Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practical and financial considerations that affect selection and purchase of ultrasound equipment

Ultrasound has become integrally involved in the medical management of obstetric patients. The decision to incorporate sonography into a routine obstetric and gynecologic practice requires input from all members of the practice. Only when there is such a commitment will patient care be optimal. Regardless of whether one believes that routine screening will improve perinatal outcome, the consensus is that timely and appropriate obstetric ultrasound examinations are beneficial.     

A fever workup guideline

Fever is a common clinical problem in patients hospitalized with trauma. When an infection is suspected, it is important to identify the source of fever and begin definitive care before more severe morbidity occurs. An undirected approach with "pan cultures" has resulted in a high rate of negative cultures obtained and has increased patient care costs. By developing and using an evidence-based fever workup guideline, this institution was able to evaluate and identify infections and reduce costs.     

Interaction of Hsp70 chaperones with substrates

The purpose of this study was to examine the effectiveness of progressive muscle relaxation (PMR) in reducing the nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Subjects comprised 60 cancer chemotherapy patients who were hospitalized in a cancer center. These subjects were randomly assigned to either the experimental or control group. In addition to routine nursing care, subjects in the experimental received PMR training, while those in the control received contact with the investigator. Results from this study verified the effectiveness of PMR in reducing total scores used to measure nausea, vomiting, and retching; subscale scores of nausea; and subjective feelings of anxiety. The efficacy of PMR to reduce subscale scores of vomiting was not verified, partly due to an extremely low incidence of vomiting.     

Basal expression, subcellular distribution, and up-regulation of the proto-oncogene c-JUN in the rat dentate gyrus after unilateral entorhinal cortex lesion

OBJECTIVE: To compare perceived current mental health and disablement between primary care and end-stage renal disease (ESRD) patients, and to study social support and stress and severity of illness as possible determinants of mental health and disablement. METHOD: Observational cross-sectional analysis of 414 primary care patients in a rural community health center and 125 ESRD patients requiring hemodialysis in two community dialysis units. The Duke Health Profile (DUKE) anxiety-depression scale was used to assess mental health; the DUKE disability scale, to indicate disablement; the Duke Social Support and Stress Scale, to measure support and stress; and the Duke Severity of Illness Scale, to rate severity of illness. RESULTS: Perceived current mental health in terms of anxiety and depression symptoms was worse for primary care than for ESRD patients, and perceived current disablement was no different for the two groups. Patients' perception of their health status and of stress from family members were more closely associated with their level of anxiety and depression symptoms than were their diagnostic profiles or overall severity of illness. In turn, their level of anxiety and depression symptoms was the principal correlate of their disablement. CONCLUSIONS: The demonstration of strong relationships among anxiety and depression symptoms, disablement, and family stress in these two very different patient populations should stimulate further research and motivate clinicians to evaluate all three parameters as part of routine patient care.     

The structure of emotions during acute myocardial infarction: a model of coping

The present state of medical care for heart attacks, or acute myocardial infarction (AMI), clearly indicates that rapidly and expeditiously seeking definitive medical care will reduce morbidity and prevent mortality. Despite the clearly established advantages of rapid AMI treatment, the time from the onset of acute symptoms of AMI to definitive medical care is often prolonged and individuals with a prior history of AMI and/or coronary artery disease (CAD) extend care-seeking. Behaviors and actions surrounding acute care-seeking are often fraught with complex social, psychological and emotional processes. The purpose of the present paper is to bring together a theoretical and an applied understanding of the interval of time from acute symptom onset to definitive medical care during AMI; and to understand the role of emotions in the care-seeking process. This task is especially important among individuals with a prior history of AMI and/or CHD. These individuals can be seen as experiencing a "spectrum of posttraumatic disturbances", ranging from anxiety to posttraumatic stress disorder and alexithymia. These disturbances contribute to extended care-seeking thereby placing the individuals at greater risk for AMI and sudden cardiac death. Effective intervention requires three elements. First, knowledge is necessary so that individual and lay others can correctly label symptoms and signs of an AMI. Second, it is necessary to provide feasible behaviors that individuals and lay others can use to access definitive medical care. Third, and perhaps most importantly, it is necessary to provide understanding of and skills to cope with the emotional arousal surrounding both the primary traumatic experience of symptoms and signs, potential secondary traumatic consequences of AMI care-seeking and tertiary trauma from the long-term consequences of CHD.     

