Psychosomatics recent issues

[PERSPECTIVES] Understanding Fatigue in Major Depressive Disorder and Other Medical Disorders

Arnold, L. M. — 2008-04-30

BACKGROUND: Although fatigue is a common symptom that occurs in many psychiatric and other medical disorders, the pathophysiological mechanisms of fatigue are still unclear. OBJECTIVE: The goal of this review is to assess the state of knowledge about fatigue in depression and other disorders and identify new avenues for research in the study of fatigue. METHOD: The author reviewed some 50 articles in the field. CONCLUSION: An approach that emphasizes the similarities between fatigue and depression may improve the understanding of these complex syndromes. As more is learned about the neuropathology of the heterogeneous syndrome of depression, the etiology of many of the symptoms domains associated with depression, including fatigue, may become clearer.

[REVIEW ARTICLES] Treating the Physical Symptoms of Depression With Second-Generation Antidepressants: A Systematic Review and Metaanalysis

2008-04-30

BACKGROUND: Approximately two-thirds of patients with depression experience physical pain symptoms. Coexisting pain complicates the treatment of depression and is associated with worse depression outcomes. OBJECTIVE: The authors reviewed the effect of newer antidepressants on pain in patients with depression. METHOD: The authors searched systematically for trials of second-generation antidepressants that enrolled depression patients and reported pain outcomes, pooling changes on the pain visual-analog scale (VAS), using random-effects models. RESULTS: Eight trials were eligible. Pooled analysis of head-to-head trials showed no difference in VAS between duloxetine and paroxetine. Both drugs were superior to placebo. CONCLUSION: The authors found insufficient evidence to support the choice of one second-generation antidepressant over another in patients with pain accompanying depression.

[ORIGINAL RESEARCH REPORTS] A Prospective Examination of Antidepressant Use and Its Correlates in Patients With Acute Coronary Syndrome

Grace, S. L., Leung, Y. W., Stewart, D. E. — 2008-04-30

BACKGROUND: Depression has been implicated in the occurrence of recurrent coronary events and cardiac or all-cause mortality in acute coronary syndrome (ACS) patients. OBJECTIVE: The authors describe the frequency and type of antidepressant use and its correlates 18 months after ACS hospital discharge. METHOD: A sample of 661 ACS inpatients, recruited from three hospitals, completed a sociodemographic survey and the Hospital Anxiety and Depression Scale (HADS), and clinical data were extracted from charts. A mailed survey 9 months and 18 months post-discharge assessed self-reported antidepressant use, and the HADS was re-administered. RESULTS: Approximately 9% of participants reported antidepressant use both 9 and 18 months post-hospitalization, with 77% concordance in usage over time. Participants most frequently reported using selective serotonin reuptake inhibitors and least often tricyclics. Logistic regression revealed that antidepressant users were more likely to be anxious and have more comorbidity, and were less likely to work full-time, whereas number of medications, age, and marital status were not related. CONCLUSION: Patients with comorbid physical and mental conditions who are unemployed may be more likely to receive an antidepressant because of greater depression symptoms or greater exposure to healthcare providers, which increases the potential for symptom recognition and treatment.

[ORIGINAL RESEARCH REPORTS] The Safety of ECT in Patients With Chronic Obstructive Pulmonary Disease

Schak, K. M., Mueller, P. S., Barnes, R. D., Rasmussen, K. G. — 2008-04-30

BACKGROUND: Electroconvulsive therapy (ECT) involves the administration of general anesthesia and assisted ventilation while the patient is apneic. OBJECTIVE: Care must be taken to screen for significant pulmonary dysfunction before treatment. Very little has been written about the safety and management strategy of ECT patients with chronic obstructive pulmonary disease (COPD). METHOD: In this retrospective chart review, authors describe their experience with patients in recent years who had this disorder and were treated with ECT. RESULTS: Authors list recommendations for the pre-ECT work up and anesthetic management during and after the treatments. CONCLUSION: Recent guidelines recommend administration of patients’ prescribed inhalers on the morning of ECT treatment. Also, caution is recommended when using ECT in patients taking theophylline because this drug has been associated with prolonged seizures and status epilepticus in these patients.

[ORIGINAL RESEARCH REPORTS] Normalizing Attributions May Contribute to Non-Help-Seeking Behavior in People With Fibromyalgia Syndrome

Gulec, H. — 2008-04-30

BACKGROUND: Causal attributions of bodily perceptions indicate the possibility of some degree of control over events. Therefore, attributions are important to support the social significance of experience and confer meaning. OBJECTIVE: The aim of this study is to investigate whether non-patients with fibromyalgia (FMS) use more normalizing attributions than healthy control subjects and help-seeking patients. METHOD: Thirty-seven FMS patients attending tertiary care were compared with 38 non-patients and 34 healthy controls on mean anxiety, depression, attribution style, and alexithymia scores. RESULTS: Mean normalizing scores were greatest in the non-patient group, followed by the healthy-control group, and smallest in the tertiary-care attending group. Non-patients are using more normalizing explanations than the FMS patients and the healthy-control subjects. CONCLUSION: Thus, normalization may negatively influence help-seeking behavior and contribute to non–help-seeking behavior.

