Psychosomatics ORIGINAL RESEARCH REPORTS

Pattern of Depressive Symptoms in Parkinson's Disease [ORIGINAL RESEARCH REPORTS]

Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Depressive symptoms are common in Parkinson’s disease (PD); however, it is unclear whether there are specific depressive symptom patterns in patients with PD and comorbid depression (dPD). OBJECTIVE: The goal of this study is to examine the frequency and correlates of specific depressive symptoms in PD. METHOD: A sample of 158 individuals with PD completed the self-rated Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS). By multiple-regression analysis, the authors examined the association between HANDS total and subscale scores and various demographic variables. RESULTS: The frequency of depression was 37% (N=58). Patients with a history of depression before PD had significantly more serious depression than those who had no such history. Of those who were more depressed, the most common symptoms of depression endorsed were low energy, difficulty with concentration/making decisions, feeling blue, feeling hopeless, and having poor sleep. CONCLUSION: There is a relatively high prevalence of dPD. Items on the HANDS that discriminated best between depressed and nondepressed subjects with PD included feeling blue, feeling hopeless, feeling worthless, lack of interest, and self-blame. It remains to be defined whether dPD should be understood primarily as a psychological reaction to a physical disability or perceived impending one, or as a direct expression of the neuropathology of PD.

Fatigue in Psychiatric HIV Patients: A Pilot Study of Psychological Correlates [ORIGINAL RESEARCH REPORTS]

Paddison, J., Fricchione, G., Gandhi, R. T., Freudenreich, O. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Even though viral management of HIV infection is now more effective, clinical observations suggest that fatigue remains a problem for a substantial proportion of patients. OBJECTIVE: The authors delineated prevalence and severity of fatigue in HIV patients with psychiatric comorbidities and examined psychological correlates of fatigue. METHOD: The authors comprehensively assessed fatigue in 38 consecutive HIV patients referred for psychiatric treatment with the Identity-Consequence Fatigue Scale. RESULTS: About 80% of patients reported at least moderate feelings of fatigue, and about 25% judged that fatigue was severely affecting their daily functioning. Depression, anxiety, and perceived stress explained between 20% and 75% of the variance in fatigue ratings. DISCUSSION: The results suggest that fatigue in the era of effective antiretroviral treatment is prevalent, relevant, and related to psychological morbidities. Recognition and treatment of these comorbidities may be important in reducing this fatigue.

Poor Perceived Social Support in Implantable Cardioverter Defibrillator (ICD) Patients and Their Partners: Cross-Validation of the Multidimensional Scale of Perceived Social Support [ORIGINAL RESEARCH REPORTS]

Pedersen, S. S., Spinder, H., Erdman, R. A.M., Denollet, J. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Social support is a known buffer of psychological distress and has also been shown to influence adverse medical outcomes. OBJECTIVE: The authors investigated the role of social support and its correlates in patients with an implantable cardioverter defibrillator (ICD) and their partners. METHOD: The authors cross-validated the Multidimensional Scale of Perceived Social Support (MSPSS) in Danish and Dutch cardiac patients and their partners and examined correlates of poor support. RESULTS: The three-factor structure of the MSPSS, its validity, and internal consistency were confirmed, with the test–retest reliability found to be lower than in previous studies. Being an ICD patient or an ICD partner, as compared with a chronic heart failure (CHF) patient, having no partner, and having a Type D personality were correlates of poor support, independent of anxiety and depressive symptoms. CONCLUSIONS: The validity and reliability of the MSPSS were confirmed in a mixed group of Dutch and Danish cardiac patients and their partners. Preliminary findings indicate that ICD patients and their partners may be more in need of support than CHF patients.

Psychiatric Evaluation of Mental Capacity in the General Hospital: A Significant Teaching Opportunity [ORIGINAL RESEARCH REPORTS]

Kornfeld, D. S., Muskin, P. R., Tahil, F. A. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Requests for evaluation of mental capacity in general hospitals have increased in frequency. OBJECTIVE: The authors sought to determine the interventions required to respond adequately and assess the initiating circumstances. METHOD: Questionnaires completed by psychiatric consultants were analyzed, and chart reviews were completed. RESULTS: Capacity evaluation alone resolved 32% of the requests; 31% required an evaluation plus additional interventions; 37% did not require a capacity evaluation. Patients threatening to leave against advice, and/or refusing treatments or procedures represented 64% of requests. Consultants successfully resolved 88% of such cases. CONCLUSION: A mental capacity evaluation alone was insufficient to resolve two-thirds of problems eliciting requests. Consultation–liaison psychiatrists can use these evaluations as teaching opportunities.

