Comparing two measures of depression in spinal cord injury.

Compared 2 measures of depression, the Zung Self-Rating Depression Scale (SRDS) and the Brief Symptom Inventory (BSI), and discussed their use with (1) 162 spinal cord injury (SCI) outpatients and (2) 30 SCI inpatients. Sample 2 was used to study the predictor validity of the tests based on clinicians' ratings of Ss' depression status. Results indicate a fair degree of correlation between these tests. Fairly good test reliability was also found. The SRDS was more clearly delineated into distinct conceptual factors than the BSI. An analysis of predictive validities of the 2 tests using test scores and independent clinician ratings suggests that the BSI and the SRDS were the most useful predictors of depression among SCI Ss. However, the SRDS was superior for identifying SCI persons at risk of being depressed during or after rehabilitation hospitalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the validities of the Beck, Zung, and MMPI Depression scales.

Compared the validities of 3 widely used self-report depression measures: the Beck Depression Inventory (BDI), the MMPI Depression scale, and the Self-Rating Depression Scale (SRDS). Each inventory was administered to 101 inpatient psychiatric ward patients and to 99 chemical dependency ward patients. All of the Ss were male and less than 60 yrs of age. The 3 scales were correlated with clinicians' global ratings of depression, with scores on 5 DSM-III-based factor-analytic depression scales, and with an overall depression score based on the DSM-III criteria. In general, the SRDS produced better validity coefficients than the BDI, which in turn yielded higher correlations with these criteria than did the MMPI Depression Scale. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Symptom Inventory norms for spinal cord injury.

Investigated the effects of spinal cord injury (SCI) upon a person's response to the Brief Symptom Inventory (BSI) by analyzing differences across item-response distributions from 225 Ss with SCI (aged 17–68 yrs) vs a nonpatient normative sample of 719 Ss. The study also developed more appropriate BSI normative data for persons with SCI. Because Ss' time since injury varied at time of BSI administration, normative scores were provided within 3 groupings: at discharge from the hospital; 0–24 mo post-discharge; and beyond 24 mo. Results show that SCI Ss had higher BSI scores when compared with Ss in the normative sample. These differences were particularly significant across 8 BSI items that reflected actual SCI physical and psychosocial symptoms. SCI Ss reported more distress during the period immediately following discharge to 24 mo. Overall, BSI scores tended to be lower at discharge and after 24 mo post-discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spondyloarthropathies

OBJECTIVE: Prediction of outcome of ambulatory capacity and hand function in tetraplegic patients with spinal cord injury (SCI) using neurologic examination, according to the protocol of the American Spinal Injury Association (ASIA) and motor-evoked potentials (MEP). DESIGN: Correlation study on a prospective cohort. SETTING: SCI center, university hospital. PATIENTS: Thirty-six patients with acute and 34 with chronic SCI. OUTCOME MEASURES: (1) ASIA motor and sensory scores, (2) MEP recordings of upper and lower limb muscles, and (3) outcome of ambulatory capacity and hand function. RESULTS: In acute and chronic SCI, both the initial ASIA scores and the MEP recordings were significantly related (p < .0001) to the outcome of ambulatory capacity and hand function. In tetraplegic patients, the MEP of the abductor digiti minimi muscle (Spearman correlation coefficient, .75; p < .0001) and the ASIA motor score for the upper limbs (Spearman correlation coefficient, .83; p < .0001) were most related to the outcome of hand function. Ambulatory capacity could be predicted by the ASIA motor score of the lower limbs (Spearman correlation coefficient, .78; p < .0001) and by MEP recordings of the leg muscles (Spearman correlation coefficient, .77; p < .0001). In patients with acute SCI, for the period 6 months posttrauma, the ASIA motor score increased significantly (ANOVA, p < .05), whereas the ASIA sensory scores and MEP recordings were unchanged (ANOVA, p > 0.1). CONCLUSION: Both ASIA scores and MEP recordings are similarly related to the outcome of ambulatory capacity and hand function in patients with SCI. MEP recordings are of additional value to the clinical examination in uncooperative or incomprehensive patients. The combination of clinical examination and MEP recordings allows differentiation between the recovery of motor function (hand function, ambulatory capacity) and that of impulse transmission of descending motor tracts.     