[ORIGINAL RESEARCH REPORTS] Depression After Diagnosis of Advanced Non-Small Cell Lung Cancer and Survival: A Pilot Study

2008-04-30

BACKGROUND: Major depressive disorder is estimated to occur in 10%–25% of people with cancer, and it has been inconsistently linked to increased mortality. OBJECTIVE: This pilot study investigates the association of depression and survival in advanced non-small cell lung cancer (NSCLC) patients. METHOD: Forty-three recently-diagnosed advanced NSCLC patients completed the Hospital Anxiety and Depression Scale and were followed prospectively. RESULTS: Patients with depression had poorer survival. Median survival was four times shorter than those without depression. Controlling for baseline performance status, depression predicted 6-month mortality, but was not significant for overall survival. CONCLUSION: Although depression after advanced-NSCLC diagnosis was associated with poorer survival at 6 months, this association was not present for overall survival; however, further research with larger samples should be pursued.

[ORIGINAL RESEARCH REPORTS] The Effect of Pegylated Interferon-{alpha}2b and Ribavirin on Posttraumatic Stress Disorder Symptoms

Dieperink, E., Leskela, J., Dieperink, M. E., Evans, B., Thuras, P., Ho, S. B. — 2008-04-30

BACKGROUND: Patients with chronic psychiatric diagnoses have a prevalence of chronic hepatitis C (HCV) approximately 11 times higher than the general American population. Posttraumatic stress disorder (PTSD) is particularly common among HCV patients. OBJECTIVE: The authors describe the effect of treatment with pegylated-interferon-_2b (IFN) and ribavirin for patients with HCV on their posttraumatic stress disorder (PTSD) symptoms. METHOD: Sixteen patients with HCV and combat-related PTSD were followed for 24 weeks and assessed with self-report measures of PTSD, hostility, and depression. RESULTS: Depression and Resentment scores significantly increased in five patients treated with IFN and ribavirin, but no significant differences were found in PTSD scores when compared with 11 control patients. CONCLUSION: The results suggest that patients with PTSD and HCV can be safely treated with anti-viral therapies when they are given appropriate psychiatric care.

[ORIGINAL RESEARCH REPORTS] Cardiovascular Symptoms in Coronary-Artery Disease Patients Are Strongly Correlated With Emotional Distress

2008-04-30

BACKGROUND: The relationship of cardiovascular events and cardiovascular symptoms is unclear, and physical symptoms, including most cardiovascular symptoms, are known to be influenced by emotional distress. OBJECTIVE: Authors examined the relative strength of association of multiple measures of emotional distress and accepted cardiac risk factors with five common cardiac symptoms (chest pain, fatigue, palpitations, presyncope, and dyspnea). METHOD: The authors tested the association of multiple cardiovascular symptoms with various measures of emotional distress (i.e., the scales of the Symptom Checklist-90–Revised) and the putative risk factors for disease status in 109 patients with documented coronary artery disease. RESULTS: Measures of emotional distress were stronger correlates of patient-rated distress due to the symptoms than were traditional risk factors. CONCLUSION: Treatment of emotional distress may be a viable strategy for symptom-control in cardiovascular disease.

[ORIGINAL RESEARCH REPORTS] Comorbid Somatic Symptoms and Functional Status in Patients With Fibromyalgia and Chronic Fatigue Syndrome: Sensory Amplification as a Common Mechanism

2008-04-30

BACKGROUND: Somatic symptoms are common in conditions such as fibromyalgia (FM) and chronic fatigue syndrome (CFS). OBJECTIVE: Authors investigated a potential shared pathologic mechanism: a generalized perceptual abnormality where there is heightened responsiveness to varied sensory stimulation, including pain. METHOD: A composite measure of sensory sensitivity was created and compared with measures of somatic symptoms, comorbid psychological disturbances, and self-reported physical functioning in 38 patients with FM and/or CFS. RESULTS: Sensory amplification influenced physical functioning indirectly through pain intensity, and physical symptoms and fatigue also independently contributed to physical functioning. CONCLUSION: Sensory amplification may be an underlying pathophysiologic mechanism in these disorders that is relatively independent of depression and depressive symptoms.

[ORIGINAL RESEARCH REPORTS] Determinants of Quality of Life in Marfan Syndrome

2008-04-30

BACKGROUND: Marfan syndrome (MFS) is a rare, heritable disorder that affects connective tissue. Men and women are equally affected. Clinical manifestations involve multiple sites, especially bones and ligaments and heart and blood vessels. OBJECTIVE: Authors sought to investigate quality of life (QoL) in MFS patients, assessing positive and negative sociodemographic factors and self-perceived well-being and functional status. METHOD: Thirty-six patients affected by MFS were interviewed and were administered the SF–36 psychometric questionnaire. RESULTS: Subjects affected by MFS reported an impaired quality of life in the psychological domain but not in the physical domain, as compared with a healthy population. Being male and older was significantly associated with a poorer perceived mental QoL. CONCLUSION: The authors found that MFS negatively influences QoL, increases psychological distress, and may be a possible risk for some psychiatric disorders.

[CASE REPORTS] Too Much Too Soon? Refeeding Syndrome as an Iatrogenic Cause of Delirium

Caplan, J. P. — 2008-04-30

BACKGROUND: Delirium is a significant and costly complication of medical hospitalization, and it has been shown to be a significant predictor of morbidity and mortality. It is often noted as a symptom in reported cases of refeeding syndrome, which is a potentially fatal complication in the treatment of patients suffering from malnutrition. OBJECTIVE: A case of delirium due to refeeding syndrome in a 61-year-old man is presented to help clinicians recognize this entity. The pathophysiology of refeeding syndrome and its possible role as an as-yet poorly-identified iatrogenic cause of delirium are discussed. METHOD: A diagnosis of delirium due to refeeding syndrome was made, and a nutrition consult was requested. Per nutrition recommendations, the patient was placed on a restricted calorie regimen, with aggressive supplementation of magnesium and phosphate. RESULTS: With his new dietary regimen, his mental status gradually improved, with complete resolution of his delirium by the 8th hospital day. He suffered no further episodes of confusion or disorientation. CONCLUSION: The relationship between refeeding syndrome and delirium may be of particular significance in the elderly, since malnutrition, medical hospitalization, and delirium are prevalent phenomena in this population.