Obesity and Quality of Life: A Controlled Study of Normal-Weight and Obese Individuals [ORIGINAL RESEARCH REPORTS]

Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Obesity is a major public health problem that is associated with substantial morbidity and mortality. OBJECTIVE: The authors investigated the associations between health-related quality of life (HRQL) and Body Mass Index (BMI), gender, age, mental and somatic disorders, as well as therapy-seeking status. METHOD: A cross-sectional controlled study assessed 640 male and female individuals, clustered into four weight categories. RESULTS: Linear-regression analyses revealed that higher BMI, higher age, and higher numbers of current somatic and mental disorders negatively predicted the physical dimension of HRQL. Higher numbers of both mental and somatic disorders as well as female gender and younger age seemed to be independent negative predictors of mental HRQL, whereas BMI was not associated with mental HRQL. Therapy status was not related to mental or physical HRQL. CONCLUSION: Physical and mental disorders are important detrimental factors for both physical and mental dimensions of HRQL.

Anxiety Predicts Poor Perceived Health in Patients With an Implantable Defibrillator [ORIGINAL RESEARCH REPORTS]

van den Broek, K. C., Nyklicek, I., Denollet, J. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Implantation with an implantable cardioverter defibrillator (ICD) may cause psychological problems, including anxiety. OBJECTIVE: The objective was to determine whether general anxiety and disease-specific anxiety differentially predict poor perceived health in ICD patients. RESULTS: Patient concerns about the ICD and feelings of disability were independently predicted by general as well as disease-specific anxiety. Clinical anxiety was predicted by general anxiety only, whereas cardiopulmonary symptoms were predicted by disease-specific anxiety. CONCLUSION: Identifying and supporting ICD patients with various anxiety symptoms is important. Future research should examine the differential predictive value of different forms of anxiety toward medical endpoints as well as possible interventions for disease-related anxiety.

Minor Depression as a Short-Term Risk Factor in Outpatients With Congestive Heart Failure [ORIGINAL RESEARCH REPORTS]

Rafanelli, C., Milaneschi, Y., Roncuzzi, R. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: In the past decade, there has been an increasing awareness of both quality-of-life impairment and the negative prognostic role of depression in congestive heart failure (CHF) patients. OBJECTIVE: The aims of this study were to evaluate distress, psychological well-being, and clinical and subclinical depression in 68 CHF outpatients at Bellaria Hospital in Bologna, Italy, at an initial assessment and at a 2-month routine follow-up visit. RESULTS: Patients reported a high prevalence of somatic complaints, depression, and demoralization, and low scores on psychological well-being. Among the variables examined as potential risk factors for cardiovascular outcome events, based on rehospitalization and cardiac death, only minor depression attained statistical significance. CONCLUSION: Clinicians should thus assess minor depression among other psychological variables in these patients.

Antiviral Completion Rates and Sustained Viral Response in Hepatitis C Patients With and Without Preexisting Major Depressive Disorder [ORIGINAL RESEARCH REPORTS]

Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Despite evidence suggesting that the majority of patients with hepatitis C virus (HCV) have psychiatric and substance use disorders, patients with these comorbidities have historically been excluded from antiviral therapy for HCV. OBJECTIVE: The authors compared antiviral completion and sustained virologic response (SVR) rates between hepatitis C (HCV) patients with versus those without preexisting major depressive disorder (MDD). METHOD: The authors performed a chart review of HCV patients (30 with MDD and 25 control subjects) who attended an optional HCV education class and signed informed consent allowing collection of clinical data. RESULTS: The MDD group had completion and SVR rates similar to those of control subjects. Neuropsychiatric side effects and reasons for discontinuation of treatment were not different between groups. CONCLUSION: Patients with MDD can be safely and effectively treated with antiviral therapy.

Symptoms of Depression and Delirium Assessed Serially in Palliative-Care Inpatients [ORIGINAL RESEARCH REPORTS]

Leonard, M., Spiller, J., Keen, J., MacLullich, A., Kamholtz, B., Meagher, D. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Delirium occurs in approximately 1 in 5 general hospital admissions and up to 85% of patients with terminal illness, but can be difficult to differentiation from other disorders, such as depression. OBJECTIVE: The authors assessed and compared mood states as they relate to onset of delirium. METHOD: Symptoms of depression and delirium were assessed in 100 consecutive palliative-care admissions immediately after admission and 1 week later. RESULTS: Overall, 51% experienced either major depression or delirium. Most patients with syndromal delirium also met criteria for major depressive illness, and 50% of those with depression had delirium or subsyndromal delirium (SSD). Delirium symptoms were less common in patients with major depression than depressive symptoms in patients with delirium or SSD. DISCUSSION: Delirium should be considered in patients with altered mood states, and screening for depression should initially rule out delirium. Sustained alterations in mood may be more frequent in delirium than previously recognized.