Classifying college students as depressed or nondepressed using the Beck Depression Inventory: An empirical analysis.

In Study 1, the classification of 150 college students as nondepressed or mildly or moderately depressed was compared using Beck Depression Inventory (BDI) scores obtained on 2 occasions, either on the same day or 1 wk later. Whereas the overall test–retest reliability coefficients were acceptable, particularly when both administrations occurred on the same day, the consistency of classification of Ss into the mild and moderate levels of depression was poor. In an attempt to determine the factors contributing to the poor classification consistency, a 2nd study with 207 Ss compared the effect of exposure to the BDI on subsequent BDI responses. Ss who completed the BDI on 2 occasions showed significantly lower BDI scores compared to Ss exposed to an alternate depression inventory (the Self-Rating Depression Scale [SRDS]) or no prior questionnaire. In addition, a large percentage of Ss classified as moderately depressed following the initial BDI administration failed to be classified within the moderate categories on retesting the same day. Ss tested using the SRDS maintained the same depression classification when retested on the BDI. Item analyses failed to reveal significantly different amounts of change among individual BDI items. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the Beck Depression Inventory in veterans with spinal cord injury.

Hypothesized that 7 Beck Depression Inventory items would be poor discriminators between depressed and nondepressed spinal cord injury Ss. To test this hypothesis, 124 veterans (aged 19–79 yrs) with spinal cord injury were administered the Beck Depression Inventory and evaluated for the presence of a major depressive episode. Ss were first administered the Mini-Mental Status Examination, interviewed and then administered the Beck Depression Inventory. Discriminant function analysis revealed that 3 of the 7 items were poor discriminators. Since clinicians are faced with the dilemma of deciding whether endorsement of Beck Depression Inventory items is indicative of depressive symptomatology or the sequelae of spinal cord injury, the authors derived cut scores appropriate for spinal cord injury patients. Data on the sensitivity and specificity of these cut scores are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Brief Symptom Inventory: Measuring psychological distress in spinal cord injury.

Explored the appropriateness of the Brief Symptom Inventory (BSI) as a measure of psychological distress among 79 traumatic spinal cord injured (SCI) patients (aged 18–70 yrs) and emphasized the limitations of using the BSI as a replacement for the SCL-90—Revised (SCL-90—R). Ss' BSI scores were compared with a nonpatient normative group (N?=?974). Ss were significantly more psychologically distressed in somatization, depression, and phobic anxiety than the normative group. However, several somatization symptoms endorsed by these Ss are common physical effects of SCI rather than psychosomatic complaints. When comparing BSI and SCL-90—R scores of the same Ss, significant statistical differences were found with respect to the level of psychological distress being reported by each test. The BSI may not represent an equivalent abbreviated form of the SCL-90—R for the SCI population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological problems of spinal cord injury patients: Emotional distress as a function of time and locus of control.

A scale assessing psychological problems was developed and administered to 136 male VA hospital spinal cord injury (SCI) patients (under 30 yrs of age). Results suggest that reaction to SCI was dominated by emotional distress and was best predicted by external locus of control and by recent injury. The scale was correlated with self-reports of anxiety, adjustment, affiliation, and sociability in a college population. Results do not support a simple stage theory of reaction to SCI but are consistent with other studies of coping patterns in SCI patients. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among African Americans, Latinos, and Caucasians with spinal cord injury: A exploratory study.