[CASE REPORTS] A Patient With Acute Traumatic Quadriplegia Who Requested a DNR Order

Field, H. L. — 2008-04-30

[CASE REPORTS] Elevated Clozapine Serum Level After Treatment With Amiodarone

Stevens, J. R., Freudenreich, O., Stern, T. A. — 2008-04-30

[MED-PSYCH UPDATE] A Preliminary Attempt to Personalize Risperidone Dosing Using Drug-Drug Interactions and Genetics: Part I

de Leon, J., Sandson, N. B., Cozza, K. L. — 2008-04-30

BACKGROUND: Personalized prescription is described even in lay journals, but there has been no attempt to propose personalizing dosing for any specific psychiatric drug. OBJECTIVE: Any attempt to develop personalized dosing needs to be anchored in our understanding of the pharmacological response of each drug in each person’s environment, particularly drug–drug interactions (DDIs) and how genetic make-up influences drug response. METHOD: Risperidone (R) is used as an example. R’s pharmacologic response is reviewed in detail by focusing on our current knowledge of its pharmacodynamic and pharmacokinetic actions. The influences of the environment and genetics on these two actions are reviewed. RESULTS: R’s antipsychotic action is probably mainly explained by the blocking of dopamine receptors, particularly D₂ receptors. There are polymorphic variations of this gene (DRD₂), but it is not clear that they have clinical relevance in predicting adverse drug reactions (ADRs) or antipsychotic response. CONCLUSION: Previous exposure to antipsychotics increases the need for higher R dosing, but the mechanism for this tolerance is not well understood. Other brain receptors, such as other dopamine, serotonin, and adrenergic receptors may explain some of these ADRs. Some polymorphic variations in these receptors have been described, but they cannot yet be used to personalize R dosing.

[LETTERS TO THE EDITOR] Electroconvulsive Therapy for Severe Major Depressive Disorder After Orthotopic Liver Transplantation * Case Report

Goforth, H. W., Shiry, K. G. — 2008-04-30

[LETTERS TO THE EDITOR] Neuroleptic Use in a Patient With a Prolonged QTc Interval

Winter, E. C., Alessi, L. E. — 2008-04-30

[LETTERS TO THE EDITOR] Delirium With Psychotic Features Possibly Associated With Mesotherapy

Tor, P.-C., Lee, T.-S. — 2008-04-30

[CORRECTION] Erratum

2008-04-30

[BOOK REVIEWS] Communication in Cancer Care

Wise, T. N. — 2008-04-30

[BOOK REVIEWS] Family Behavioral Issues in Health and Illness

Zofnass, J. S. — 2008-04-30

[PERSPECTIVES] Challenges for Consultation-Liaison Psychiatry in the 21st Century

Strain, J. J., Blumenfield, M. — 2008-03-19

[REVIEW ARTICLES] Confidentiality in the Age of HIPAA: A Challenge for Psychosomatic Medicine

Mermelstein, H. T., Wallack, J. J. — 2008-03-19

This review, a work project of The Standards and Ethics Committee of The Academy of Psychosomatic Medicine, examines the challenges posed for consultation–liaison psychiatrists as they struggle to maintain the trust between patient and physician while balancing compliance with the increasing complexities of confidentiality with the provision of enough information to our medical colleagues for good clinical care. The authors discuss the moral, legal, and ethical issues that arise from the many-layered state and federal regulations, especially the impact of the Health Information Portability and Accountability Act (HIPPA) and make recommendations for practical application in the clinical setting.

[ORIGINAL RESEARCH REPORTS] Misdiagnosed Delirium in Patient Referrals to a University-Based Hospital Psychiatry Department

Swigart, S. E., Kishi, Y., Thurber, S., Kathol, R. G., Meller, W. H. — 2008-03-19

The authors examined the factors associated with referral errors in which the presence of delirium was ostensibly not recognized by medical staff personnel. Medical records of 541 university-hospital patients consecutively referred for psychiatric consultation were scrutinized for extant delirium. The data indicated that a greater likelihood of a missed diagnosis was associated with younger age; referrals outside of family practice service; orientation as to person, place, and time; and a history of bipolar affective disorder or psychosis. The ramifications of failure to diagnose existing delirium include increased morbidity and mortality, longer length of hospital stay, and increased healthcare costs.

[ORIGINAL RESEARCH REPORTS] Quality of Life in Individuals With Serious Mental Illness and Type 2 Diabetes

2008-03-19

Diabetes is a pervasive metabolic disease that disproportionately affects persons with serious mental illness. The authors studied the effect of diabetes on quality of life in a sample of 369 adult outpatients with schizophrenia or major mood disorder, 201 of whom had type 2 diabetes. Patients with diabetes reported greater impairment in both physical and mental-health quality of life than those without diabetes. The diabetes patients also reported less satisfaction with health but not with other life domains. Medical providers need to be attentive to the burden of disease experienced by patients with both serious mental illness and diabetes.