Symptom severity and diagnoses related to sexual assault history

The current study examines associations between a history of sexual assault or abuse and severity of symptoms and diagnostic categories in an adult clinical outpatient sample. Twelve of 68 men (18%) and 71 of 120 women (59%) reported a history of sexual trauma. Abuse history was associated with mood and anxiety disorder diagnoses. Women were also more likely to receive these diagnoses; abused women were particularly likely to be diagnosed with an anxiety disorder. Abused subjects showed higher scores on every subscale of the SCL-90-R; there were no interactions between sex and history of abuse. Women scored higher than men on subscales indicating anxiety, phobia, and general distress. The results indicate an association between history of sexual trauma and symptom severity across a broad range of psychopathology, and with mood and anxiety disorders. There is no indication of differential gender effects of sexual assault.     

Office sonography and office hysteroscopy

Researchers involved in assessing technology and healthcare, including gynecologic care, have identified differences among the terms efficacy, effectiveness and efficiency. In order to assess the efficiency of procedures such as office sonography and hysteroscopy, it is first necessary to compare them with the alternatives in terms of patient-focused outcomes. Office sonography has been used to diagnose early pregnancy disorders such as ectopic gestations and evaluate other adnexal pathology, with mixed results. The use of office hysteroscopy to assess abnormal bleeding may replace procedures that are associated with greater risk and expense. More information regarding outcomes is needed for both procedures before they can be recommended as efficient alternatives for the diagnosis or treatment of gynecologic conditions.     

Dissociation as a predictor of psychopathology following burns injury

Forty-six burned adults were seen, on average 7 days after admission to hospital. Eighty per cent suffered from one or more dissociative symptoms during trauma and three or more dissociative phenomena were experienced by 19.5 per cent. Blunting or absence of emotion was the symptom most frequently reported. The number of dissociative phenomena during trauma was statistically significant and associated with extreme anxiety. The intensity of the dissociation-anxiety reaction during trauma was a predictor for psychopathology measured at the moment of discharge.     

Gynecologic problems in older women

Regular gynecologic evaluation in older women is an integral part of medical care, just as it is for women of reproductive age. This should be emphasized since older women often neglect early symptoms of gynecologic diseases, some of which are potentially lethal. With this in mind, the health care provider must be cognizant of not only gynecologic problems that affect all women, but also those disease processes which are either specific to or more prevalent in an older population. This article emphasizes these aspects in caring for the older gynecologic patient.     

Bioavailability of iron in cottonseed meal, ferric sulfate, and two ferrous sulfate by-products of the galvanizing industry

BACKGROUND: The aim of this study was to compare the outcome of severe blunt trauma in children receiving prehospital care from either physician-staffed advanced life support (ALS) units, or from basic life support (BLS) units staffed by emergency medical technicians. METHODS: The records of 288 children with severe blunt trauma who required intensive care in the regional level 1 trauma center or who died from their injuries were analyzed retrospectively. Patients were excluded if resuscitation at the scene was not attempted, if the level of prehospital care was unspecified, or if arrival at the level 1 trauma center was delayed beyond 150 minutes. Seventy-two patients met the inclusion criteria of BLS-, and 49 the criteria of ALS-prehospital care. RESULTS: A reduced mortality rate (22.4% v 31.9%) was seen in the ALS group, which was more apparent in a "salvageable but high-risk" subgroup, characterized by Glasgow Coma of Scale 4 through 8, Pediatric Trauma Score of 0 through 5, and Injury Severity Score (ISS) of 25 through 49. However, a statistically significant difference was only seen when trauma severity was evaluated by the ISS. CONCLUSION: An improved outcome in children with severe blunt trauma has been demonstrated when prehospital care is provided by physician-staffed ALS units compared with BLS units.     

Neurosyphilis with multiple gummas and AIDS. Report of a case

Victims of facial trauma require global, and not exclusively surgical, management. We describe the psychological and psychiatric problems associated with facial trauma and emphasize the need for psychiatric care to complete surgical treatment in facial trauma.     

Absorption of lycopene from single or daily portions of raw and processed tomato

The present study examined the association of childhood risk factors with exposure to traumas and posttraumatic stress disorder (PTSD). PTSD is a unique symptom configuration after exposure to an unusual, extreme event. Data come from the US National Comorbidity Study of 5,877 respondents aged 15-54 years conducted between September 1990 and February 1992. The risk factors examined were preexposure affective, anxiety, and substance use disorders; parental mental and substance use disorders; parental aggression toward the respondent and toward the other parent; and a nonconfiding relationship with the mother during childhood. Analyses were stratified by gender and adjusted for demographic variables and traumatic experiences prior to the index trauma. The occurrence of trauma was associated with many risk factors in women but few in men. Similarly, more risk factors predicted PTSD in women than in men. Overall, when respondents were grouped into broad trauma categories, an increase in the number of risk factors was associated with higher rates of PTSD. However, in analyses of the trauma subsample that adjusted for individual type of trauma (e.g., rape, physical attack), only one risk factor (history of affective disorder) predicted PTSD in women, and two (history of anxiety disorder and parental mental disorder) predicted PTSD in men. The results thus indicate that although these risk factors have an important association with PTSD, they operate largely by predicting trauma exposure rather than by predicting the onset of disorder after exposure.     