Medically Unexplained Physical Symptoms in Primary Care: A Controlled Study on the Effectiveness of Cognitive-Behavioral Treatment by the Family Physician [ORIGINAL RESEARCH REPORTS]

Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Disabling medically unexplained physical symptoms occur in 16% of all patients in primary care. OBJECTIVE: The aim of this study was to assess the effectiveness of a cognitive-behavioral intervention by the family physician. METHOD: In a controlled design with detailed information on patient selection, 6,409 patients were screened on somatoform disorder, and 65 participants were allocated to care-as-usual or the experimental condition. RESULTS: After 6 and 12 months, the cognitive-behavioral intervention by trained family physicians was not more effective than care-as-usual. CONCLUSION: Possibly, the intensity of treatment was insufficient for the severe and persistent symptoms that were encountered in primary care.

Religiosity and Hope: A Path for Women Coping With a Diagnosis of Breast Cancer [ORIGINAL RESEARCH REPORTS]

Hasson-Ohayon, I., Braun, M., Galinsky, D., Baider, L. — Fri, 23 Oct 2009 10:47:50 PDT

BACKGROUND: Both religiosity and hope are known for their positive role in coping with cancer. OBJECTIVE: This study examines the mediating role of hope between religiosity and coping for women diagnosed with breast cancer. METHOD: Israeli Jewish women with breast cancer (N=233) completed the Mental Adjustment to Cancer Scale, The Systems of Belief Inventory, and The Hope Scale. RESULTS: By use of hierarchical regression, hope was found to be a mediator between religiosity and three coping styles. CONCLUSION: Special attention should be given to the role of hope for religious patients because it increases the positive effects of religion in coping with cancer.

Clinical Presentation of Bipolar Mania in HIV-Positive Patients in Uganda [ORIGINAL RESEARCH REPORTS]

Nakimuli-Mpungu, E., Musisi, S., Mpungu, S. K., Katabira, E. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: Secondary mania in HIV-positive individuals has been well documented; however, cases of bipolar mania in HIV infection occur, as well. OBJECTIVE: This is the first controlled study of the demographic and clinical characteristics of bipolar mania and secondary mania in persons with HIV/AIDS in Uganda and Africa. METHOD: Patients were consecutively recruited from the adult psychiatric wards of Makerere University (Uganda) teaching hospitals. Diagnosis of acute manic episode was based on DSM–IV criteria. RESULTS: The HIV-positive patients with bipolar mania had more immune suppression and more cognitive impairment, suggesting that these patients may already have been cognitively and functionally impaired by their mental illness by the time they acquired HIV infection. DISCUSSION: These findings may be used to help clinicians and policymakers recognize and design appropriate interventions for this vulnerable group of patients. Further studies to delineate the phenomenology of mania in patients with HIV infection/AIDS are warranted.

Somatization Symptoms Are Related to Right-Hemispheric Primary Brain Tumor: A Population-Based Prospective Study of Tumor Patients in Northern Finland [ORIGINAL RESEARCH REPORTS]

Mainio, A., Hakko, H., Niemela, A., Koivukangas, J., Rasanen, P. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: Somatization symptoms have been found to be early symptoms of tumor among brain tumor patients. OBJECTIVE: The authors followed patients through diagnosis of brain tumor and subsequent surgery. METHOD: Patients with a supratentorial tumor were given repeated measurements for somatization with the Crown-Crisp Experiential Index. RESULTS: Before tumor operation, the patients with a tumor in the right hemisphere had significantly higher somatic anxiety scores than those with a tumor located in the left hemisphere. The specific symptoms were dizziness and palpitation among patients with a right hemispheric tumor. CONCLUSION: It is important to remember possible very unusual causes behind somatization symptoms.

Attitudes of Neuroscience Nurses Toward Patients With Conversion Symptoms [ORIGINAL RESEARCH REPORTS]

Ahern, L., Stone, J., Sharpe, M. C. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: Patients with conversion symptoms on neurology wards often report negative interactions with nursing staff. Objective/METHOD: The authors therefore systematically studied, by means of an anonymous questionnaire, the attitudes of neuroscience nurses (N=68) toward these patients. RESULTS: Negative attitudes were common: 16% disagreed that conversion symptoms were "real;" 46% thought the patients were "manipulative;" and 34% disagreed that neurology was "an appropriate place" for these patients. Levels of self-perceived knowledge were low. CONCLUSION: These negative attitudes toward patients are likely to impair effective management. Illness beliefs of patients with conversion symptoms need to be understood in the context of the beliefs of the health professionals looking after them.