[ORIGINAL RESEARCH REPORTS] Parental Bonding and Alexithymia in Adults With Fibromyalgia

Gil, F. P., Weigl, M., Wessels, T., Irnich, D., Baumuller, E., Winkelmann, A. — 2008-03-19

In a cross-sectional study, the authors investigated 40 female patients with fibromyalgia syndrome (FS) for the degree of alexithymia and parental bonding style. Alexithymia was assessed by the Toronto Alexithymia Scale–26; parental style by the FDEB (a German version of the Measure of Parental Style). In 15% of patients with FS, clinically significant alexithymia was found. Also, there was a positive association between the alexithymia scores (TAS total score) and "maternal abuse" and higher values in "paternal indifference," which predicted higher scores on "Difficulties identifying feelings" (TAS). The results of this study suggest that parental styles are associated with higher alexithymia scores.

[ORIGINAL RESEARCH REPORTS] Evidence of Exacerbated Cognitive Deficits in Schizophrenia Patients With Comorbid Diabetes

Dickinson, D., Gold, J. M., Dickerson, F. B., Medoff, D., Dixon, L. B. — 2008-03-19

Type 2 diabetes is associated with both schizophrenia and cognitive performance. The authors compared cognitive performance in three groups: patients with schizophrenia and diabetes, patients with diabetes only, and patients with schizophrenia only. Results indicated that the schizophrenia/diabetes group was impaired cognitively relative to both other groups, especially in the domains of processing speed and visual/spatial ability. Also, these impairments were associated with diabetes severity markers. Because either illness creates cognitive vulnerability, comorbid occurrence is even more likely to undermine essential functional brain systems, leading to an increased rate and magnitude of cognitive decline with associated declines in community functioning.

[ORIGINAL RESEARCH REPORTS] Gastroenterologists' Perceptions of Need and Availability of Psychiatric Services for Patients With Hepatitis C

Gleason, O., Fucci, J., Yates, W. — 2008-03-19

The authors examined gastroenterologists’ perceptions of psychiatric comorbidity in hepatitis C, access to, and use of psychiatric services. An eight-item survey was mailed to gastroenterologists, with a total of 75 participating. Fifty-eight (77.3%) agreed with the statement "My patients with hepatitis C have significant rates of psychiatric and substance-abuse comorbidity." Less than half (41%) agreed or strongly agreed that "My patients with hepatitis C have adequate access to psychiatric consultation." However, only eight (11%) referred to a mental health provider. Gastroenterologists are aware of the need for psychiatric services for their hepatitis C patients, but few refer for it, and access may be limited.

[ORIGINAL RESEARCH REPORTS] Risk Factors for Major Depressive Disorder and the Psychological Impact of Hysterectomy: A Prospective Investigation

2008-03-19

The authors prospectively evaluated the risk of major depressive disorder and the psychological impact of recent hysterectomy in 68 women who underwent hysterectomy for non-malignant conditions. Depression, anxiety, body image, sexual functioning, family support, life stress, and subjective gynecological symptoms were assessed 2 weeks before surgery and at 1 month and 4 months after surgery. Depression, anxiety, body image, and subjective gynecological symptoms improved after surgery; however, sexual functioning worsened after surgery. Previous emotional problems and poorer body image, sexual functioning, and higher stress 1 month after surgery are risk factors for post-hysterectomy major depressive disorder.

[ORIGINAL RESEARCH REPORTS] Selection of Donors for Adult Living-Donor Liver Donation: Results of the Assessment of the First 205 Donor Candidates

2008-03-19

Psychosomatic assessment for living liver donors for adults has as yet not been described in detail. Between August 1998 and September 2003, 205 donor candidates were admitted for psychosomatic evaluation; 13.2% of whom (N=27) were excluded. Mental disturbances, especially when accompanied with social stress, were frequent reasons for exclusion. Selected donors had higher social status with regard to education and employment rate than other donor candidates. Candidates with better psychosocial resources are selected in the psychosomatic evaluation, and this contributes to the good psychosocial outcome of living donors.

[ORIGINAL RESEARCH REPORTS] Overlap, Comorbidity, and Stability of Somatoform Disorders and the Use of Current Versus Lifetime Criteria

Leiknes, K. A., Finset, A., Moum, T., Sandanger, I. — 2008-03-19

The authors examined disorder overlap, comorbidity, stability, and predictors of somatoform disorders (SDs) by "lifetime" and "current" symptom criteria in a general population sample of 421 respondents interviewed with the Composite International Diagnostic Interview in 1990 and 2001. Disorder overlap and comorbidity were considerable. "Current" SDs were four times more likely to occur among respondents with depression. Diagnostic stability was highest for "current" SDs (retrospective consistency: 42%). Young women were more prone to a stable (chronic) course over time. Previous depression and physical disease were risk factors for "current" but not for "lifetime" SDs; diagnostic criteria should therefore be based on current symptoms.

[CASE REPORTS] Antipsychotic-Induced Hyperprolactinemia and Delusion of Pregnancy

Ahuja, N., Moorhead, S., Lloyd, A. J., Cole, A. J. — 2008-03-19

The authors describe 12 patients with antipsychotic-induced hyperprolactinemia. Six patients had erroneous ideas of being pregnant (four delusional and two non-delusional) temporally associated with hyperprolactinemia and resolving as prolactin levels returned to normal. The remaining six patients did not develop such ideas. Contrasting the clinical features of the two groups of patients in the context of existing literature informs on the possible biological and cognitive mechanisms that can be hypothesized to underlie the relationship between hyperprolactinemia due to antipsychotics and the development of inaccurate beliefs and feelings about pregnancy, and the effect of current mental state on the propensity to develop these beliefs.

[MED-PSYCH UPDATE] Oral Contraceptives

Oesterheld, J. R., Cozza, K., Sandson, N. B. — 2008-03-19

Nearly 50 years ago, the introduction of Enovid^© (norethynodrel 10 µg and mestranol 150 µg), which provided convenient and reliable contraception, revolutionized birth control. Reports of interactions between oral contraceptives (OCs) and other drugs began to trickle into the literature. At first, these drug interactions appeared to be random and unrelated. Increased understanding of P450 enzymes and phase II reactions of sulfation and glucuronidation has permitted preliminary categorization and assessment of the clinical relevance of these drug interactions.