Objective: Explored the relationship between depression and racial–ethnic group membership among people with spinal cord injury (SCI). No literature exists on this topic, and research on related areas reveals variable findings with regard to ethnic–racial differences in depression. Study Design: During their annual physical exams at an SCI clinic in Southern California, 171 Ss with SCI completed the Older Adult Health and Mood Questionnaire, a clinically validated measure of depressive symptomatology. Participants: Forty-six Caucasians, 28 African Americans, and 97 Latinos over 21 years of age with either tetraplegia or paraplegia. Main Outcome Measures: Depression scores, diagnoses, and item clusters. 42% of the Ss reported clinically significant symptomatology; 18% reported possible major depression. Latino Ss reported higher overall depression scores than either African American or Caucasian Ss, who did not differ from each other. Latinos also had a greater prevalence of possible major depression, along with higher item clusters reflecting loss of pleasure and greater feelings of hopelessness and fatigue. Conclusions: These findings suggest a need for routine screening for depression after SCI, particularly among individuals from Latino backgrounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in vocational interests after spinal cord injury.

117 males (aged 20–72 yrs) with spinal cord injury (SCI) completed an SCI questionnaire and 2 versions of the Strong-Campbell Interest Inventory (SCII), one with standardized instructions and one with instructions to recall interests from an earlier, preinjury age. Strong Vocational Interest Blanks taken prior to injury were located for 14 Ss. These provided direct evidence concerning stability of interests and suggested that the larger group was relatively accurate in the recall of preinjury interests. 130 age-matched males without SCI also completed the SCII twice to assess the presence of any variance uniquely associated with the preinjury recall method. Results show that the interests of SCI Ss were as stable as those of the non-SCI Ss and that changes that did occur were consistent with those found in nondisabled samples. It is suggested that the recall method is potentially useful for future research. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Release of lactate by the lung in acute lung injury

The pathogenesis of hyperlactatemia during sepsis is poorly understood. We have previously described an increase in lactate concentration across the lung in the dog during early endotoxemia. Accordingly, we sought to determine if the lung releases lactate in humans and what relation this has with lung injury. METHODS: We measured lactate concentrations across the lung and lung injury scores (LIS) in two groups of patients. Group 1 consisted of nine patients with acute lung injury (LIS > or = 2.0) and elevated lactate concentrations (> 2.0 mmol/L). Group 2 contained 12 patients with no acute lung injury (LIS scores < or = 1.5), with or without increased lactate concentrations. Simultaneous measurements of plasma lactate and blood gases were obtained from indwelling arterial and pulmonary artery catheters. Measurements of cardiac output were also obtained. Lactate measurements were done using a lactate analyzer (YSI; Yellow Springs, Ohio). RESULTS: For each patient with acute lung injury and hyperlactatemia, an arterial-venous lactate gradient existed demonstrating release of lactate by the lung. This gradient persisted after correction for changes in hemoconcentration across the lung. The lactate gradient across the lung was 0.4 +/- 0.2 mmol/L for group 1 vs 0.05 +/- 0.1 mmol/L for group 2 (p = 0.001). This corresponded to a mean pulmonary lactate flux of 231.3 +/- 211.3 vs 5.0 +/- 37.2 mmol/h (p = 0.001). The lactate flux and the arterial-venous lactate difference correlated with LIS both for the entire sample and for the subgroup with hyperlactatemia (r = 0.69, p < 0.01). Pulmonary lactate flux was not related to arterial lactate levels (r = 0.25). CONCLUSION: In patients with acute lung injury and hyperlactatemia, the lung is a major source of lactate and lactate flux correlates with LIS. This lactate flux could explain some of the hyperlactatemia seen in sepsis.     

The acute abdomen in spinal cord injury individuals

A review of 1300 patients with spinal cord injury (SCI), over a period of 14 years, revealed 12 patients with an 'acute abdomen'. Seven events occurred during the initial admission, ranging from 10 days to 9 months from injury, and five during readmission of 'chronic' SCI patients. Four were in the acute stage 10-30 days from injury, all with peptic ulcer perforations. The remainder had either an intestinal obstruction, appendicitis or peritonitis. All of the neurological levels were above T6 except for one patient who had a low level paraplegia. The classical signs of an 'acute abdomen' may be missing in such patients thus delaying diagnosis by 1-4 days. The most important signs were autonomic dysreflexia, referred shoulder tip pain, abdominal pain, abdominal distension, increased spasticity and abdominal pain with nausea and vomiting. Less importance was given to the classical signs of abdominal tenderness, abdominal muscle rigidity, rebound, fever and of leukocytosis. Prompt diagnosis and treatment will minimise morbidity and mortality.     