Differences in Physical and Mental Health Symptoms and Mental Health Utilization Associated With Intimate-Partner Violence Versus Childhood Abuse [ORIGINAL RESEARCH REPORTS]

Nicolaidis, C., McFarland, B., Curry, M., Gerrity, M. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: There is ample evidence that both intimate-partner violence (IPV) and childhood abuse adversely affect the physical and mental health of adult women over the long term. OBJECTIVE: The authors assessed the associations between abuse, symptoms, and mental health utilization. METHOD: The authors performed a cross-sectional survey of 380 adult female, internal-medicine patients. RESULTS: Although both IPV and childhood abuse were associated with depressive and physical symptoms, IPV was independently associated with physical symptoms, and childhood abuse was independently associated with depression. Women with a history of childhood abuse had higher odds, whereas women with IPV had lower odds, of receiving care from mental health providers. CONCLUSION: IPV and childhood abuse may have different effects on women’s symptoms and mental health utilization.

Association Between Anxiety and C-Reactive Protein Levels in Stable Coronary Heart Disease Patients [ORIGINAL RESEARCH REPORTS]

Bankier, B., Barajas, J., Martinez-Rumayor, A., Januzzi, J. L. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: Anxiety is highly prevalent among patients with stable coronary heart disease (CHD). However, the biologic effects that may connect these two seemingly unrelated disorders is not well understood. OBJECTIVE: This study aimed for a comprehensive evaluation of anxiety in stable CHD patients, in addition to cardiac biomarkers such as C-reactive protein (CRP), troponin T, and amino-terminal pro-B-type brain natriuretic peptide. METHOD: The study included 43 CHD patients with anxiety disorder and 42 CHD patients without psychiatric disorder given the Structured Clinical Interview for DSM–IV. RESULTS: Regression analyses showed an association between anxiety (anxiety disorder, not otherwise specified) and CRP levels, despite model adjustment for various related demographic and clinical variables. Anxiety was associated with CRP levels. CONCLUSION: There are significant associations between anxiety and CHD risk, with a potential biologic link between anxiety and elevations in a biomarker with powerful prognostic risk, namely CRP. It is not clear whether this association is directly causal or relates to other medical processes among patients with heightened anxiety. The findings suggest that the current focus on depressive disorders with respect to biomarkers and CHD outcomes should be broadened to include anxiety disorders, as well.

The Five-Year Evolution of a Mixed Psychiatric and Somatic Care Unit: A European Experience [ORIGINAL RESEARCH REPORTS]

Alberque, C., Gex-Fabry, M., Whitaker-Clinch, B., Eytan, A. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: There are virtually no reported experiences of mixed medical/psychiatry inpatient units in Europe. Such a program was created in Geneva, Switzerland, in 1999. OBJECTIVE: The authors retrospectively analyzed clinical data from its first 5 years of operation. METHOD: These data represent 1,380 hospitalizations. A descriptive analysis was carried out on all collected data for each year of activity. RESULTS: The severity of physical disorders increased with time. The number of medical comorbidities, length of hospital stay, and compulsory admissions increased. The proportion of mood disorders decreased, whereas the proportion of psychotic and adjustment disorders increased. CONCLUSION: Patients with comorbid medical and psychiatric disorders are often refused admission to both medical and psychiatric wards. Once they are admitted, they are often released prematurely or transferred to another ward too quickly because of behavioral management difficulties. Physicians who refer patients to the unit recognize the complex nature of these cases and refer them because the unit is capable of offering acute psychiatric and medical treatments and provides an environment that encourages patient cooperation and treatment adherence.

Suffering and Posttraumatic Growth in Women With Systemic Lupus Erythematosus (SLE): A Qualitative/Quantitative Case Study [ORIGINAL RESEARCH REPORTS]

Wittmann, L., Sensky, T., Meder, L., Michel, B., Stoll, T., Buchi, S. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: In spite of the evident importance of suffering, the medical and psychological literature, with some exceptions, contains few contributions toward an understanding of its phenomenology, etiology, and alleviation.OBJECTIVE: To enhance understanding of suffering in chronic physical disease, the authors applied qualitative content analysis to semistructured interviews with 12 patients with systemic lupus erythematosus.METHOD: This study was intended to be exploratory, adopting a predominantly qualitative approach, supplemented with quantitative data. Case reports, complemented by psychometric and objective illness-related data, were used to elucidate a model of suffering and to explain its etiology and its interaction with personal growth.RESULTS: Findings were consistent with the concept of suffering as a psychological process triggered and sustained by an appraised threat to the "Self" or "Personhood."CONCLUSION: Results indicate that various types of suffering have to be differentiated. Recognizing personal growth in response to the illness-experience may reduce suffering.