[LETTERS TO THE EDITOR] Clozapine Toxicity in Smoking Cessation and With Ciprofloxacin * Case Report

Brownlowe, K., Sola, C. — 2008-03-19

[LETTERS TO THE EDITOR] Hysteria and Technology: Was Eliot Slater Right? * Case Report

Sirois, F. J. — 2008-03-19

[BOOK REVIEWS] Psychodynamic Diagnostic Manual (PDM) PDM Task Force

Lichtman, C. — 2008-03-19

[BOOK REVIEWS] Neuroscience for the Mental Health Clinician

Alici-Evcimen, Y. — 2008-03-19

[EDITORIALS] Term Limits: Editors Included

Wise, T. N. — 2008-01-22

[PERSPECTIVES] Presidential Address: Academy of Psychosomatic Medicine Tucson, AZ November 2006

Saravay, S. M. — 2008-01-22

[REVIEW ARTICLES] Consultants' Conflicts: A Case Discussion of Differences and Their Resolution

Caplan, J. P., Epstein, L. A., Stern, T. A. — 2008-01-22

Conflicts among consultants are frequent in general hospitals. Unfortunately, such disputes are rarely resolved to the satisfaction of all concerned. The authors discuss the conflicts that may arise among consultants and review techniques that can lead to more effective collaboration. Authors review the literature on consultants’ conflicts and discuss strategies for their resolution. They present the case of a man with neuropsychiatric symptoms and discuss how practitioners of psychiatry and neurology often approach differential diagnosis, work-up, and treatment of challenging cases. The consultants were able to find several points of agreement and generated a workable plan that led to improvement in the patient’s symptoms. Conflict among medical consultants is poorly described in the literature. However, an understanding of conflict and strategies for its resolution can lead to improved patient care. Conflict is a common and virtually unavoidable aspect of multidisciplinary care. However, effective tools exist that can help physicians embrace, rather than avoid, conflict, and lead to more effective collaboration. Effective management of interdisciplinary conflict improves communication, assists in medical decision-making, and, most importantly, improves the delivery of patient care.

[REVIEW ARTICLES] A Reconceptualization of the Somatoform Disorders

Noyes, R., Stuart, S. P., Watson, D. B. — 2008-01-22

Since its introduction in DSM–III, the Somatoform Disorders category has been a subject of controversy. Critics of the grouping have claimed that it promotes dualism, assumes psychogenesis, and that it contains heterogeneous disorders that lack validity. The history of these disorders is one of shifting conceptualizations and disputes. A number of changes in the classification have been proposed, but few address problems that arise with the current formulation. The authors propose a dimensional reconceptualization based on marked and persistent somatic distress and care-eliciting behavior. This formulation is based on the interpersonal model of somatization. The authors propose testing of this conceptualization and indicate how this might be done.

[ORIGINAL RESEARCH REPORTS] Which Measures of Obesity Are Related to Depressive Symptoms and in Whom?

Lim, W., Thomas, K. S., Bardwell, W. A., Dimsdale, J. E. — 2008-01-22

The authors asked which obesity measurements were associated with depressive symptoms, whether this relationship differed by gender, and whether controlling for fatigue and response bias affected the relationship. A sample of 129 subjects (66 men, 63 women), with a mean age of 36.9 years and a mean Body Mass Index (BMI) of 26.4 participated in the study. Depressive symptoms, levels of fatigue, response bias, and anthropometrics were assessed. In women, but not men, BMI and percent of ideal body weight were related to depression. However, percent of body fat did not show a relationship with depression after controlling for fatigue and response bias. These findings suggest that women’s depressive symptoms are more influenced by body size than body fat composition, whereas men’s depressive symptoms seem to be unrelated to obesity.

[ORIGINAL RESEARCH REPORTS] New Potential Clinical Indicators of Consultation-Liaison Psychiatry's Effectiveness in Brazilian General Hospitals

2008-01-22

The authors identified patients’ subjective well-being (SWB), relatives’ satisfaction with their information needs, and the medical team’s difficulty in helping patients, as potential indicators of effectiveness of consultation–liaison psychiatry. A random sampling of 74 beds was carried out (1 bed=1 patient + 1 relative + 1 nurse + 1 physician). There were negative correlations between SWB and anxious and depressive symptoms, and positive correlations with nurses’ difficulty in helping patients and patients’ depressive symptoms, nurses’ difficulty in helping patients and their perception about anxious and depressive symptoms; and physicians’ difficulty in helping patients and their perception about anxious and depressive symptoms. Patients’ SWB and difficulty in helping them constituted potential indicators in consultation–liaison psychiatry, whereas relatives’ satisfaction did not.

[ORIGINAL RESEARCH REPORTS] Heart Transplant, Social Support, and Psychiatric Sequelae: A 10-Year Follow-Up Clinical Case Review

Hategan, A., Nelson, C., Jarmain, S. — 2008-01-22

The authors document a case of a 65-year-old heart transplant recipient at 10-year follow-up, with particular reference to his psychiatric recovery. This case illustrates the importance of social support as both an acute intervention and for long-term maintenance in the heart-transplant patient with psychiatric and multiple medical conditions. It was found that the influence of social support on transplant recovery may be affected by critical periods, including initial postoperative stabilization and convalescence, and then again with longer-term changes in social roles. Enhanced collaboration between cardiac transplant teams and mental health professionals is warranted.

