: it may provide a way to distinguish depressed patients with typical cognitive biases, who require specific treatment for depression alongside pain management.
Pain 2002 Sep
PMID:A confirmatory factor analysis of the Beck Depression Inventory in chronic pain. 1223 7

Undesirable sensing of external sources of electromagnetic interference by ICDs is well known. A transcutaneous electrical nerve stimulation (TENS) device has been reported to interfere with an ICD resulting in an inappropriate shock and patients with implanted defibrillators or pacemakers have been cautioned about the use of such units to treat chronic pain. We describe a patient regularly using TENS therapy for pain who subsequently received a biventricular ICD for malignant ventricular arrhythmias and medically refractory cardiac failure. He underwent testing for device interaction immediately post-implant. This did not show inappropriate sensing by either ICD or pacemaker component of his heart failure device. However, six months later, the patient complained of dizziness and bradycardia with application of TENS. Further testing did reveal interference with pacemaker function. Thus, even if initial testing is negative and reassuring, patients with a biventricular ICD still require careful follow-up for potential interaction and should be cautioned against the use of TENS, especially if they are pacemaker-dependent.
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PMID:The simultaneous use of a biventricular implantable cardioverter defibrillator (ICD) and transcutaneous electrical nerve stimulation (TENS) unit: implications for device interaction. 1250 47

In the course of a WHO study,we report on the prevalence of somatoform disorders (SFD) and the associated psychosocial impairment in five western German primary care settings. In accordance with ICD-10 classification, a 4-week prevalence of 28.5% was found for SFD (number of patients in the age between 18 and 60 with an SFD in the last 28 days). The accumulation of SFD was higher in female patients than in males (RR 1.7), in particular when the number of children was >1 (RR 1.8). The female-male difference was more marked in persistent somatoform pain disorder (RR 2.1) and unspecific somatization disorder (RR 5.0). Concerning other psychiatric disorders, neurasthenia occurred most frequently,with a 4-week prevalence of 8.2%. The 4-week prevalence of concomitant occurrence of SFD and other psychiatric disorders was 7.7%. Working capability was most severely impaired, with 22.5 days of absence from work during the last month, in male patients with hypochondriacal disorder. In comparison, somatization disorder resulted in a severe level of psychosocial impairment, with 10.3 days of absence in work during the last month in female patients. The coexistence of SFS with other psychiatric disorders resulted in a greater extent of psychosocial impairment.
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PMID:[The 4-week prevalence of somatoform disorders and associated psychosocial impairment]. 1262 39

Neuromuscular electrical stimulation (NMES) is a frequently applied therapy for the treatment of pain and a therapeutic option to increase thigh muscle strength and endurance capacity in patients with heart failure. Electromagnetic interference (EMI) by the signals with sensing of ICDs is possible. Eight patients with subpectoral ICD systems and different transvenous bipolar sensing leads were subjected to electrical stimulation of the neck and shoulder and of the thighs using different stimulation algorithms. EMI with ventricular sensing was detectable in three of eight subjects. EMI occurred during stimulation of the neck (n = 2) and thigh (n = 2). EMI by NMES with atrial sensing was seen in two of four subjects with dual chamber ICDs. The safety of peripheral NMES has to be individually tested as EMI can also occur in ICD patients with bipolar sensing.
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PMID:Electromagnetic interference by transcutaneous neuromuscular electrical stimulation in patients with bipolar sensing implantable cardioverter defibrillators: a pilot safety study. 1271 Mar 24

We examined 143 patients, aged 18-65 years, with chronic low back pain, in 78 of patients diagnosed as chronic somatoform pain disorder (CSPD)--ICD-10 F45.4--and in 65 as chronic pain syndrome (CPS) caused by spine pathology (M48.0, M51.1, M54.4). Depressive symptoms predominated in CSPD patients, who exhibited more pronounced psychopathological disturbances and two-fold higher frequency of personality disorders, comparing to those with CPS. In CSPD patients pain severity and reaction to pain syndrome were significantly higher than in CPS patients. Psychodiagnostic study revealed higher expressed anxiety and depression as well as socio-psychological maladaptation in CSPD patients as compared to CPS ones. After neurological examination, significant between-group differences were found in the frequency of muscular-tonic myofacial, syndrome and iliosacral joint dysfunction.
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PMID:[Psychiatric, psychological, and neurological characteristics of patients with chronic low back pain]. 1280 May 48

The aim of this paper is to report on the prevalence of somatoform disorders in older age. A total of 630 representatively selected persons older than 60 years were asked to complete the questionnaire SOMS 2 (Screening for somatoform disorders, Rief et al., 1997). The results show that somatoform pain is very common in old age. Of the people, 71.8% report at least one symptom, 50.5% on at least four symptoms and 23.4% suffer from at least eight symptoms. The frequency of somatoform symptoms is much higher in people over 60 years old than in persons who are younger than 60 years old. Pain is very often localized in several body regions. In contrast to findings from younger age groups, older women do not report more somatoform pain than older men. When looking at the differences between "young olds" and "old olds" somatoform pain increases with increasing age. The high frequency of somatoform pain in older people is in clear contrast to the low prevalences of somatoform disorders defined according to DSM-IV or ICD-10 (0%-0.3%). The results show that the real prevalence of somatoform disorders is extremely underestimated because of the restrictive criteria of the diagnosis systems.
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PMID:[Somatoform complaints in elderly of Germany]. 1293 34

Somatization is common among children and adolescents. A consecutive series of 112 children and adolescents who fulfilled the ICD-10 clinical diagnostic criteria for somatoform disorders attended at a psychiatric consultation center were included in this study to delineate the pattern of presenting features and to find out associated abnormal psychosocial situations and disabilities. Out of 112 cases 52 were boys, 60 girls, of them 59 were children and 53 adolescents. Polysymptomatic presentation was commoner (92%) than monosymptomatic presentation (8%). Pain was the most prevalent symptom. Children showed significantly higher rates of abdominal complaints and adolescents showed higher rates of headaches. All cases reported an average of 14.21 somatic symptoms. Boys and girls reported an average of 13.75 and 14.61 somatic symptoms respectively and this difference between two groups was not significant. Whereas children reported an average of 12.66 somatic symptoms and adolescents reported an average of 15.94 somatic symptoms. The difference was significant. Differences were also found in the diagnostic categories of somatoform disorders. Girls reported higher rates of somatization disorder and persistent somatoform pain disorder than that of boys. Children reported higher rates of undifferentiated somatoform disorder and somatoform autonomic dysfunction. In contrast, adolescents reported higher rates of somatization disorder. Abnormal psychosocial situations were found to be associated with predisposition, onset, and course of the disorders in majority of the cases and most common was parental overprotection. Remarkable social impairments particularly, in the domains of academic and peer relationship were found among the cases. Findings suggest that somatoform disorders in children and adolescents are frequent in clinical practice. Better understanding of these disorders can promote early diagnoses and timely treatments and improve the quality of life by preventing negative consequences.
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PMID:Somatoform disorders in children and adolescents. 1450 83


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