Coping Patterns and Psychosocial Distress in Female Partners of Prostate Cancer Patients [ORIGINAL RESEARCH REPORTS]

Couper, J., Bloch, S., Love, A., Duchesne, G., MacVean, M., Kissane, D. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: With medical advances since the 1990s, a growing proportion of patients are living for many years with prostate cancer (PCA) and the consequences of its treatment.OBJECTIVE: The authors investigated the experience of being diagnosed with cancer and the effects of its treatment on patients’ partners.METHOD: The authors conducted an observational, longitudinal study of 103 couples facing the diagnosis of either localized (potentially curable) or metastatic (incurable) PCA at Time 1 and then 6 months later (Time 2).RESULTS: At both Time 1 and Time 2, psychological distress, marital satisfaction, and family functioning were measured in patients and partners; coping was measured in partners only. Partner maladaptive coping patterns of avoidance and self-blame at Time 1 predicted greater partner psychological distress at Time 2, as did "wishful thinking" at Time 2.DISCUSSION: Psychosocial interventions designed to promote adaptive coping in couples facing PCA warrant systematic study.

Mixed Anxiety/Depression Symptoms in a Large Cancer Cohort: Prevalence by Cancer Type [ORIGINAL RESEARCH REPORTS]

Brintzenhofe-Szoc, K. M., Levin, T. T., Li, Y., Kissane, D. W., Zabora, J. R. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: Mixed anxiety/depression is associated with poorer psychosocial and treatment outcomes, worse quality of life, pooreradherence to treatment, slower recovery, greater suicide risk, and highercost-utilization. OBJECTIVE: This study aimed to examine the cancer-specific prevalence of these symptoms. METHOD: Cross-sectional anxiety and depression symptom data were collected with the Brief Symptom Inventory from adult outpatients presenting to a tertiary cancer center (N=8,265). RESULTS: Mixed anxiety/depression symptoms were seen in 12.4% of patients; overall depression symptoms in 18.3%, overall anxiety symptoms in 24.0%, pure anxiety symptoms in 11.7%, and pure depression symptoms in 6.0%; 70% had neither. Higher rates of mixed anxiety/depression symptoms were seen with stomach, pancreatic, head and neck, and lung cancers, but lower rates were seen in those with breast cancers. The mixed anxiety/depression phenotype occurs in two-thirds of depressed cancer patients. DISCUSSION: The fact that 70% of patients did not meet thresholds for depression or anxiety symptoms can be interpreted as a reflection of the resistance to developing a significant level of these symptoms. However, because stomach, pancreatic, head and neck, and lung cancers have higher levels of mixed anxiety/depression symptoms, the question can be raised as to whether these are associated with a more biological type of anxiety/depression (e.g., due to cytokine release) and whether this phenotype should be actively targeted because of its frequent occurrence in these cancers.

Depression and Costs of Health Care [ORIGINAL RESEARCH REPORTS]

Welch, C. A., Czerwinski, D., Ghimire, B., Bertsimas, D. — Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: In spite of its global importance, the interaction between depression and chronic comorbid diseases remains incompletely understood with regard to prevalence, severity of disease, and potential causative factors mediating this interaction. OBJECTIVE: The authors sought to compare overall medical costs in nondepressed and depressed individuals. METHOD: Insurance claims for 618,780 patients were examined for total annual non-mental health cost of care in 11 chronic diseases. In each disease cohort, median annual non-mental health cost was calculated for individuals with and without depression. RESULTS: Patients with depression had higher median per-patient annual non-mental health costs than patients without depression in all 11 diseases studied. There was a higher-than-random comorbidity between depression and all 11 chronic comorbid diseases. CONCLUSION: Even when controlling for number of chronic comorbid diseases, depressed patients had significantly higher costs than non-depressed patients, in a magnitude consistent across 11 chronic comorbid diseases.

Duloxetine for the Treatment of Recurrent Major Depressive Disorder in Elderly Patients: Treatment Outcomes in Patients With Comorbid Arthritis [ORIGINAL RESEARCH REPORTS]

Mon, 17 Aug 2009 08:37:45 PDT

BACKGROUND: Evaluation and treatment of major depression (MDD) in elderly patients is frequently complicated by the presence of comorbid medical conditions, which can reduce the effect of depression treatment, leading to lower rates of depressive-symptom improvement and higher rates of relapse. OBJECTIVE: The authors investigated results of antidepressant concurrent with arthritis pain treatment in elderly patients. METHOD: Patients age 65 and over with recurrent MDD were stratified by arthritis status and randomized to duloxetine (a dual reuptake-inhibitor of serotonin and norepinephrine) or placebo treatment for 8 weeks (duloxetine, N=117; placebo, N=55). RESULTS: Duloxetine significantly reduced MDD symptom severity in elderly patients with and without arthritis, and produced significant reduction in several pain measures in those patients with comorbid arthritis. DISCUSSION: The magnitude and time-course of depressive symptom improvement did not differ significantly between patients with and without arthritis. Some studies have suggested that the severity of pain in arthritis patients may be linked to depression severity.