[ORIGINAL RESEARCH REPORTS] Depressive Symptoms and Heart Failure Stages

2008-01-22

The authors measured depressive symptoms cross-sectionally, across evolving stages of heart failure as defined by the American College of Cardiology, from low risk, through high risk for heart failure (Stage A), asymptomatic cardiac dysfunction (Stage B), up to symptomatic heart failure (Stage C), in a community sample of 338 noninstitutionalized adults age ≥45 years. Depressive symptoms were measured with the Beck Depression Inventory (BDI). Women scored significantly higher on the BDI. Adjusted BDI scores increased linearly with heart failure stages in women, whereas, in men, only Stage C was associated with a significantly higher score.

[ORIGINAL RESEARCH REPORTS] The Role of Anxiety in a Mammography Screening Program

Brown Sofair, J., Lehlbach, M. — 2008-01-22

Fifty-eight women, at least 35 years old, without breast cancer, were approached to examine the role of anxiety in mammography compliance. Forty-seven women for pre- and 43 for pre- and post-mammography completed the analysis. Mean age was 50; 64% were Hispanic, and 83% had no health insurance. Anxiety scores decreased after mammography. Residual anxiety was associated with having more than four films taken or with "non-negative" results. Eighty-five percent intended to return as recommended. Even though 26% of the group reported post-mammography anxiety, most planned to return. Future studies should explore staff influence on compliance across cultures.

[ORIGINAL RESEARCH REPORTS] Interferon-{alpha} in Oncology Patients: Fewer Psychiatric Side Effects Than Anticipated

2008-01-22

Interferon- (IFN-) treatment in both oncological and hepatological settings is associated with depression. If IFN- treatment induces depression in high numbers, it could serve as a model for studying the pathophysiology of depression, in general. The authors therefore studied 43 oncology patients treated with standard or pegylated IFN- with baseline psychiatric assessment and at regular time-points in the first 6 months of treatment. Apart from a severe depression because of brain metastases, authors observed only two clinically relevant depressive states. Contrary to findings in most of the literature, most depressive episodes in this study were self-limiting and short-lasting and were associated with either episodes of flu-like symptoms common at the start of the treatment or with concurrent psychosocial events. In the group as a whole, scores on both observer-based and self-report rating scales did not show clinically relevant changes. The results of this study indicate that IFN- treatment is not suitable as a study model for depression in general.

[ORIGINAL RESEARCH REPORTS] Depression and IL-6 Blood Plasma Concentrations in Advanced Cancer Patients

Jacobson, C. M., Rosenfeld, B., Pessin, H., Breitbart, W. — 2008-01-22

The authors explored the relationship between depression and interleukin-6 (IL-6) blood plasma concentrations among advanced-stage cancer patients. Seventy-three patients with advanced cancer were rated on depression with the Hamilton Rating Scale for Depression and gave blood to be assayed for blood plasma concentration of IL-6. Initial results found no correlation between depression and IL-6. Subsequent analyses found that among those whose blood was drawn within 48 hours of interview completion, depression and IL-6 were highly correlated. Future studies focusing on the relationship between immune functioning and depression must be particularly vigilant regarding methodological issues.

[CASE REPORTS] ECT in Patients With Psychopathology Related to Acute Neurologic Illness

Rasmussen, K. G., Hart, D. A., Lineberry, T. W. — 2008-01-22

Psychiatrists are occasionally called upon to assist in the management of patients with severe psychopathologic syndromes resulting from acute neurologic illness. In the absence of other options for treating the underlying neurological disorder or with persistence of the psychopathology after resolution of the neurologic illness, electroconvulsive therapy (ECT) may be considered. The authors treated four such patients, two of whom experienced no benefit and two of whom experienced dramatic benefit. The authors provide recommendations for the approach to acutely ill neurologic patients with regard to the use of ECT.

[CASE REPORTS] Clinical Utility and Use of DSM-IV and ICD-10 Criteria and The Memorial Delirium Assessment Scale in Establishing a Diagnosis of Delirium After Cardiac Surgery

2008-01-22

Authors evaluated the sensitivity and specificity of DSM–IV and ICD–10 criteria and the cutoff value of the Memorial Delirium Assessment Scale (MDAS) in diagnosing postoperative delirium in 260 cardiac surgery patients. Incidence of delirium diagnosed on the basis of DSM–IV and ICD–10 criteria, and with the use of the MDAS was 11.5%, 9.2%, and 6.5%, respectively. The DSM–IV criteria for delirium were found to be more inclusive than those of ICD–10. The cutoff point of 10 of the MDAS was optimal in relation to the presence or absence of delirium after cardiac surgery.

[CASE REPORTS] Olfactory Reference Syndrome

Bizamcer, A. N., Dubin, W. R., Hayburn, B. — 2008-01-22

[CASE REPORTS] Severe Acute Hyperammonemia After Brief Exposure to Valproate

Eubanks, A. L., Aguirre, B., Bourgeois, J. A. — 2008-01-22

The authors describe a case of acute hyperammonemia after the addition of valproate to the medication regimen of a patient on multiple psychotropic medications. The patient presented with acute mental-status changes consistent with delirium. With prompt intervention and supportive care, her delirium quickly cleared.