Prevalence and relationships of posttraumatic stress in families experiencing pediatric spinal cord injury.

Objective: To investigate the severity of posttraumatic stress (PTS) and the prevalence of posttraumatic stress disorder (PTSD) in individuals with pediatric spinal cord injury (SCI) and their parents and to assess relationships among family members' degree of PTS and PTSD diagnoses. Study Design: Cross-sectional mail survey. Setting: A pediatric orthopedic surgical and rehabilitation hospital. Participants: A volunteer sample of 64 pediatric SCI patients (59% male and 41% female), 64 mothers, and 49 fathers. Main Outcome Measures: The Posttraumatic Diagnostic Scale was used for parents and for patients more than 18 years of age and the Child Posttraumatic Stress Scale was used for patients 18 years of age and under. Results: Sixteen (25.4%) patients, 25 (41%) mothers, and 16 (35.6%) fathers reported current PTSD. Mothers' total PTS scores statistically predicted patients' and fathers' PTS scores, and patients' PTS scores statistically predicted mothers' PTS scores. In addition, mothers' and patients' PTSD diagnoses related significantly. Conclusions: PTSD may be among the most prevalent psychological comorbidities in families experiencing pediatric SCI. Screening and treatment for PTSD appear warranted as part of standard psychosocial care for these families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and medical complications following spinal cord injury.

Evaluated the relationship between substance use; depression and disability acceptance; and 2 preventable medical complications, pressure ulcers and urinary tract infections (UTIs), following spinal cord injury (SCI). 103 SCI patients (aged 16–63 yrs) undergoing inpatient rehabilitation, were recruited for interviews after 2-, 6-, and 18-mo of admission. 80 Ss completed all 3 evaluations, of which, 71 were followed up for 30 mo. Information was obtained on substance use, severity of drinking problems, depression intensity, and psychological aspects of post-injury adaptation. An increased risk of pressure ulcers 30 mo after injury, was associated with use of psychotropic medications, and abstinence from alcohol, with a history of drinking problems. UTIs were related to illicit substance use. Impairment characteristics were important predictors initially after injury, while abstinence with a history of drinking problems predicted ulcers later. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negro vs Caucasian psychological test performance revisited.

Reports that in a group of 2,750 1st and 2nd admissions to the psychiatric unit of a Veteran's Administration hospital differences in proportion of Negroes vs Caucasians receiving schizophrenic, alcoholic, and depressive psychiatric diagnoses were found. Race, education (12 yrs or more vs 11 yrs or less), and diagnosis (schizophrenic vs nonschizophrenic) were varied. Contrary to past research, data from 160 Negro and Caucasian, schizophrenic and nonschizophrenic, and high- and low-educated patients under age 50 reveal no significant race-related main effects on the 9 MMPI clinical scales. Schizophrenics scored higher on the Paranoia (Pa) and Schizophrenia (Sc) scales, and poorly educated patients scored higher on Sc. Higher Pa and Sc scale scores were obtained from poorly educated Negroes but not from higher educated Negroes or Caucasians at both educational levels. Results are discussed in terms of education having an inculturating effect on minority groups and a selective process whereby poorly motivated minority group members drop out of school. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality test correlates of psychiatric case history data.