Dexmedetomidine and the Reduction of Postoperative Delirium after Cardiac Surgery [ORIGINAL RESEARCH REPORTS]

Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. OBJECTIVE: The authors investigated the effects of postoperative sedation on the development of delirium in patients undergoing cardiac-valve procedures. METHODS: Patients underwent elective cardiac surgery with a standardized intraoperative anesthesia protocol, followed by random assignment to one of three postoperative sedation protocols: dexmedetomidine, propofol, or midazolam. RESULTS: The incidence of delirium for patients receiving dexmedetomidine was 3%, for those receiving propofol was 50%, and for patients receiving midazolam, 50%. Patients who developed postoperative delirium experienced significantly longer intensive-care stays and longer total hospitalization. CONCLUSION: The findings of this open-label, randomized clinical investigation suggest that postoperative sedation with dexmedetomidine was associated with significantly lower rates of postoperative delirium and lower care costs.

Falls in the General Hospital: Association With Delirium, Advanced Age, and Specific Surgical Procedures [ORIGINAL RESEARCH REPORTS]

Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: Falls and delirium in general-hospital inpatients are related to increases in morbidity, mortality, and healthcare costs. Patients fall despite safeguards and programs to reduce falling. OBJECTIVE: The authors sought to determine the prevalence of diagnosed and undiagnosed delirium in patients who fell during their hospital stay. METHOD: The authors performed a retrospective electronic chart review of 252 patients who fell during their hospital stay. Falls were categorized by their severity (i.e., minor, moderate, and major). Demographic information, patient outcomes, and diagnostic criteria for delirium (per DSM–IV) were collected on the day of admission, the day of the fall, and the 2 days preceding the patient’s fall. RESULTS: Falls in the general hospital were associated with delirium (both diagnosed and undiagnosed), advanced age, and specific surgical procedures. CONCLUSION: Improving the recognition of undiagnosed delirium may lead to sustainable and successful fall prevention programs. Detection of impairments in mental status can assist staff to create individualized patient care plans. Knowledge about which patients are at risk for injury from delirium and falls can lead to improvements in patient safety, functioning, and quality of life.

Prevention of Major Depression in Complex Medically Ill Patients: Preliminary Results From a Randomized, Controlled Trial [ORIGINAL RESEARCH REPORTS]

Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: Depression is highly prevalent in patients with physical illness and is associated with a diminished quality of life and poorer medical outcomes. OBJECTIVE: The authors evaluated whether a multifaceted intervention conducted by a psychiatric consultation–liaison nurse could reduce the incidence of major depression in rheumatology inpatients and diabetes outpatients with a high level of case complexity. METHOD: Of 247 randomized patients, the authors identified 100 patients with a high level of case complexity at baseline and without major depression (65 rheumatology and 35 diabetes patients). Patients were randomized to usual care (N=53) or to a nurse-led intervention (N=47). Main outcomes were the incidence of major depression and severity of depressive symptoms during a 1-year follow-up, based on quarterly assessments with standardized psychiatric interviews. RESULTS: The incidence of major depression was 63% in usual-care patients and 36% in the intervention group. Effects of intervention on depressive symptoms were observed in outpatients with diabetes but not in rheumatology inpatients. CONCLUSION: These preliminary results based on subgroup analysis suggest that a multifaceted nurse-led intervention may prevent the occurrence of major depression in complex medically ill patients and reduce depressive symptoms in diabetes outpatients.

Impact of Delirium on Short-Term Mortality in Elderly Inpatients: A Prospective Cohort Study [ORIGINAL RESEARCH REPORTS]

Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: Delirium is an important problem especially in older medical inpatients. OBJECTIVE: The authors asked whether delirium and its duration are associated with higher mortality in a 3-month follow-up period. METHOD: In this prospective cohort study, inpatients age 65 and older were assessed every 48 hours with the Confusion Assessment Method. RESULTS: Of 542 patients enrolled, 192 (35.4%) developed delirium. After 3 months, mortality in the delirium cohort was 25.9%, and in the nondelirium cohort was 5.8%. Delirium was independently associated with mortality, and increased by 11% for every 48 hours of delirium. CONCLUSION: Delirium and increased delirium durations are significantly associated with higher mortality.

Depression in Frontotemporal Dementia [ORIGINAL RESEARCH REPORTS]

Blass, D. M., Rabins, P. V. — Tue, 30 Jun 2009 11:04:36 PDT

OBJECTIVE: The authors describe mood abnormalities seen in a case series of patients with frontotemporal dementia (FTD). METHOD: Authors provide a structured review of outpatient and inpatient charts of FTD patients. RESULTS: Three distinct depressive syndromes were identified: The first corresponds to DSM–IV major depression. The second is a syndrome of mood lability with prominent responsiveness to the environment. The third is a syndrome of profound apathy, without other evidence of depression. CONCLUSION: A variety of mood disorders are seen in FTD, requiring careful attention to differential diagnosis. FTD should be included in the differential diagnosis during the evaluation of older patients with mood abnormalities.