[CASE REPORTS] Pneumonitis Related to Venlafaxine

Vazquez, M. J. M., Carretero Quevedo, B. — 2008-01-22

[LETTERS TO THE EDITOR] On Catatonia, Seizures, and Bradycardia

Ahuja, N., Lloyd, A. J. — 2008-01-22

[LETTERS TO THE EDITOR] Treatment of Hepatitis C With Interferon-{alpha} and Ribavirine in a Patient With Long-Term Clozapine Treatment

Liukkonen, T., Sorjonen, M., Jokelainen, J., Timonen, M. — 2008-01-22

[BOOK REVIEWS] Helping Students Overcome Substance Abuse: Effective Practices for Prevention and Intervention

Roth, J., Ramchandani, D. — 2008-01-22

[BOOK REVIEWS] Psychosis in the Elderly

Stanton, L. A. — 2008-01-22

[REVIEW ARTICLES] Antiemetics, Akathisia, and Pregnancy

Wright, M. T. — 2007-12-10

Gastrointestinal disorders are common in pregnant women. These disorders are often treated with antiemetic medications that block central dopaminergic neurotransmission. Dopamine antagonists can cause akathisia. Hormonal changes and other factors may place pregnant women at increased risk for the development of severe antiemetic-induced akathisia. The mental symptoms that can accompany akathisia can be misinterpreted as primary mental illness. The author reports on the case of a pregnant woman who attempted to injure herself after developing severe antiemetic-induced akathisia.

[REVIEW ARTICLES] Psychosocial Aspects of Pulmonary Hypertension: A Review

Wryobeck, J. M., Lippo, G., McLaughlin, V., Riba, M., Rubenfire, M. — 2007-12-10

Pulmonary arterial hypertension (PAH) is characterized by progressive and sustained elevation of pulmonary-artery pressure, which ultimately leads to right-ventricular failure and death. The diagnosis carries with it an uncertain and historically very bleak prognosis. Although new oral and chronic parenteral (intravenous and subcutaneous) treatments have had a significant positive medical impact on the physical functioning of individuals with PAH, patients often struggle with new short- and long-term psychosocial challenges. The purpose of the current article is to 1) provide a brief review of PAH and its treatment; 2) summarize the limited literature examining the psychosocial adjustment of those with a PAH diagnosis; and 3) provide pertinent information extrapolated from the larger literature on chronic illness that might inform us on the psychosocial challenges faced by the patient diagnosed with PAH.

[ORIGINAL RESEARCH REPORTS] Parental Physical Illness as a Risk for Psychosocial Maladjustment in Children and Adolescents: Epidemiological Findings From a National Survey in Germany

Barkmann, C., Romer, G., Watson, M., Schulte-Markwort, M. — 2007-12-10

The authors assessed the risk for psychosocial maladjustment in a population-based sample of dependent children of parents with serious physical illness. In the context of The Hamburg Health Survey, a wide range of data on current life situation and health status was collected from a representative sample of families with children and adolescents between 4 and 18 years old (N=1,950). For 4- to 18-year-old children and adolescents in Germany, the prevalence of a serious physical illness in a parent was 4.1%. The adjusted risk of psychosocial maladjustment in this target group, depending on the case definition, is elevated, with internalizing problems being more prevalent than externalizing problems. Although problems for affected boys decline with puberty, they increase for girls. In this age-group, girls and boys appear to be under particular strain when the respective same-sex parent has a serious physical illness. Exposure to serious parental physical illness is an epidemiologically relevant risk factor for psychosocial maladjustment in children and adolescents that needs to be better recognized by medical professionals.

[ORIGINAL RESEARCH REPORTS] Depression Treatment Preferences of VA Primary Care Patients

Dobscha, S. K., Corson, K., Gerrity, M. S. — 2007-12-10

The authors identified veterans’ depression treatment preferences and explored relationships between preferences, process of care, and clinical outcomes. Patients entering a collaborative depression intervention trial in primary care completed an assessment of treatment preferences. Medical record review was used to identify treatments offered and received over a 12-month period. Of 314 patients, 32% preferred antidepressants; 19%, individual counseling; 18%, anti-depressants plus counseling; 7%, group counseling; and 25%, "watchful waiting." Although the treatment that was offered was associated with treatment preferences, being offered preferred treatment was not associated with receiving treatment or with changes in depression severity or satisfaction over time.

[ORIGINAL RESEARCH REPORTS] Alexithymia and Emotional Distress in Patients With Central Serous Chorioretinopathy

Conrad, R., Weber, N. F., Lehnert, M., Holz, F. G., Liedtke, R., Eter, N. — 2007-12-10

The authors studied 31 consecutive patients newly diagnosed with central serous chorioretinopathy (CSC) as compared with 31 age- and gender-matched control subjects, assessing emotional distress (ED), nine psychopathological symptoms, critical life events, and alexithymia. Results showed no difference in the number of critical life events; however CSC patients showed elevated ED and elevated scores on seven psychopathological symptoms, including hostility. Controlling for ED, CSC patients showed elevated alexithymia sum scores. Alexithymia was correlated with hostility. Our findings point to personality-based difficulties in emotional regulation associated with hostility in CSC.

[ORIGINAL RESEARCH REPORTS] Chronic Obstructive Lung Diseases and Prevalence of Mood, Anxiety, and Substance-Use Disorders in a Large Population Sample

Patten, S. B., Williams, J. V.A. — 2007-12-10

Only a few population-based studies have examined prevalence of mental disorder in people with chronic respiratory conditions. Clinical studies have yielded mixed results. In this analysis, data from the 2002 Canadian Community Health Survey (CCHS) were used. This was a national health survey that included administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Participants were asked about chronic medical conditions that had been diagnosed by a health professional. Chronic respiratory conditions were associated with major depressive disorder, bipolar disorder, panic disorder (including agoraphobia), social phobia, and substance dependence. Although the observed associations were statistically highly significant, the prevalence estimates were lower than previous reports from studies using clinical samples, suggesting that selection bias may have influenced some estimates.