Correlated scores on factor analytically derived traits of normal personality, as measured by the Comrey Personality Scales (CPS), with ratings of psychological disturbance and psychiatric diagnosis derived from case-history data for 210 female (mean age 31.8 yrs) and 184 male (mean age 30.2 yrs) psychiatric outpatients. Results confirm findings from past statistical studies, showing that extreme scores on normal personality trait scales were associated with psychological disturbance, especially low scores on Trust vs Defensiveness, Activity vs Lack of Energy, Emotional Stability vs Neuroticism, Extraversion vs Introversion, and high scores on Orderliness vs Lack of Compulsion. New statistical evidence was obtained in the present study for the importance of certain extreme trait scores where only clinical evidence was available before. Findings provide further support for the premise that objective tests of normal personality traits have an important role to play in psychiatric screening, diagnosis, and design of clinical interventions. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biochemical changes in denervated muscle identified by magnetic resonance spectroscopy

The significance of the ASIA (American Spinal Injury Association) scores and SSEP (somatosensory evoked potentials) recordings in predicting the recovery of bladder function was evaluated in 70 patients with acute, traumatic spinal cord injury (SCI). The patients were examined following admission to the rehabilitation centre (mean 10 days post-trauma) both clinically by the ASIA scores and electrophysiologically by tibial and pudendal SSEP recordings. The results of the initial examinations were related to the degree of recovery of bladder function of the patients assessed by urodynamic examination at the end of the rehabilitation programme (at least 6 months post-trauma). The recovery of somatic nerve function (external urethral sphincter function) involved in bladder function was correlated to both the initial ASIA scores and SSEP recordings (Spearman correlation, P < 0.001). The latter parameters, however, were not related to the outcome of autonomic nerve function (eg detrusor vesicae function) (Spearman correlation, P = 0.1). Therefore, the initial clinical and electrophysiological examinations are of value in assessment of the degree to which the patient will recover somatic nervous control of bladder function. However, these examinations are not indicative of urodynamic impairment. Therefore, urodynamic examination should be mandatory for the diagnostic assessment and therapeutical approach of bladder dysfunction in patients with acute SCI.     

Limitation of therapeutic activity in elderly critically ill patients. Project for the Epidemiological Analysis of Critical Care Patients

OBJECTIVE: To establish whether the age of patients admitted into the intensive care unit (ICU) influences the amount of therapy received. DESIGN: Observational, prospective, multicenter study. SETTING: Eighty-six multidisciplinary ICUs in Spain, including coronary patients. PATIENTS: The patients (n = 8,838) were studied during a 6-month period between 1992 and 1993. Patients < 16 yrs of age and patients dying within the first 6 hrs were excluded from the study. MEASUREMENTS AND MAIN RESULTS: We collected data on age, gender, type of diagnosis at the time of admission, severity level by Acute Physiology and Chronic Health Evaluation (APACHE) II and III, quality of life survey score, therapeutic activity during the first 24 hrs by Therapeutic Intervention Scoring System, and ICU and hospital mortality rates. In the sample of patients, 12.5% were > 75 yrs of age. Compared with younger patients, these patients had higher APACHE II (18.41 +/- 0.23 vs. 15.14 +/- 0.09 points, p < .001) and APACHE III (65.8 +/- 0.81 vs. 53.32 +/- 0.33 points, p < .001) scores, a higher quality of life survey score (i.e., worse quality of life, 7.19 +/- 0.19 vs. 3.86 +/- 0.05 points, p < .001), and a greater ICU mortality rate (21.9% vs. 15.3%, p < .00001) and hospital mortality rate (30.8% vs. 19.3%, p < .00001). However, patients > 75 yrs had a lower Therapeutic Intervention Scoring System score (19.83 +/- 0.28 vs. 21.17 +/- 0.12 points, p < .001). Multivariate analysis showed that once severity, need for mechanical ventilation, diagnostic group, and mortality rate were taken into account, there was less therapeutic activity in patients > 75 yrs of age. CONCLUSIONS: Patients > 75 yrs of age represent a large proportion of patients in Spanish ICUs. Although their mortality rate and severity scores were higher than those values in younger patients, patients > 75 yrs of age received less therapy.