Phenomenological Subtypes of Delirium in Older Persons: Patterns, Prevalence, and Prognosis [ORIGINAL RESEARCH REPORTS]

Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: Delirium is an acute confusional state that is common, preventable, and life-threatening. OBJECTIVE: The authors investigated the phenomenology of delirium severity as measured with the Memorial Delirium Assessment Scale among 441 older patients (age 65 and older) admitted with delirium in post-acute care. METHODS: Using latent class analysis, they identified four classes of psychomotor-severity subtypes of delirium: 1) hypoactive/mild; 2) hypoactive/severe; 3) mixed, with hyperactive features/severe; and 4) normal/mild. RESULTS: Among those with dementia (N=166), the hypoactive/mild class was associated with a higher risk of mortality. Among those without dementia (N=275), greater severity was associated with mortality, regardless of psychomotor features, when compared with the normal/mild class. CONCLUSION: The data suggest that instruments measuring delirium severity and psychomotor features provide important prognostic information and should be integrated into the assessment of delirium.

Factor Analysis of The Colombian Translation of The Delirium Rating Scale (DRS), Revised-98 [ORIGINAL RESEARCH REPORTS]

Franco, J. G., Trzepacz, P. T., Mejia, M. A., Ochoa, S. B. — Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: The phenomenology of delirium needs further elucidation using validated tools. OBJECTIVE: The authors sought to derive valid factors from the Delirium Rating Scale (DRS), Revised –98. METHOD: A factor analysis of the DRS-R–98 was performed among 161 medical-surgical patients. RESULTS: Scores ranged from 0 to 7 in 120 patients (74.53%; no delirium), 8 to 13 in 19 (11.80%; subclinical/prodromal delirium), and ≥14 in 22 (13.66%; delirium). The DSM-IV–TR delirium incidence was 19.87%. The first two rotated factors explained 63.37% of the variance and may correspond to Cognition and Psychosis/Agitation factors. The dimension of motor retardation loaded with cognitive items. Motor agitation and retardation clustered with inattention, which is the cardinal symptom of delirium. CONCLUSION: The DRS-R–98 has good construct validity in this Latino population.

Emotional and Behavioral Changes in Parents of Children Affected by Hemolytic-Uremic Syndrome Associated With Verocytotoxin-Producing Escherichia Coli: A Qualitative Analysis [ORIGINAL RESEARCH REPORTS]

Pollock, K. G.J., Duncan, E., Cowden, J. M. — Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: The long-term clinical outcome for childrenaffected by hemolytic uremic syndrome associated with verocytotoxin-producing Escherichia coli (VTEC–HUS) is well documented, but the parental experience is not. OBJECTIVE: The authors investigated the effects of the critical-care hospitalization for this condition on well-being of patients’ families. METHOD: A group of 30 parents completed a free-response format survey when their child presented to the hospital; 19 of this cohort completed a 1-year follow-up. RESULTS: Content analysis demonstrated that this cohort of parents experienced long-term emotional distress and substantive disruption to family and daily life. DISCUSSION: These results corroborate anecdotal clinical observations. The authors suggest future research initiatives and best practices to reduce parental distress.

Pain and Depression in Gynecology Patients [ORIGINAL RESEARCH REPORTS]

Poleshuck, E. L., Bair, M. J., Kroenke, K., Watts, A., Tu, X., Giles, D. E. — Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: The prevalence and consequences of comorbid pain and depression in gynecology patients are understudied. OBJECTIVE: The purpose of the study was to determine the prevalence of pain, depression, and their co-occurrence among gynecology patients, and to examine how pain and depression are associated with additional comorbid mental disorders. METHOD: Self-reported pain, depressive symptoms, other mental-disorder symptoms, functional status, interpersonal distress, and abuse were assessed in 1,647 gynecology patients by use of the Patient Health Questionnaire and the Medical Outcomes Study (SF–20). RESULTS: Moderate-to-severe pain was reported by 29% of patients; depression, by 21%; with both present in 10.3%. Comorbid pain and depression was associated with anxiety, suicidal or death ideation, functional impairment, interpersonal distress, and physical or sexual abuse. DISCUSSION: Innovative approaches are needed to assess and treat gynecology patients with comorbid pain and depression, given the degree of overlap between them.

Psychological Distress in Women With Uterovaginal Agenesis (Mayer-Rokitansky-Kuster-Hauser Syndrome, MRKH) [ORIGINAL RESEARCH REPORTS]

Heller-Boersma, J. G., Schmidt, U. H., Edmonds, D. K. — Tue, 30 Jun 2009 11:04:36 PDT

BACKGROUND: Uterovaginal agenesis (Mayer-Rokitansky-Küster-Hauser Syndrome; MRKH) is a congenital nonformation of the vagina and the uterus, but with normal ovaries. OBJECTIVE: The authors investigated the psychological impact of this disorder, about which very little is known. METHOD: A group of 66 women with MRKH were compared with 31 control-group women on a range of self-rating scales assessing psychological distress and self-esteem. RESULTS: Women with MRKH had significantly more pathological scores on some of the scales and subscales, such as phobic anxiety and psychoticism (interpersonal alienation), with a similar trend for subscales measuring depression and anxiety. CONCLUSION: MRKH has a lasting negative impact on affected women’s level of psychological distress and self-esteem.