[ORIGINAL RESEARCH REPORTS] Course and Outcome of Somatoform Disorders in Non-Referred Adolescents

Essau, C. A. — 2007-12-10

The author examined the course of somatoform disorders in non-referred adolescents. Somatoform disorders were coded from DSM–IV criteria, using the computerized Munich (Germany) version of the Composite International Diagnostic Interview. About 35.9% of the adolescents with somatoform disorders at the index investigation continued to have the same disorders at the follow-up investigation: 26.7% had anxiety, 17.1% had depression, 22% had substance-use disorders, and 53.7% had no psychiatric disorders. Factors related to the chronicity of somatoform disorders included gender, comorbid depressive disorders, parental psychiatric disorders, and negative life events. Somatoform disorders showed a heterogeneous pattern of course.

[ORIGINAL RESEARCH REPORTS] Comparison of Participants and Non-Participants in a Randomized Psychosocial Intervention Study Among Patients With Malignant Melanoma

Boesen, E., Boesen, S., Christensen, S., Johansen, C. — 2007-12-10

The authors investigated barriers for entering a randomized psychosocial intervention study among patients with malignant melanoma. Data on age, sex, prognostic factors, social class, marital status, mood, coping, social relations, and social desirability from participants and non-participants were compared in a regression model. More patients in lower socioeconomic classes declined participation. Non-participation was associated with low levels of distress and adaptive coping and higher levels of empathy and congruence from spouses. The type of intervention offered in this study may have more appeal to patients belonging to higher socioeconomic classes.

[ORIGINAL RESEARCH REPORTS] A Comparison of Psychiatric Consultation Liaison Services Between Hospitals in the United States and Japan

2007-12-10

The authors investigated psychiatric consultation in two hospitals, one in the United States, the other in Japan. They examined similarities and differences, and drew inferences on possible cross-cultural values and/or temporary cultural conditions. As compared with the Japanese consultation patients, the Americans had more mood disorders, including anxiety and chemical-dependency problems, in respective diagnostic classifications. Patients in the United States also showed more acute as well as more serious chronic conditions. These differences may relate to disorder base-rates in the respective countries. In general, psychosocial problems emerged as ascendant in Japan, as compared with chemical-dependency difficulties among American patients. The results are discussed in terms of current conditions in Japan that affect the mental health professions, together with attempts by Japanese clinicians to protect collective mores by ascribing causation for disorders to the individual, rather than the societal conditions often invoked in the United States.

[ORIGINAL RESEARCH REPORTS] Alexithymia and Life Satisfaction in Primary Healthcare Patients

Mattila, A. K., Poutanen, O., Koivisto, A.-M., Salokangas, R. K.R., Joukamaa, M. — 2007-12-10

The relationship between life satisfaction and alexithymia was studied in a sample of 229 patients as a part of a naturalistic follow-up study of depression in Finnish primary health care. The measures were the abbreviated Life Satisfaction Scale and the 20-item Toronto Alexithymia Scale. Depression was assessed by telephone with the short form of the Composite International Diagnostic Interview. Of all subjects, 19.2% were alexithymic, and 9.2% were depressed. Alexithymia was negatively associated with life satisfaction even when depression and other confounding factors were controlled for. Alexithymia is a risk factor for life dissatisfaction in primary-care patients.

[CASE REPORTS] Quetiapine-Induced Leucopenia and Thrombocytopenia

Shankar, B. R. — 2007-12-10

Antipsychotic drugs can cause neutropenia, which can progress to life-threatening agranulocytosis if drug therapy is not interrupted. The newer atypical antipsychotics are reputedly without adverse hematological effects. Quetiapine is a recently introduced atypical antipsychotic. It is a dibenzothiazepine derivative and shows similarities with clozapine in that it is characterized by high 5-HT₂-relative-to-DA₂ receptor affinity. Although adverse effects are usually mild, the author reports here a case of leucocytopenia and thrombocytopenia with quetiapine treatment that required its discontinuation.

[CASE REPORTS] Parathyroid Adenoma Presenting as Bipolar Affective Disorder

Das, P. P., Sharan, P., Grover, S., Behera, A. — 2007-12-10

[CASE REPORTS] Treatment of Catatonia With Olanzapine and Amantadine

Babington, P. W., Spiegel, D. R. — 2007-12-10

Catatonia is a disorder characterized by mutism, posturing, echophenomena, and negativism. The preferred treatment for non-malignant catatonia is benzodiazepines, which often produce a reduction in symptoms within 24 hours. Presented here is a case report of a 19-year-old woman appearing in a catatonic state that did not respond to lorazepam. On the basis of emerging evidence that atypical antipsychotics and weak N-Methyl-D-Aspartate (NMDA) receptor-antagonists may effectively treat catatonia, we treated our patient with olanzapine and amantadine, which resulted in a dramatic reduction in her catatonic symptoms.

[MED-PSYCH UPDATE] Cardiovascular Medications

Williams, S., Wynn, G., Cozza, K., Sandson, N. B. — 2007-12-10

[LETTERS TO THE EDITOR] Additional Information on German Study About Denial and Concealment of Pregnancy

Wessel, J. — 2007-12-10

[LETTERS TO THE EDITOR] Nonepileptic Hallucinations in Use of Levetiracetam

Evcimen, H., Kushon, D., Jenssen, S. — 2007-12-10

[BOOK REVIEWS] Essentials of Psychosomatic Medicine

Amos, J. J. — 2007-12-10

[BOOK REVIEWS] Integrated Care for the Complex Medically Ill

Wise, T. N. — 2007-12-10