Untreated anxiety among adult primary care patients in a Health Maintenance Organization

BACKGROUND: Untreated anxiety may be particularly difficult for primary care physicians to recognize and diagnose because there are no reliable demographic or medical profiles for patients with this condition and because these patients present with a high rate of comorbid psychological conditions that complicate selection of treatment. METHOD: A prospective assessment of untreated anxiety symptoms and disorders among primary care patients. RESULTS: Approximately 10% of eligible patients screened in clinic waiting rooms of a mixed-model health maintenance organization reported elevated symptoms and/or disorders of anxiety that were unrecognized and untreated. These patients with untreated anxiety reported significantly worse functioning on both physical and emotional measures than "not anxious" comparison patients; in fact these patients reported reduced functioning levels within ranges that would be expected for patients with chronic physical diseases, such as diabetes and congestive heart failure. The most severe reductions in functioning were reported by untreated patients whose anxiety was mixed with depression symptoms or disorders. CONCLUSION: Primary care physicians may benefit from screening tools and consultations by mental health specialists to assist in recognition and diagnosis of anxiety symptoms and disorders alone and mixed with depression.     

Prevalence and consequences of disaster-related illness and injury from hurricane ike.

Objective: To explore the extent to which disasters may be a source of injury and disability in community populations, we examined the prevalence and short-term consequences of disaster-related illness and injury for distress, disability, and perceived needs for care. Design: A random population survey was conducted 2–6 months after Hurricane Ike struck Galveston Bay on September 13, 2008. Participants: The sample was composed of 658 adults representative of Galveston and Chambers Counties, Texas. Results: The prevalences of personal injury (4%) and household illness (16%) indicated that approximately 7,700 adults in the two-county area were injured, and another 31,500 adults experienced household-level illness. Risk for injury/illness increased with area damage and decreased with evacuation. In bivariate tests, injury or illness or both were related to all outcome measures. In multivariate analyses that controlled for co-occurring stressors representing trauma, loss, adversities, and community effects, injury or illness or both were associated with global stress, posttraumatic stress, dysfunction, days of disability, and perceived needs for care, but not with depression or anxiety. Conclusions: The associations of injury with distress and disability suggest that community programs should reach out to injured persons for early mental health and functional assessments and, where indicated, intervene in ways that reduce further disability and need for complex rehabilitative services. The results also point to the potential effectiveness of evacuation incentives with regard to the prevention of disaster-related injury and disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma and chronic depression among patients with anxiety disorders

This study examined the relationship between a history of trauma and the features and persistence of major depression (MDD) in patients with anxiety disorders. The study found that, among 408 patients with an anxiety disorder and past or current MDD, those patients who reported a history of trauma had a greater number of previous episodes of major depression than those patients without trauma histories. Also, of 174 patients with an anxiety disorder and current major depression, patients who reported histories of trauma, compared with patients who did not report such experiences, were less likely to remit from MDD over a 5-year period. Results suggest that a history of trauma is a risk factor for chronic depression.     

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles.

Examined psychosocial factors related to pre- and postnatal anxiety in 291 pregnant Mexican women (aged 15–38 yrs). Ss completed the State-Trait Anxiety Inventory and questions designed to assess variables such as preferred characteristics of health care providers. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All Ss preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery were related to postnatal anxiety adjusted for prenatal anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The formation and persistence of a dental treatment phobia

The anxiety which accompanies dental care may in some cases represent a disabling handicap. The authors have outlined the characteristics of this type of dental anxiety and describe the typical pattern with which "odontophobia" is formed and persists over time. This enables them to understand the "attempted solutions" used to overcome this phobia, opening the way to the study of psychological interventions which may prove efficacious and effective.     

Frequently missed diagnoses in adolescent psychiatry

Symptom overlap, comorbidity, disagreement among informants, and the impact of development complicate psychiatric diagnoses in the adolescent patient. This review of frequently missed diagnoses includes anxiety disorders, ADD without hyperactivity, early-onset bipolar disorder, syndromes associated with trauma, and substance abuse.