Shared or Discordant Grief in Couples 2-6 Years After the Death of Their Premature Baby: Effects on Suffering and Posttraumatic Growth [ORIGINAL RESEARCH REPORTS]

Fri, 17 Apr 2009 11:44:01 PDT

BACKGROUND: The loss of a baby causes severe short- and long-term distress to parents and their marital relationship, but little is known about how this distress is shared between spouses. The authors hypothesized that the grief-related concordance within a couple 2 to 6 years after the loss of a premature baby could be an indicator of shared emotional distress within a couple. OBJECTIVE: The authors investigated the long-term grief experience among couples. METHOD: A group of 44 parents (22 couples) were assessed by questionnaire regarding grief, suffering, posttraumatic growth, and affective symptoms, and semistructured interviews with 6 couples added qualitative information about processes within couples. RESULTS: The extent of grief concordance was found to be related to different patterns of suffering and posttraumatic growth within couples. CONCLUSION: The emotional exchange between partners after the loss of the child appears to be crucial for a process of concordant grief, which in turn is associated with a more synchronous process of individual posttraumatic growth

The Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder in the Neonatal Intensive Care Unit [ORIGINAL RESEARCH REPORTS]

Fri, 17 Apr 2009 11:44:01 PDT

BACKGROUND: Having an infant hospitalized in the neonatal intensive care unit (NICU) is a highly stressful event for parents. Researchers have proposed posttraumatic stress disorder (PTSD) as a model to explain the psychological reaction of parents to their NICU experience. OBJECTIVE: The authors sought to examine the prevalence of PTSD in parents 4 months after the birth of their premature or sick infants and the relationship of PTSD and symptoms of acute stress disorder (ASD) immediately after their infant’s birth. METHOD: Eighteen parents completed a self-report measure of ASD at baseline in addition to self-report measures of PTSD and depression at a 4-month follow-up assessment. RESULTS: In the sample, 33% of fathers and 9% of mothers met criteria for PTSD. ASD symptoms were significantly correlated with both PTSD and depression. Fathers showed a more delayed onset in their PTSD symptoms, but, by 4 months, were at even greater risk than mothers. DISCUSSION: The relatively high levels of psychological distress experienced by parents coupled with the potential negative outcomes on the parent and infant suggest that it is important to try to prepare parents for the expected psychological reactions that may occur in the event of a NICU hospitalization and also to support parents during the transition to home care.

Uncertainty, Symptoms, and Quality of Life in Persons With Chronic Hepatitis C [ORIGINAL RESEARCH REPORTS]

Fri, 17 Apr 2009 11:44:01 PDT

BACKGROUND: Chronic hepatitis C (CHC) is the most common blood-borne infection in the United States, but little is known about illness uncertainty in these patients. OBJECTIVE: The authors examined the constructs of illness uncertainty. METHOD: In this cross-sectional study, Mishel’s Uncertainty in Illness Scale was used to examine these constructs (ambiguity, complexity, inconsistency, unpredictability) and their relationships with fatigue, pain, depressive symptoms, comorbidity, and quality of life (QOL) in 126 CHC patients undergoing a watchful-waiting protocol. RESULTS: The Ambiguity subscale had the strongest relationships with depressive symptoms, QOL, and fatigue, and three of the four subscales were significantly correlated with pain. CONCLUSION: The results suggest targets for patient self-management interventions.

Use of the Temperament and Character Inventory (TCI) for Assessment of Personality in Chronic Fatigue Syndrome [ORIGINAL RESEARCH REPORTS]

Fri, 17 Apr 2009 11:44:01 PDT

BACKGROUND: Chronic fatigue syndrome (CFS) is characterized by severe and prolonged fatigue, along with a set of nonspecific symptoms and signs, such as sore throat, muscle pain, headaches, and difficulties with concentration or memory. OBJECTIVE: The study examined whether CFS is associated with specific dimensions of Cloninger’s psychobiological model of personality. METHOD: Personality profiles were compared between 38 CFS patients and 42 control subjects by means of the Temperament and Character Inventory (TCI). RESULTS: The CFS group showed significantly higher scores on Harm-Avoidance and Persistence. CONCLUSION: The current study shows a significant association between specific personality characteristics and CFS. These personality traits may be implicated in the onset and/or perpetuation of CFS and may be a productive focus for psychotherapy.